PROVIDER NOTICE OF
NOTICE FOR MEDICAL INFORMATION: Pages 1 - 5.
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT
Information Privacy Notice
May 1, 2021
We are required by law to
protect the privacy of your health information. We are also required to provide
you this notice, which explains how we may use information about you and when
we can give out or "disclose" that information to others. You also
have rights regarding your health information that are described in this
notice. We are required by law to abide
by the terms of this notice.
The terms “information” or “health information” in
this notice include any information we maintain that reasonably can be used to
identify you and that relates to your physical or mental health condition, the
provision of health care to you, or the payment for such health care. We will
comply with the requirements of applicable privacy laws related to notifying
you in the event of a breach of your health information.
We have the right to change our privacy practices and
the terms of this notice. If we make a material change to our privacy
practices, and if we maintain a website, we will post a copy of the revised
notice on our website www.beavermedicalgroup.com. If we maintain a physical
delivery site, we will also post a copy in at our office. The notice will also be available upon request. We reserve the
right to make any revised or changed notice effective for information we
already have and for information that we receive in the future.
How We Use or Disclose Information
We must use
and disclose your health information to provide that information:
you or someone who has the legal right to act for you (your personal
representative) in order to administer your rights as described in this notice;
the Secretary of the Department of Health and Human Services, if necessary, to
make sure your privacy is protected.
We have the right to use and disclose health information for your
treatment, to bill for your health care and to operate our business. For
example, we may use or disclose your health information:
Payment. We may use or
disclose health information to obtain payment for health care services. For example, we may disclose your health
information to your health plan in order to obtain payment for the medical
services we provide to you. We may ask you for advance payment.
Treatment. We may use or disclose health information
to aid in your treatment or the coordination of your care. For example, we may disclose information to
your physicians or hospitals to help them provide medical care to you.
Health Care Operations. We may use or disclose health
information as necessary to operate and manage our business activities related
to providing and managing your health care. For example, we might analyze data
to determine how we can improve our services.
We may also de-identify health information in accordance with applicable
laws. After that information is de-identified, it is no longer subject to this
notice and we may use it for any lawful purpose.
Provide You Information on Health Related Programs or Products such
as alternative medical treatments and programs or about health-related products
and services, subject to limits imposed by law.
Reminders. We may use or disclose health
information to send you reminders about your care, such as appointment reminders
with providers who provide medical care to you or reminders related to
medicines prescribed for you.
We may use
or disclose your health information for the following purposes under limited
- As Required by Law. We
may disclose information when required to do so by law.
Persons Involved With Your Care. We may use or
disclose your health information to a person involved in your care or who helps
pay for your care, such as a family member, when you are incapacitated or in an
emergency, or when you agree or fail to object when given the opportunity. If you are unavailable or unable to object,
we will use our best judgment to decide if the disclosure is in your best
interests. Special rules apply regarding
when we may disclose health information to family members and others involved
in a deceased individual’s care. We may
disclose health information to any persons involved, prior to the death, in the
care or payment for care of a deceased individual, unless we are aware that
doing so would be inconsistent with a preference previously expressed by the
Public Health Activities such as reporting or preventing
disease outbreaks to a public health authority.
We may also disclose your information to the Food and Drug Administration
(FDA) or persons under the jurisdiction of the FDA for purposes related to
safety or quality issues, adverse events or to facilitate drug recalls.
Reporting Victims of Abuse, Neglect or Domestic Violence to
government authorities that are authorized by law to receive such information,
including a social service or protective service agency.
Health Oversight Activities to a health oversight agency for activities authorized by law, such
as licensure, governmental audits and fraud and abuse investigations.
Judicial or Administrative Proceedings such as in
response to a court order, search warrant or subpoena.
Law Enforcement Purposes. We may
disclose your health information to a law enforcement official for purposes such
as providing limited information to locate a missing person or report a
Avoid a Serious Threat to Health or Safety to you, another person, or the public, by,
for example, disclosing information to public health agencies or law
enforcement authorities, or in the event of an emergency or natural disaster.
Specialized Government Functions such as military
and veteran activities, national security and intelligence activities, and the
protective services for the President and others.
Workers’ Compensation as
authorized by, or to the extent necessary to comply with, state workers
compensation laws that govern job-related injuries or illness.
Research Purposes such as research related to the
evaluation of certain treatments or the prevention of disease or disability, if
the research study meets federal privacy law requirements.
Provide Information Regarding Decedents. We may
disclose information to a coroner or medical examiner to identify a deceased
person, determine a cause of death, or as authorized by law. We may also
disclose information to funeral directors as necessary to carry out their
Organ Procurement Purposes. We may use or
disclose information to entities that handle procurement, banking or
transplantation of organs, eyes or tissue to facilitate donation and
- To Correctional Institutions or Law
Enforcement Officials if you are an inmate of a
correctional institution or under the custody of a law enforcement official,
but only if necessary (1) for the institution to provide you with health care;
(2) to protect your health and safety or the health and safety of others; or
(3) for the safety and security of the correctional institution.
