NOTICE OF PRIVACY PRACTICES
This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. If you have questions about this notice, please
contact us at (805) 965-3400. This notice describes our privacy practices and that of:
- All employees and office personnel
- Any intern(s), volunteer(s) or student(s) that we allow to input or maintain patient data files
- All internal departments and units of Santa Barbara Fertility Center
- All entities, sites and locations owned by Santa Barbara Fertility Center
Our Commitment to Your Privacy
We are dedicated to assisting you and deeply committed to maintaining your privacy. During the course of your treatment, it will be important for us to discuss and exchange certain personal
information about you with other members of your healthcare team. This information is called your Protected Health Information (PHI). Because the individuals of your healthcare team are often at
different institutions, we need your permission prior to participating in discussions about you. Healthcare providers have exchanged this sort of information for years in the practice of medicine.
However, in this day of electronic databases, there is concern about how private health information about you is collected and shared. For that reason, the United States Federal Government has issued a
regulation to provide safeguards for the privacy and security of health information that may identify you. This rule was issued under a law called the Health Insurance Portability and Accountability Act (HIPAA).In conducting our business, we may receive, create, use, or disclose individually protected health information regarding you and the services we provide you. We are required by law to provide you
with this notice of our legal duties and privacy practices concerning your PHI.
Health Information Security
Santa Barbara Fertility Center requires its employees to follow security policies and procedures that
limit access to those employees who need it to perform their job responsibilities. In addition, we
maintain physical, administrative and technical measures to safeguard your PHI.
Understanding Your Records
We create a record of the services you receive from Santa Barbara Fertility Center. This record may
contain your prescription information and/or correspondence from other healthcare providers. All the
information we have about you is called PHI. PHI means health information, including your
demographic information, collected from you and created or received by another healthcare provider, a
health plan and/or a healthcare clearinghouse.
How We May Use and Disclose Health Information about You
For Treatment: We may use health information about you to provide you assistance with the treatment
provided by another healthcare provider. We may disclose health information about you to doctors,
nurses, technicians, office staff or other personnel who are involved in taking care of you and your
health.
For Payment: We may use and disclose health information about you so that the services you receive
may be billed to and payment may be collected from you, an insurance company or a third party.
For Health Care Operations: We may use and disclose your protected health information in order to perform our daily business activities, which may include data management, customer service,
complying with laws and quality.
As Required by Law: We will disclose health information about you when required to do so by federal,
state, or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you
when necessary to prevent a serious threat to your health and safety or the health and safety of the
public or another person. Any disclosure would be to someone able to help stop or reduce the threat.
For Research: We may use and disclose health information about you for research projects that are
subject to a special approval process. We will ask you for your permission if the researcher will have
access to your name, address or other information that reveals who you are, or will be involved in your
care at the office.
To Maintain Public Health: We may disclose health information about you for public health activities.
These activities generally include, but are not limited to the following:
- To prevent or control disease, injury or disability
- To report births or deaths
- To regulate products subject to FDA regulations
- To notify a person who might have been exposed to a disease or might be a risk for getting or spreading a disease or condition
- To report child abuse or neglect
- To notify the appropriate government agency if we think a patient has been the victim of abuse, neglect, or domestic violence
For Health Oversight Activities: We may disclose health information to a health oversight agency for
audits, investigations, inspections, accrediting or licensing purposes. These disclosures may be
necessary for certain state and federal agencies to monitor the health care system, government
programs, and compliance with civil rights laws.
For Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may
disclose health information about you in response to a court or administrative order. Subject to all
applicable legal requirements, we may also disclose health information about you in response to a
subpoena.
As Information Not Personally Identifiable: We may use or disclose health information about you in a
way that does not personally identify you or reveal who you are.
To Individuals Involved in the Payment of Your Care: We may disclose health information about you
to your family members or friends if we obtain your verbal agreement to do so; or if we give you an
opportunity to object to such a disclosure and you do not raise an objection. We may also disclose
health information to your family or friends if we can infer from the circumstances, based on our
professional judgment that you would not object.
Consent
You may revoke your Consent at any time by giving us written notice. Your revocation will be effective when we receive it, but will not apply to any uses and disclosures which occurred before that time. If you do revoke your Consent, we will not be permitted to use or disclose information for purposes of service, payment or health care operations, and we may therefore choose to discontinue providing you service.
Your Rights Regarding Health Information about You
You have the following rights regarding health information we maintain about you:
- Right to Inspect and Copy – You have the right to inspect and request a copy of certain health information we have on file. To inspect and request a copy of health information on file about you, you must submit a written request. If you request a copy of your health information, we may charge you for the costs of copying, mailing, or other associated supplies.
- Right to Request an Amendment – If you believe health information we have about you is incorrect or incomplete; you may ask us to amend the information. You have the right to request an amendment as long as the information originates at Santa Barbara Fertility Center. You must request an amendment in writing. You must also tell us the reason for your request. The request to amend your record may be denied, in which case you have the right to enter a statement into your record saying that you disagree with the decision.
- Right to Request Restrictions – You have the right to request a restriction or limitation on the health information we use or disclose about you for service, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. You must submit your request for restrictions in writing.
- Right to a Paper Copy of This Notice – You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. This notice is also available on our website, www.santabarbarafertility.com.
Other Uses of Health Information
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will only be made with your written permission or after you have had an opportunity to agree to object. If you provide us with permission to use or share your health information, you may revoke that permission, in writing, at any time. If you revoke, or take away, your permission, we will no longer use or share your health information for the reasons in your written authorization. We will not be able to
take back any information that we have already shared.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have, as well as information we receive in the future.
For More Information or to Report a Problem
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. All complaints must be in writing. There will be no retaliation for filing a complaint.
Effective June 27, 2010, physicians in California must inform their patients that they are licensed by the Medical Board of California, and include the Board’s contact information. As such, please be informed of the following should you wish to obtain more information or file a complaint:
NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the
Medical Board of California
(800) 633-2322
www.mbc.ca.gov
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