WHO DOES THIS NOTICE APPLY TO?

This Notice describes the privacy practices of Maxlife Medical Group Health System, including physicians and medical groups (collectively referred to as “MAXLIFE URGENT CARE CLINIC”). This Notice applies to physicians, allied health professionals, other health care providers, non- employee volunteers, and other personnel providing services to you at a facility or office operated by the entities above. These MAXLIFE URGENT CARE CLINIC entities may share your medical information for treatment, payment, or health care operations purposes as described in this Notice. This Notice applies to all of the records of your care generated at MAXLIFE URGENT CARE CLINIC, whether made by MAXLIFE URGENT CARE CLINIC personnel or your personal doctor when caring for you at MAXLIFE URGENT CARE CLINIC, unless your provider gives you their notice of privacy practices that describes how they will protect your medical information.

OUR RESPONSIBILITY TO YOU REGARDING YOUR MEDICAL INFORMATION:

We understand that your medical information is personal. We are committed to safeguarding the privacy of your medical information.

To comply with specific legal requirements, we must:

  • Keep your medical information private.
  • Provide you with a copy of this notice.
  • Follow the terms of this notice.
  • Notify you if we cannot agree to a restriction you requested.
  • Accommodate your reasonable requests to communicate medical information at alternative means or locations.
  • Notify you following a breach of your unsecured medical information, as the law requires.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:

We typically use or disclose your health information for the following reasons:

Treatment: We may use and disclose your medical information for your treatment. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.

We may also disclose your medical information to people, places, and entities outside of MAXLIFE URGENT CARE CLINIC so that we can coordinate your care. For example, we may give your physician access to your medical information to assist your physician in treating you.

Payment: We may use and disclose your medical information to obtain payment. For example, we may give your health plan information about a surgery you received so your health plan will pay us or reimburse you for that surgery.

Health Care Operations: We may use and disclose your medical information to support our operations outside MAXLIFE URGENT CARE CLINIC and coordinate your care. These uses and disclosures are necessary to ensure our patients receive quality care and cost-effective services. For example, we may use medical information to review our treatment and services and evaluate the performance of our staff in caring for you. Unless you instruct us otherwise, we may also use or disclose your medical information for the following purposes:

  • Fundraising Activities: We may use your medical information to contact you to solicit support for certain fundraising activities related to our operations. In such cases, we would only release a limited amount of your medical information, such as demographic information, dates of service, and contact information. You will have an opportunity to opt out of receiving such communications.
  • Health Information Exchange: We may participate in one or more health information exchanges (HIEs) and may electronically share our medical information for treatment, payment, and healthcare operations purposes with other participants in the HIEs. HIEs allow your healthcare providers to access and use medical information necessary for treatment and other lawful purposes.

The inclusion of your medical information in an HIE is voluntary and subject to your right to opt out. If you do not opt out of this exchange of information, we may provide your medical information in accordance with applicable law to the HIEs in which we participate. You can choose not to have your information shared through any of our HIE networks (that is, “opt- out”) at any time.

You may contact the MAXLIFE URGENT CARE CLINIC Health Information Management Department at (562) 800-0603 or Privacy-Security@maxlifeurgentcare.com.

We may be required to use or disclose medical information about you without prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without your prior approval for the following purposes:

  • Research: We may use and disclose your medical information for research purposes. All research projects are subject to a special approval process through an appropriate committee.
  • Required by Law: We may disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances or response to valid judicial or administrative orders.
  • Public Health: We may share your medical information as required or permitted by law to public health authorities or government agencies whose ongoing activities include preventing or controlling disease, injury, or disability.

These disclosures include reporting communicable diseases, reactions to medications, problems with products or adverse events, immunization registries, abuse or neglect, or vital statistics such as reporting births or deaths.

