Wellness Primary CareA Physician Assistant Practice

Notice of Privacy Practices

Your information. Your rights. Our responsibilities.

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.

Wellness Primary CareA Physician Assistant Practice
Effective date
To be finalized
Privacy contact
Daniel Riboh, PA-C
info@wellnessprimarycare.com
Phone: (818) 600-1237

Your Rights

You have rights concerning your health information.

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Contact us to learn how to make a request.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Contact us to learn how to make a request.
  • We may say “no” to your request, but we will tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way, such as at home, at work, or by cell phone, or to send mail to a different address.
  • We will agree to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our health care operations. We are not required to agree, and we may say “no,” for example, if it could affect your care. If we agree, we may still share the information if you need emergency treatment.
  • If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will agree unless a law requires us to share it.

Get a list of certain disclosures

  • You can ask for an accounting of the times we shared your health information during the six years before the date of your request, including who received it and why.
  • The accounting will not include disclosures for treatment, payment, or health care operations and certain other disclosures, including disclosures you asked us to make. We will provide one accounting each year at no charge. We may charge a reasonable, cost-based fee for another request within 12 months.

Get a copy of this Notice

You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. We will provide a paper copy promptly.

Choose someone to act for you

  • If someone has legal authority to act as your personal representative, such as through a medical power of attorney or legal guardianship, that person can exercise your rights and make choices about your health information.
  • We will verify that the person has this authority before taking action.

File a complaint if you believe your rights were violated

  • You can complain if you believe we violated your privacy rights by contacting the Privacy Contact listed on this page.
  • You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights using the information in the Questions or Complaints section below.
  • Wellness Primary Care will not retaliate against you for filing a complaint.

Your Choices

You have choices about certain sharing.

For certain health information, you can tell us your choices about what we share. If you have a clear preference in the situations below, tell us what you want us to do, and we will follow your instructions.

You have both the right and the choice to tell us to:

  • Share information with your family, close friends, or others involved in your care or payment for your care.
  • Share information in a disaster relief situation.

If you cannot tell us your preference, such as if you are unconscious, we may share information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

We generally need your written permission for:

  • Marketing purposes involving your protected health information.
  • The sale of your protected health information.
  • Most sharing of psychotherapy notes.

If fundraising communications ever apply, you may tell us not to contact you again. If we have substance use disorder patient records subject to 42 CFR part 2 and such records would be used for fundraising communications, we will provide clear and obvious advance notice and a choice about whether to receive those communications.

Our Uses and Disclosures

How we may use or share your health information.

We may use and share health information as permitted or required by law. Common examples are described below.

Treat you

We can use your health information and share it with other professionals who are treating you. For example, a treating professional may ask another treating professional about your overall health.

Run the practice

We can use and share your health information to operate the practice, improve your care, and contact you when necessary. For example, we may use information about you to manage your treatment and services.

Bill for services

We can use and share your health information to bill and obtain payment from health plans or other responsible entities. For example, we may provide information to your health plan so it can process payment for services.

Help with public health and safety activities

When legal requirements are met, we can share health information for activities such as preventing disease, assisting with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to health or safety.

Conduct health research

We can use or share health information for health research when legally permitted and when applicable legal safeguards and requirements are met.

Comply with the law

We will share information about you when state or federal law requires it, including with the U.S. Department of Health and Human Services if it requests information to evaluate our compliance with federal privacy law.

Respond to organ and tissue donation requests

We can share health information with organ procurement organizations when applicable.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation and government requests

We can use or share health information for workers’ compensation claims, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.

Law enforcement

We may share health information for law enforcement purposes or with a law enforcement official when legally permitted and when applicable legal conditions are met.

Respond to judicial and administrative proceedings

We may share health information in response to a court or administrative order or in response to a subpoena when legally permitted.

Special Privacy Protections

Additional protections may apply to certain records.

Some categories of information may receive additional protection under federal or state law.

Our Responsibilities

We are responsible for protecting your information.

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will notify affected individuals as required if a breach occurs that may have compromised the privacy or security of their information.
  • We must follow the duties and privacy practices described in the currently effective Notice and provide you with a copy.
  • We generally will not use or share your information other than as described in this Notice unless the law permits it or you authorize us in writing. If you authorize a use or disclosure, you may change your mind at any time by notifying us in writing.

Changes to This Notice

We may change the terms of this Notice.

We may change the terms of this Notice, and the changes may apply to all health information we maintain about you, including information created or received before the change. The current Notice will be available on the Wellness Primary Care website, upon request, and at the practice when applicable.

Questions or Complaints

Contact us or file a privacy complaint.

If you have questions about this Notice or believe your privacy rights have been violated, contact:

Privacy Contact

Daniel Riboh, PA-C
Wellness Primary Care
info@wellnessprimarycare.com
Phone: (818) 600-1237

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:

Wellness Primary Care will not retaliate against you for filing a complaint.