Notice of Privacy Practices
Introduction
This Notice of Privacy Practices (“Notice”) describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. It applies to the health records generated by Elisa C. Alvarado M.D. Inc. (“Healthcare Provider”), as defined under California law, including any entity or individual that provides health care services to you at the direction of the Healthcare Provider.
This Notice applies to all protected health information as defined by federal and California state laws concerning the privacy of individually identifiable health information. This Notice is provided to you pursuant to our obligations under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the California Confidentiality of Medical Information Act (“CMIA”).
Your Health Information Rights
In accordance with the Notice of Privacy Practices, as a Patient, you have the following rights
regarding your protected health information:
1. Right to Inspect and Copy: You have the right to inspect and obtain a copy of your
protected health information that is contained in a designated record set for as long as
the Healthcare Provider maintains the information.
2. Right to Amend: If you believe that your protected health information is incorrect or
incomplete, you may ask the Healthcare Provider to amend the information. The
Healthcare Provider may deny your request under certain circumstances, but you will be
provided with a written explanation of the denial.
3. Right to an Accounting of Disclosures: You have the right to request an accounting of
certain disclosures of your protected health information made by the Healthcare
Provider, except for disclosures made for treatment, payment, healthcare operations, or
certain other purposes.
4. Right to Request Restrictions: You have the right to request a restriction or limitation
on the Healthcare Provider’s use or disclosure of your protected health information for
treatment, payment, or healthcare operations. The Healthcare Provider is not required to
agree to your request, but if it does, it will comply with your request unless the
information is needed to provide you with emergency treatment.
5. Right to Request Confidential Communications: You have the right to request that
the Healthcare Provider communicate with you about medical matters in a certain way or
at a certain location. The Healthcare Provider will accommodate reasonable requests.
6. Right to a Paper Copy of the Notice: You have the right to a paper copy of the Notice
of Privacy Practices at any time, even if you have agreed to receive the notice
electronically.
Our Responsibilities
The Healthcare Provider is required by law to maintain the privacy and security of your
protected health information. As mandated by the Health Insurance Portability and
Accountability Act (HIPAA) and California state law, we are committed to ensuring that your
protected health information is kept confidential and secure. This Notice of Privacy Practices
provides you with the details of our legal duties and privacy practices concerning your protected
health information, including how we may use and disclose this information for treatment,
payment, and healthcare operations, as well as for other purposes that are permitted or required
by law.
We are obligated to follow the terms of this Notice of Privacy Practices currently in effect. We
reserve the right to change our privacy practices and the terms of this Notice at any time, as
allowed by federal and state law. Any changes will be applicable to all protected health
information that we maintain. If we make a significant change to our privacy practices, we will
update this Notice and make the new Notice available upon request.
Additionally, we are required to inform you promptly if there is a breach of your unsecured
protected health information. We will also ensure that any use or disclosure of your protected
health information complies with the law, including when it comes to your rights to access and
control this information. Specifically, you have the right to inspect and copy your protected
health information, amend incorrect or incomplete information, request an accounting of certain
types of disclosures, request restrictions on certain uses and disclosures, and make a complaint
if you believe your privacy rights have been violated.
Uses and Disclosures of Health Information
This Notice of Privacy Practices describes how we, as a Healthcare Provider, may use and
disclose your protected health information (PHI) to carry out treatment, payment, or healthcare
operations and for other purposes that are permitted or required by law. It also describes your
rights to access and control your PHI. PHI is information about you, including demographic
information, that may identify you and that relates to your past, present, or future physical or
mental health or condition and related healthcare services.
We are required by law to maintain the privacy of your PHI, to provide you with this notice of our
legal duties and privacy practices with respect to PHI, and to notify you following a breach of
unsecured PHI.
Uses and Disclosures of PHI:
• We may use and disclose your PHI for treatment, payment, and healthcare operations
purposes without your prior consent.
• We may disclose your PHI to a family member, friend, or other person to the extent
necessary to help with your healthcare or with payment for your healthcare, subject to
the limitations of your rights and choices.
• We may use or disclose your PHI for public health activities, such as reporting births,
deaths, and diseases, or for health oversight activities authorized by law.
• Your PHI may be disclosed as required by law and when we believe that the disclosure
is necessary to prevent a serious threat to your health or safety or the health or safety of
others.
• We may disclose PHI to a health oversight agency for activities authorized by law, such
as audits, investigations, and inspections. Our agency is subject to the oversight of the
government agencies that enforce health care laws.
• We may use or disclose your PHI in response to a court or administrative order,
subpoena, discovery request, or other lawful process, under certain circumstances.