  • To Avert a Serious Threat to Health or Safety: We may use and disclose your medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  • Law Enforcement: We may disclose your medical information to law enforcement officials upon their request, but only as authorized by law, such as to identify or locate a suspect, fugitive, material witness, or missing person.– in response to a court order, subpoena, warrant, investigative demand, or other similar process;– to help identify or locate a suspect, fugitive, material witness, or missing person;– about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;– about a death we believe may be the result of criminal conduct;– about criminal conduct occurring on our premises;– in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
  • Health Oversight: We may disclose your medical information to health oversight agencies for purposes of legally authorized health oversight activities, such as audits and investigations necessary for oversight of the health care system and government benefit programs.
  • Business Associates: Some services are provided through contracts with business associates. For example, a company that bills insurance companies on our behalf is also our business associate, and we may provide your medical information to such a company so the company can help us obtain payment for the health care services we provide. We require our business associates to safeguard your medical information through a written agreement appropriately to protect your medical information.
  • Funeral Directors, Medical Examiners, and Coroners: We may disclose medical information to funeral directors, coroners, or medical examiners in a manner consistent with applicable law so that they can carry out their duties.
  • Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose your medical information in response to a court or administrative order. We may also disclose your medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if e orts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.
  • Organ and Tissue Donation: Consistent with applicable law, we may disclose your medical information to organ procurement organizations or other entities for tissue donation and transplant.
  • Military and Veterans: If you are an armed forces member, we may release your medical information as military command authorities require. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
  • National Security: We may release your medical information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We may also release your medical information to authorized federal officials so they may protect the President, other authorized persons, or foreign heads of state or conduct special investigations.
  • Multidisciplinary Personnel Teams: We may disclose your medical information to a multidisciplinary personnel team relevant to the protection, identification, management, or treatment of (i) an abused child and the child’s parents or (ii) elder abuse and neglect.
  • Food and Drug Administration (FDA): We may disclose certain medical information relative to reporting adverse events to the FDA.
  • Workers’ Compensation: We may disclose medical information necessary to comply with laws relating to workers’ compensation or other similar programs established by law.
  • Correctional Institutions: Should you be an inmate of a correctional institution, we may disclose medical information necessary for your health and the health and safety of other individuals to the institution or its agents.
  • Special Categories of Information: In some circumstances, your medical information may be subject to restrictions limiting or precluding some uses or disclosures described in this notice. For example, there are special restrictions on the use or disclosure of certain types of medical information (e.g., HIV test results, mental health records, and alcohol and substance abuse treatment records). Government health benefit programs may also limit the disclosure of beneficiary information for purposes unrelated to the program and the care provided to the beneficiary.

OTHER USES OR DISCLOSURES OF MEDICAL INFORMATION:

In any other situation not covered by this Notice, we will ask for your written authorization before using or disclosing your medical information. Specific examples of uses and disclosures requiring your authorization include:

  1. Most uses and disclosures of psychotherapy notes (private notes of a mental health professional kept separately from a medical record);
  2. Subject to limited exceptions, uses, and disclosures of your medical information for marketing purposes;
  3. Disclosures that constitute the sale of your medical information. Suppose you authorize us to use or disclose your medical information. In that case, you can later revoke that authorization by notifying us in writing of your decision, except to the extent that we have taken action in reliance on your authorization.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:

You have the following rights regarding medical information we maintain about you:

  • To request in writing a restriction on certain uses or disclosures of your medical information for treatment, payment, or health care operations (e.g., a restriction on who may access your medical information). Although we will consider your request, we are not legally required to agree to a requested restriction, except we must agree to your written request that we restrict the disclosure of information to a health plan if the information relates solely to an item or service for which you have paid out of pocket in full. We must abide by such a request unless we are required by law to make the disclosure. It is your responsibility to notify any other providers about this restriction.
  • To obtain a paper copy of this notice upon request, even if you have agreed to receive this notice electronically, you must contact the Medical Record Department.
  • To inspect and obtain a copy of your medical information, in most cases. If you request a copy (paper or electronic), we may charge you a reasonable, cost-based fee.
  • To request in writing an amendment to your records if you believe the information in your record is incorrect or important information is missing. We could deny your request to amend a record if we did not create the information, if we do not maintain it, or if we determine the record is accurate. You may appeal, in writing, a decision by us not to amend your record. Even if we deny your request for amendment, you have the right to submit a written addendum with respect to any item or statement in your record you believe is incomplete or incorrect.
  • To obtain an accounting of certain disclosures we have made of your medical information. The accounting will provide information about disclosures made outside of MAXLIFE URGENT CARE CLINIC for purposes other than treatment, payment, health care operations, or where you specifically authorized a use or disclosure in the past six (6) years. The request must be in writing, and the time period desired for the accounting must be stated. The first list you request will be free. There may be a charge for additional requests made within a twelve (12) month period.
  • To request that medical information about you be communicated in a certain way or location. For example, you can ask that we only contact you at work or by mail.

All written requests or appeals should be submitted to the MAXLIFE URGENT CARE CLINIC Privacy Office listed below.

CHANGES TO THIS NOTICE:

We reserve the right to change this Notice at any time. We have the right to make the revised Notice effective for any medical information we already have and any information we receive in the future. If we make a material change to this Notice, we will post it at our location where you receive services and on our website and make it available upon request.

COMPLAINTS:

If you have any questions or would like additional information, or if you believe your privacy rights have been violated, you can contact the MAXLIFE URGENT CARE CLINIC Privacy Officer listed at the following:

MAXLIFE MEDICAL GROUP Corporate Compliance Office.
Attn: Privacy Officer
11161 Washington Blvd,
Whittier, CA 90606.
(562) 800-0603
Privacy-Security@maxlifeurgentcare.com

You may also file a complaint with the

U.S. Department of Health and Human Services Office of Civil Rights.
200 Independence Avenue, S. W.,
Washington, DC 20201.

Filing a complaint will not negatively affect your treatment or coverage. MAXLIFE URGENT CARE CLINIC is committed to the prevention of intimidating or retaliatory actions against any individual for the exercise by the individual of any right established or for participation in any process provided for filing complaints against the covered entity.