- To Business Associates
that perform functions on our behalf or provide us with services if the
information is necessary for such functions or services. Our business associates are required, under
contract with us and pursuant to federal law, to protect the privacy of your
information and are not allowed to use or disclose any information other than
as specified in our contract and permitted by law.
- Additional Restrictions on Use and
Certain federal and state laws may require special privacy protections
that restrict the use and disclosure of certain health information, including
highly confidential information about you. Such laws may protect the following
types of information:
- Alcohol and
- Child or Adult Abuse or Neglect, including Sexual
- Communicable Diseases;
- Genetic Information
- Mental Health
- Minors Information
- Reproductive Health
- Sexually Transmitted Diseases
If a use or disclosure of health
information described above in this notice is prohibited or materially limited
by other laws that apply to us, it is our intent to meet the requirements of
the more stringent law.
Except for uses
and disclosures described and limited as set forth in this notice, we will use
and disclose your health information only with a written authorization from
you. This includes, except for limited
circumstances allowed by federal privacy law, not using or disclosing
psychotherapy notes about you, selling your health information to others, or
using or disclosing your health information for certain promotional communications
that are prohibited marketing communications under federal law, without your
written authorization. Once
you give us authorization to release your health information, we cannot
guarantee that the recipient to whom the information is provided will not
disclose the information. You may take back or "revoke" your written
authorization at any time in writing, except if we have already acted based on
your authorization. To find out how to revoke an authorization, use the contact
information below under the section titled “Exercising Your Rights.”
What Are Your Rights
The following are your rights with respect to your
have the right to ask to restrict uses or
disclosures of your information for treatment, payment, or health care
operations. You also have the right to ask to restrict disclosures to family
members or to others who are involved in your health care or payment for your
health care. Please note that while we will try to honor your request and
will permit requests consistent with our policies, we are not required to agree
to any restriction other than with respect to certain disclosures to health
plans as further described in this notice.
- You have the right to request that
we not send health information to health plans
in certain circumstances if the health information concerns a health care item
or service for which you or a person on your behalf has paid us in full. We will agree to all requests meeting the
above criteria and that are submitted in a timely manner.
have the right to ask to receive confidential communications of
information in a different manner or at a different place (for example, by
sending information to a P.O. Box instead of your home address). We will accommodate reasonable requests. In certain circumstances, we will accept your
verbal request to receive confidential communications; however, we may also
require you confirm your request in writing.
In addition, any request to modify or cancel a previous confidential
communication request must be made in writing. Mail your request to the address
have the right to see and obtain a copy of certain health information we maintain
about you such as medical records and billing records. If we maintain a copy of
your health information electronically, you will have the right to request that
we send a copy of your health information in an electronic format to you.
You can also request that we provide a copy of your information to a third
party that you identify. In some cases, you may receive a summary of this
health information. You must make a written request to inspect or obtain a copy
your health information or have your information sent to a third party. Mail your request to the address listed
below. In certain limited circumstances,
we may deny your request to inspect and copy your health information. If we deny your request, you may have the
right to have the denial reviewed. We may charge a reasonable fee for any
have the right to ask to amend certain health information we maintain about you
such as medical records and billing records if you believe the information is
wrong or incomplete. Your request must
be in writing and provide the reasons for the requested amendment. Mail your request to the address listed
below. If we deny your request, you may
have a statement of your disagreement added to your health information.
have the right to receive an accounting of certain
disclosures of your information made by us during the six years prior to your
request. This accounting will not include disclosures of information made: (i)
for treatment, payment, and health care operations purposes; (ii) to you or
pursuant to your authorization; and (iii) to correctional institutions or law
enforcement officials; and (iv) other disclosures for which federal law does
not require us to provide an accounting.
have the right to a paper copy of this notice. You
may ask for a copy of this notice at any time. Even if you have agreed to
receive this notice electronically, you are still entitled to a paper copy of
this notice. If we maintain a website, we will post a copy of the revised
notice on our website. You may also obtain a copy of this notice on our
website, www.beavermedicalgroup.com or by calling 909-786-0821.
Exercising Your Rights
- Contacting your Provider. If you have any questions about this notice
or want information about exercising any of your rights, please call the
Compliance Department at 909-786-0821.
a Written Request. You
can mail your written requests to exercise any of your rights, including
modifying or cancelling a confidential communication, requesting copies of your
records, or requesting amendments to your record, to us at the following
Beaver Medical Group
Attn: Compliance Department
P.O. Box 19020
Redlands, CA 92423-9020
- Filing a Complaint. If
you believe your privacy rights have been violated, you may file a complaint
with us at the following address:
Attn: Compliance Officer
P.O. Box 19020
Redlands, CA 92423-9020
You may also notify the Secretary of the U.S.
Department of Health and Human Services of your complaint. We will not take any action against you for filing a
Medical Information Notice of Privacy Practices applies to the following
provider that is affiliated with Optum, Inc.: Beaver Medical Group