Notice of Privacy Practices

Your rights

You have the right to get an electronic or paper copy of your medical record; ask us to correct your record; request confidential communications; ask us to limit what we use or share; receive an accounting of certain disclosures; receive a copy of this notice; choose someone authorized to act for you; and file a complaint if you believe your privacy rights have been violated.

Get an electronic or paper copy of your medical record

You may ask to see or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy or summary as required by law and may charge a reasonable, cost-based fee when permitted.

Ask us to correct or supplement your record

You may ask us in writing to correct health information you believe is incorrect or incomplete. We may deny a request when permitted by law and will explain a denial in writing. California law may also give you rights to submit a written addendum concerning information in your record that you believe is incomplete or incorrect.

Request confidential communications

You may ask us to contact you in a particular way or at a particular location. We will accommodate reasonable requests as required by law.

Ask us to limit what we use or share

You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are generally not required to agree. If you pay in full out of pocket for a service or item, you may ask us not to disclose information about that service or item to your health plan for payment or health care operations, and we will honor that request unless disclosure is required by law.

Get an accounting of disclosures

You may ask for an accounting of certain disclosures of your health information during the six years before your request. The accounting does not include disclosures that the law excludes from this requirement, including many disclosures for treatment, payment, health care operations, and disclosures you authorized.

Choose someone to act for you

If a person has legal authority to act as your personal representative, such as under a medical power of attorney or guardianship, that person may exercise your privacy rights as allowed by law. We may verify that authority before acting on a request.

Your choices

In circumstances where the law gives you a choice, you may tell us your preferences about sharing information with family members, close friends, or others involved in your care or payment for your care, and about disaster-relief communications. If you cannot tell us your preference, we may share information when permitted by law and when, using professional judgment, it is in your best interest or necessary to lessen a serious and imminent threat to health or safety.

We will obtain your written authorization for uses and disclosures when the law requires it, including most uses of psychotherapy notes, most marketing uses, and the sale of protected health information. You may revoke an authorization in writing to the extent permitted by law.

How we may use and disclose your health information

Treatment

We may use your health information to provide your medical care and share it with physicians, pharmacists, laboratories, and other health professionals involved in your treatment.

Payment

We may use and disclose health information to bill and obtain payment for services and, when applicable, to assist other health care providers with payment activities permitted by law.

Health care operations

We may use and disclose health information to operate the practice, improve quality, coordinate care, conduct medical review and audits, obtain legal or administrative services, and perform other health care operations allowed by law. Business associates that perform services for us are required by contract and law to protect protected health information as applicable.

Appointment reminders and communications

We may use health information to contact you about appointments and other matters related to your care. Please tell us if you have specific confidential-communication preferences.

Public health and safety

We may use or disclose information as permitted or required for public-health activities, reporting abuse or neglect, reporting adverse events or product problems, preventing disease, or preventing or reducing a serious threat to health or safety.

Health oversight, law enforcement, and legal proceedings

We may disclose information to health oversight agencies, law enforcement, courts, or administrative bodies when permitted or required by applicable law and subject to the legal protections that apply to the information.

Coroners, organ and tissue donation, government functions, and workers' compensation

We may disclose information as permitted or required for these purposes under applicable law.

Research

We may use or disclose health information for research when your authorization is obtained or when another lawful basis permits the use or disclosure, such as appropriate approval by an Institutional Review Board or privacy board.

Proof of immunization

We may disclose proof of immunization to a school when permitted by law and the applicable agreement or permission requirements have been met.

Change of ownership

If the medical practice is sold, transferred, or merged, records may be transferred to the successor as permitted by law, while your applicable rights concerning your records remain in effect.

Substance use disorder patient records

To the extent we maintain substance use disorder patient records subject to 42 CFR Part 2, those records receive additional federal confidentiality protections. We will not use or disclose information from those records in civil, criminal, administrative, or legislative investigations or proceedings against you unless permitted by Part 2, including where there is your written consent or an applicable court order and subpoena.

If fundraising communications would use Part 2 information, you will receive clear notice in advance and a choice about whether to receive those communications.

Our responsibilities

We are required by law to maintain the privacy and security of protected health information, provide you with notice of our legal duties and privacy practices, notify affected individuals following a breach of unsecured protected health information as required by law, and follow the duties and privacy practices described in the notice currently in effect.

We will not use or disclose your information other than as described in this notice unless you authorize us in writing or another use or disclosure is permitted or required by law. If you authorize a use or disclosure, you may revoke that authorization in writing as allowed by law.

California privacy protections

California law may provide protections for medical information that are more stringent than federal law. When California or another applicable law imposes a greater restriction on a use or disclosure, we follow the more protective requirement. Certain categories of information—including some mental health, substance use disorder, HIV/STI, reproductive-health, genetic, and other sensitive information—may be subject to additional protections depending on the circumstances.

Changes to this notice

We may change the terms of this notice as permitted by law, and changes may apply to information we already maintain. The current notice will be available upon request, at the practice, and on our website.

Questions and complaints

If you have questions, want a paper copy, want to exercise a privacy right, or want to make a complaint, contact the Whole Family MD Privacy Officer at 415-642-0333 ext. 105.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or using the HHS HIPAA complaint website. We will not retaliate against you for filing a complaint.

Whole Family MD
1286 Sanchez Street, Suite A
San Francisco, CA 94114
wholefamilymd.org ↗