• In the event of your death, your PHI may be disclosed to coroners, medical examiners,
and funeral directors as necessary to carry out their duties.
Your Rights:
• You have the right to request restrictions on certain uses and disclosures of your PHI.
However, we are not required to agree to a requested restriction.
• You have the right to receive confidential communications of PHI, as applicable.
• You have the right to inspect and copy PHI that may be used to make decisions about
your care. Usually, this includes medical and billing records, but does not include
psychotherapy notes.
• You have the right to amend your PHI in a designated record set for as long as the
information is kept by or for our practice.
• You have the right to receive an accounting of disclosures of your PHI made by us,
excluding disclosures for treatment, payment, and healthcare operations, and certain
other disclosures.
• You have the right to obtain a paper copy of this notice from us, upon request, even if
you have agreed to accept this notice electronically.
Patient’s Acknowledgment of Receipt
This document serves as an acknowledgment by the Patient of having received a copy of the
Notice of Privacy Practices (“Notice”) provided by the Healthcare Provider. The Notice outlines
the ways in which the Healthcare Provider may use and disclose protected health information
about the Patient, as well as the Patient’s rights and the Healthcare Provider’s obligations
regarding the use and disclosure of that information.
The Patient acknowledges that they have been given the opportunity to review the Notice prior
to signing this acknowledgment. By signing, the Patient agrees that they understand the terms
of the Notice and the rights and obligations outlined therein. This acknowledgment does not
constitute consent to use or disclose protected health information in any manner not covered by
the Notice unless such use or disclosure is otherwise permitted or required by law.
The Patient is informed that a copy of the Notice will be available upon request at any time and
that changes to the Notice may occur. The Patient will be notified of any significant changes to
the terms of the Notice at their next visit or through a mailed update.
Furthermore, the Patient has the right to request and obtain a copy of their protected health
information contained within the designated record set maintained by the Healthcare Provider,
as provided under the Health Insurance Portability and Accountability Act (HIPAA) and
applicable state law. Any concerns or complaints regarding privacy practices should be directed
to the Healthcare Provider’s designated privacy officer.
Complaints
If a Patient believes their privacy rights have been violated, they may file a complaint with the
Healthcare Provider or with the Secretary of the Department of Health and Human Services.
Complaints to the Healthcare Provider must be submitted in writing. The Healthcare Provider
will not retaliate against any Patient for filing a complaint.
The Healthcare Provider is committed to maintaining the privacy of protected health information
and to providing Patients with notice of its legal duties and privacy practices with respect to
protected health information. This commitment includes addressing and resolving any
complaints concerning the handling of protected health information.
Patients are encouraged to express any concerns or complaints directly to the Healthcare
Provider’s privacy officer. The Healthcare Provider has established procedures for addressing
complaints and will provide a written response to any complaint within a reasonable period of
receipt of the complaint.
Changes to the Notice of Privacy Practices
In accordance with the Health Insurance Portability and Accountability Act (HIPAA), the
Healthcare Provider reserves the right to change the terms of the Notice of Privacy Practices at
any time. Any such changes will be effective for all protected health information that we
maintain, including information created or received before the date of the changes. Whenever a
significant change is made to our privacy practices, the Healthcare Provider will promptly revise
the Notice and make the new Notice available upon request.
Patients have the right to receive a revised copy of the Notice by contacting the Healthcare
Provider’s office. Additionally, the updated Notice will be posted in a clear and prominent
location at the Healthcare Provider’s facility and on their website, if applicable. The updated
Notice will contain the effective date on the first page.
Patients are encouraged to review the Notice periodically to be informed of how their protected
health information is being protected and to be aware of any changes to our privacy practices
that may affect their rights and how their information is used or disclosed.
Contact Information
For any questions, concerns, or complaints regarding the handling of your protected health
information as outlined in our Notice of Privacy Practices, or to exercise any of your rights as
detailed in the Notice, including but not limited to, requests to access, amend, or receive an
accounting of disclosures of your designated record set, please contact our designated Privacy
Officer at:
• Privacy Officer: Manuel Rene Alvarado
• Address: 630 S. Raymond Ave, Ste. 340, Pasadena, CA 91105
• Phone: 626-584-0026
• Email: ECAOFFICE@ECAMDINC.COM
If you believe your privacy rights have been violated, you may file a complaint with our Privacy
Officer or with the Secretary of the U.S. Department of Health and Human Services. A complaint
must be filed in writing, either on paper or electronically, and describe the acts or omissions
believed to be in violation of HIPAA regulations. You will not be retaliated against for filing a
complaint.