Privacy policy for patients of
Sierra Foothill Surgical Specialists

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY OUR PRACTICE AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice is required by law to inform you of how your health information will be protected, how Sierra Foothills Surgical Specialists may use or disclose your health information, and about your rights regarding your health information. If you have any questions about this notice, please contact the Privacy Officer at (530) 823-0701.

As a result of your visit to the doctor, information about you, your medical history, and results of any tests or studies will be documented and kept as a medical record. This information serves as a:

• Basis for planning your care and treatment
• Means of communication among the health professionals who contribute to your care
• Legal documents of the care you receive
• Means by which you or a third-party payer (e.g. health insurance) can verify that services you received were appropriately billed
• A data source for medical research and public health
• A tool with which we can assess and work to improve the care we provide

Your Health Information Rights

You have the following rights related to your medical and billing records kept by Sierra Foothills Surgical Specialists:

• Obtain a copy of this notice .
• Authorization to use your health information . Before we use or disclose your health information, other than as described below, we will obtain your written authorization, which you may revoke at any time to stop future use or disclosure.
• Access to your health information . You may request a copy of your health information that Sierra Foothills Surgical Specialists keeps in your medical or billing record. Your request must be submitted in writing. Under certain circumstances we may deny access if, in the judgement of the physician, divulging information will be harmful to the patient. We may charge for the costs of providing you access and for your copies.
• Amend your health information . If you believe the information we have about you is incorrect or incomplete, you may request that we correct or add information. Your request must be in writing.
• Request confidential communications . You may request that, when we communicate with you about your health information, we do so in a specific way (e.g. at a certain mail address or phone number). This must be in writing.
• Limit our use or disclosure of your health information . You may request in writing that we restrict the use or disclosure of your health information for treatment, payment, health care operations, or any other purpose except when specifically authorized by you, when we are required by law, or in an emergency situation in order to treat you. We will consider your request and respond, but we are not legally required to agree if we believe your request would interfere with our ability to treat you or collect payment for our services.
• Accounting of disclosures . You may request a list of disclosures of your health information that we have made for reasons other than treatment, payment or healthcare operations. Disclosures that we make with your authorization will not be listed. We will provide one list per year free of charge, but may charge for subsequent lists.

Our Responsibilities

We are required by law to protect the privacy of your health information, establish policies and procedures that govern the behavior of our workforce and businesses associates, and provide this notice about our privacy practices, and abide by the terms of this notice. We reserve the right to change our policies and procedures for protecting health information. If a change is made, the new notice will be posted.

Except for the purposes related to your treatment, to collect payment for our services, to perform necessary business functions, or when otherwise permitted or required by law, we will not use or disclose your health information without your authorization. You have the right to revoke your authorization at any time. We are unable to take back any disclosure we have already made with your permission.

Examples of uses and disclosures for treatment, payment and healthcare operations

We will use your health information to collect payment for health care services that we provide. For example : a bill may be sent to you or your health insurance company. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used. In some cases, information from your medical record is sent to your insurance company to explain the need for or provide additional information about your treatment.

We will use your health information to facilitate routine healthcare operations .

For example : Members of our medical staff or quality improvement teams may use information in you record to assess the care you have received and how your progress compares to others. This information will then be used in efforts to improve the quality and effectiveness of the healthcare and other services we provide.

For more information or to report a problem

If you have questions or would like additional information, you may contact the Sierra Foothills Surgical Specialists Privacy Officer at (530) 823-0701. You may also contact the U.S. Dept. of Health and Human Services at www.hhs.gov or (800) 638-6833. The care you receive will in no way be impacted if you file a complaint.