HIPAA Privacy

Notice of Privacy Practices

This notice takes effect on 9/1/04 and remains in effect until we replace it.

Our Pledge Regarding Medical Information

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our medical office. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosures of medical information.

Our Legal Duty

  • Keep you medical information private.
  • Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
  • We have the right to change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law. Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

Use and Disclosure of Your Medical Information

For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, or other people who are taking care of you. We may also share medical information about you to your health care providers to assist them in treating you.

For Payment: We may use and disclose your medical information for payment purposes. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include your medical information.

For Health Care Operations: We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.

Additional Uses and Disclosures:

  • Research in limited circumstances
  • Funeral Director, Coroner, Medical Examiner
  • Specialized Government Functions
  • Court Orders, Judicial and Administrative Proceedings
  • Public Health Activities
  • Victims of Abuse, Neglect, or Domestic Violence
  • Workers Compensation
  • Health Oversight activities
  • Law Enforcement
  • Appointment reminders

Your Individual Rights

You have the right to:

  • Look at or get copies of certain parts of your medical information. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You may make your request in writing. You may get the form to request access by contacting our office at 530-634-9988.
  • Receive a list of all the time we our business associates shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions.
  • Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
  • Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or different locations must be made in writing.
  • Request that we change certain parts of your medical information. We may deny your request if we not crate the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in future sharing of that information.


You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.

You may contact our Privacy Officer, Surinder T. at 530-434-0192 for further information about the complaint process.