TriValley Medical Group
TriValley Internal Medicine Group
TriValley Internal Medicine Group

TriValley Internal Medicine Group



TriValley Internal Medicine Group





TriValley Medical Group serving the Murrieta and Temecula Valleys since 2002

Notice of Privacy Practices and Patient Rights

NOTICE OF PRIVACY PRACTICES
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 CAREFULLY.
If you have any questions about this notice, please contact Tri-Valley Medical Group at (951) 894-4665.
WHO WILL FOLLOW THIS NOTICE:

This notice describes our privacy practices and that of:
• Any health care professional authorized to enter information into your medical chart.
• All employees, staff and volunteers.

OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the clinic. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by our practice, whether made by personnel or your doctor.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:
• make sure that medical information that identifies you (identifiable health information) is kept private;
• give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose identifiable health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
• FOR TREATMENT We may use your identifiable health information to treat you. For example, we may ask you to undergo laboratory tests (such as blood or urine tests), and we may use the results to help reach a diagnosis. We might use your identifiable health information in order to write a prescription for you, or we might disclose your identifiable health information to a pharmacy when we call and order a prescription for you. Many of the people who work for our practice – including our doctors and nurses – may use or disclose you identifiable health information in order to treat you or to assist others in your treatment. Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your spouse, children or parents.
• PAYMENT Our practice may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.
• HEALTH CARE OPERATIONS Our practice may use and disclose your identifiable health information to operate our business. For example, our practice may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
• HEALTH INFORMATION EXCHANGES
We may participate in health information exchanges to facilitate the secure exchange of your electronic health information between and among several health care providers or other health care entities for your treatment, payment, or other healthcare operations purposes. This means we may share information we obtain or create about you with outside entities (such as hospitals, doctors offices, pharmacies, or insurance companies) or we may receive information they create or obtain about you (such as medication history, medical history, or insurance information) so each of us can provide better treatment and coordination of your healthcare services. Your participation in a Health Information Exchange is voluntary and subject to a patient’s right to opt-out. In addition, if you visit any Tri-Valley Medical Group facility, your health information may be available to other clinicians and staff who may use it to care for you, to coordinate your health services or for other permitted purposes.
• APPOINTMENT REMINDERS Our practice may use and disclose your identifiable health information to contact you and remind you of an appointment.
• TREATMENT OPTIONS We may use and disclose your identifiable health information to inform you of potential treatment options or alternatives.
• HEALTH-RELATED BENEFITS AND SERVICES Our practice may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.
• RELEASE OF INFORMATION TO FAMILY/FRIENDS Our practice may release your identifiable health information to a friend or family member who is helping you pay for your health care, or who assists in taking care of you.
• DISCLOSURES REQUIRED BY LAW Our practice will use and disclose your identifiable health information when we are required to do so by federal, state or local law.
• MARKETING Uses and Disclosures of protected health information for marketing purposes require authorization unless (i) the communication occurs face-to-face; (ii) consists of marketing gifts of nominal value; (iii) is regarding a prescription refill reminder that is for a prescription currently prescribed or a generic equivalent; (iv) is for treatment pertaining to existing condition(s) and we do not receive any financial remuneration in either case or cash equivalent; and/or (v) communication from a healthcare provider to recommend or direct alternative treatments, therapies, healthcare providers, or settings of care when we do not receive any financial remuneration for making the communication. Disclosures that constitute a sale of protected health information require authorization.

SPECIAL SITUATIONS
• PUBLIC HEALTH RISKS As required by law, we may disclose your identifiable health information to public health or legal authority charged with preventing or controlling disease, injury, or disability.
• HEALTH OVERSIGHT ACTIVITIES We may disclose identifiable health information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure.
• LAWSUITS AND SIMILAR PROCEEDINGS If you are involved in a lawsuit or a dispute, we may disclose identifiable health information in response to a court or administrative order. We may also disclose identifiable health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
• LAW ENFORCEMENT We may disclose identifiable health information for law enforcement purposes as required by law or in response to a valid subpoena.
• CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS We may release identifiable health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release identifiable health information about patients of our practice to funeral directors as necessary to carry out their duties.
• ORGAN AND TISSUE DONATION Consistent with applicable law, we may disclose identifiable health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation or transplant.
• RESEARCH We may disclose identifiable health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
• MILITARY AND VETERANS Our practice may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.
• WORKERS’ COMPENSATION We may release identifiable health information for workers’ compensation or similar programs.
• NATIONAL SECURITY Our practice may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct special investigations.
• INMATES Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof identifiable health information necessary for your health and the health and safety of others.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding the identifiable health information that we maintain about you:
1. Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communication, you must make your request in writing to the Patient Liaison. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
2. Requesting Restrictions. You have the right to request a restriction or limitation on the identifiable health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the identifiable health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restriction, you must make your request in writing to the Director of Medical Records.
Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply. In addition, you have the right to restrict disclosure to your health plan when you pay for your services out of pocket in full at the time of service.
3. Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Tri-Valley in order to inspect and/or obtain a copy of your identifiable health information. Access may not be immediate, but will be within the guidelines of state and federal law. Our practice may charge a fee for the costs of copying, mailing, or other supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by us. Certain diagnostic results may be released directly from the ordering provider according to clinic policy.
4. Amendment. If you feel that 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 for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Director of Medical Records. You must provide us with the reason that supports your request. We will deny your request if it is not in writing or does not include a reason to support the request. In addition we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by or for the practice; (c) not part of the information which you would be permitted to inspect and copy; or (d) not created by our practice, unless the person or entity that created the information is no longer available to make the amendment.
5. Accounting of Disclosure. You have the right to request an “accounting of disclosures”. This is a list of disclosures we made of identifiable health information about you. To request this list of “accounting of disclosures”, you must submit your request in writing to Tri-Valley. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but our practice may charge you for additional lists within the same 12 month period. Our practice will notify you of the costs involved with additional request, and you may withdraw your request before you incur any costs.
6. Breach Notification. You have the right to be notified following a breach of unsecured Protected Health Information.
7. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Tri-Valley Medical Group at (951) 894-4665.
CHANGES TO THIS NOTICE
We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our practice has created or maintained in the past, and for any of your records we may create or maintain in the future. Our practice will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice at any time.

