The Children’s Clinic

SUMMARY- NOTICE OF PRIVACY PRACTICES

This is a summary of The Children’s Clinic (TCC) Notice of Privacy Practices. You have a right to receive a copy of the complete document.

TCC recognizes that your medical information is personal. We are committed to providing privacy and confidentiality of your medical information. This notice describes TCC’s privacy practices and the way in which we may use and disclose medical information about you.

We are required to maintain a complete copy of your medical history, current condition, treatment plan and all treatment given, including the results of all tests, procedures and therapies. We must maintain this information in a safe and secure manner that protects your privacy and confidentiality. You have the right to read or get a copy of your medical information.

TCC May Use and Disclose Medical Information About You in the Following Ways:

1. For Treatment: Other health professionals within or outside of TCC who are involved in your care may need to access your information.
2. For Payment: To bill or collect for payment of services from you, your insurance company, or a third party billing agency we may disclose your information.
3. For Health Care Operations: We may use or disclose medical information about you to the extent necessary to run the facility or ensure quality care.
4. For Research: Information that may identify you will not be released to anyone outside of TCC without your prior written permission but we may remove information that identifies you so that others may use it to study health care.
5. Appointment Reminders: We may use your information to contact you as a reminder that you have a scheduled appointment
6. Treatment Alternatives, Health Related Benefits and Services: We may use or disclose medical information to tell you about or recommend possible treatment options, alternatives to your current treatment, health related benefits or services that may be of interest to you.
7. To Avoid Serious Threat to Health or Safety: When necessary your information may be used or disclosed to prevent a serious threat to the health and safety of you, of the public or of another person.
8. Public Health Risks: We may disclose medical information about you for public health activities to prevent or control disease, injury or disability; to report births and deaths; to report child abuse and/or neglect; to report reactions to medications or problems with products; to notify people of recalls of products; to notify a person that they may have been exposed to a disease or may be at risk for contracting or spreading a disease; to notify a government agency about abuse, neglect or domestic violence as required by law.
9. Worker’s Compensation: We may release medical information about you for worker’s compensation benefits for work related injuries or illnesses.
10. Military or Veteran’s: If you are a member of the armed forces, we may release information about you as required by military command authorities.
11. Fundraising Activities: We may use medical information about you to contact you in an effort to raise money for the facility and its operations but we will only release contact information about you.
12. Law Enforcement: We may release information about you in response to a court order, subpoena, warrant, summons; to identify or locate a suspect, fugitive, material witness or missing person; about a victim of crime; about a death as a result of a crime; about criminal conduct at our clinic; in emergency circumstances to report a crime.
13. Coroner’s, Medical Examiners and Funeral Directors: We may release medical information about you to a coroner or medical examiner to identify a deceased person or determine cause of death. We may release information to funeral directors as necessary to carry out their duties.
14. As required by law: We may release your information as required by California Law.

We do not allow others outside of TCC to access your medical information unless we have authorization from you to do so. Any authorization to use or disclose medical information may be revoked by you in writing at any time unless (1) TCC has already taken action in reliance on that authorization or (2) if the authorization was obtained as a condition of obtaining insurance coverage.

YOU HAVE THE FOLLOWING RIGHTS REGARDING MEDICAL INFORMATION WE MAINTAIN ABOUT YOU:

• You have the right to inspect and receive a copy of your medical information.
• You have the right to amend your medical information if you believe it is incorrect or incomplete (restrictions may apply).
• You have the right to request restrictions or limitations of your medical information.
• You have the right to request the method by which we communicate with you about medical matters so that the communication is kept confidential.
• You have a right to receive an accounting of all disclosures of your medical information.
• You have a right to receive a paper copy of the TCC Notice of Privacy Practices.
  

Filing a Complaint:

If you wish to request restrictions, amendments or accountings of your medical information, you may file such a request in writing with the TCC Privacy Officer located at 2801 Atlantic Avenue, Long Beach, CA, 90805. The forms are available at the Front Desk at each clinic site.

If you believe your privacy rights have been violated, you may file a complaint with the TCC Privacy Officer or with the Secretary of the Department of Health and Human Services. All complaints must be in writing. You will not be penalized in any way for filing a complaint.