COMPLAINTS
If you believe your rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Tri-Valley at (951) 894-4665. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose identifiable health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose identifiable health information for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

ADDRESS
Please send all correspondence to:
Tri-Valley Medical Group
39765 Date Street, Suite 102
Murrieta, CA 92563

Patient Rights & Responsibilities:

YOU HAVE THE RIGHT TO:
1. Exercise these rights without regard to sex, economic status, educational background, race, color, religion, ancestry, national origin, sexual orientation or marital status or the source of payment for care.
2. Considerate, respectful, equitable and unbiased care. You have the right to respect for your personal values and beliefs. You have the right to request advice and information relating to your spiritual and emotional health.
3. Know the name of the licensed health care practitioner acting within the scope of his or her licensure who has primary responsibility for coordinating your care, and the names and professional relationships of physicians and non-physicians who will see you.
4. Receive information about your health status, diagnosis, prognosis course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to effective communication and to participate in the development and implementation of your plan of care. You have the right to participate in ethical questions that arise in the course of your care, including issues of conflict resolution, withholding resuscitative services, and foregoing or withdrawing life-sustaining treatment.
5. Make decisions regarding medical care, and receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse this course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment or non-treatment and the risks involved in each, and to be informed of the person who will carry out the procedure or treatment.
6. Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the facility even against the advice of physicians, to the extent permitted by law. You are entitled to exercise your right to inquire about or obtain a second opinion.
7. Have personal privacy respected. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. You have the right to be told the reason for the presence of any individual. You have the right to have visitors leave prior to an examination and when treatment issues are being discussed.
8. Confidential treatment of all communications and records pertaining to your care at Tri-Valley Medical Group, L.P. and Affiliates. You will receive a separate A Notice of Privacy Practices that explains your privacy rights in detail and how we may use and disclose your protected health information.
9. Appropriate assessment and management of your pain, information about pain, pain relief measures and to participate in pain management decisions. You may request or reject the use of any or all modalities to relieve pain, including opiate medication, if you suffer from severe chronic intractable pain. The doctor may refuse to prescribe the opiate medication, but if so, must inform you that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.
10. Reasonable responses to any reasonable requests made for service.
11. Reasonable continuity of care and to know in advance the time and location of appointments as well as the identity of the persons providing the care.
12. Examine and receive an explanation of the facilities bill regardless of the source of payment.
13. Formulate Advance Directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. The staff and practitioners who provide care in the facility shall comply with these directives. All patients= rights apply to the person who has legal responsibility to make decisions regarding medical care on your behalf.
14. File a grievance. If you wish to file a grievance with this facility, you may do so by writing or calling your health plan.
15. Have access to an interpreter if you do not speak or understand English. If you have a hearing impairment you should have access to a TDD or an interpreter.
16. Be advised if Tri-Valley Medical Group, L.P. or its affiliates personal physician proposes to engage in clinical trials, you have the right to refuse to participate in research projects.
17. Receive care in a safe setting, free from verbal or physical abuse or harassment. You have the right to access protective services including notifying government agencies of neglect or abuse.
18 Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience or retaliation by staff.
19. Be informed by the physician, or a delegate of the physician, of continuing health care requirements upon leaving the facility. Upon your request, a friend or family member may be provided this information also.

YOU ARE RESPONSIBLE TO:
20. Provide, to the extent possible, an accurate and complete description of your present condition and past medical history, including past illnesses, medications and hospitalizations information that the managed care organization.
21. Follow the plans and instructions for care that you have agreed on with your practitioners.
22. Make recommendations regarding Tri-Valley Medical Group L.P. and Affiliates rights and responsibilities.
23. Understand your health problems and to participate in developing mutually agreed upon treatment goals to the degree possible.
24. Follow Tri-Valley Medical Group, L.P. and Affiliates policies which affect patient care and conduct and abide by all local, state, and federal laws.
25. Keep all appointments and cooperate with your physician and others caring for you.
26. Meet your financial commitment to Tri-Valley Medical Group L. P and Affiliates.

 

Anti-Discrimination Notice
Discrimination is Against the Law
Tri-Valley Medical Group complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Tri-Valley Medical Group does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Tri-Valley Medical Group:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as:
Qualified interpreters
Information written in other languages
If you need these services, call 951-894-4665.
If you believe that Tri-Valley Medical Group has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
EPIC Management, QI Department
P.O. Box 3001,
Redlands, CA 92373
grievances@epiclp.com

You can file a grievance in person, by mail, or email. If you need help filing a grievance in person, the Patient Service Advisor is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

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