INTERNAL MEDICINE MEDICAL GROUP, INC.
NOTICE OF PRIVACY PRACTICES
Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
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
In this Notice, we use terms like “ we,” “us”
or “our” to refer to Associated Internal Medicine
Medical Group, Inc. We have offices at 350 30th Street,
#320, Oakland, CA. This notice applies to our physicians,
nurse practitioners, physician assistants, dietitians, and
all other employees. We share protected health information
among us to provide you with health care services, to treat
you, to seek reimbursement from third party payers for our
services, and to conduct our business operations (e.g.,
quality assurance, compliance, and utilization review).
AIMMG does not require written authorization from the patient
to use PHI for treatment, payment or business operations.
What is “Protected Health Information”
“Protected health information,” or “PHI”
for short, is information that identifies who you are and
relates to, your past, present, or future physical or mental
health or condition, the provision of health care to you,
or past, present, or future payment for the provision of
health care to you. PHI does not include information about
you that is publicly available, or that is in a summary
form that does not identify who you are. If you are an employee
of our participating physician’s office, PHI does
not include your health information in your personnel file.
Purpose of this Notice
In the course of doing business, we gather and maintain
PHI about our members. We respect the privacy of your PHI
and understand the importance of keeping this information
confidential and secure. This Notice describes our privacy
practices and how we protect the confidentiality of your
PHI. We are obligated to maintain the privacy of your PHI
by implementing reasonable and appropriate safeguards. We
are also obligated to explain to you by this Notice about
our legal obligations to maintain the privacy of your PHI.
We must follow our Notice that is currently in effect.
How We Protect Your PHI
We restrict access to your PHI to those employees who need
access in order to provide services to our members. We have
established and maintain appropriate physical, electronic
and procedural safeguards to protect your PHI against unauthorized
use or disclosure. We have established a training program
that our employees must complete and update annually. We
have also established a Privacy Officer, Elizabeth Diaz,
who has overall responsibility for developing, training
and overseeing the implementation and enforcement of policies
and procedures to safeguard your PHI against inappropriate
access, use and disclosure.
Types of Use and Disclosure of PHI We May Make
Without Your Authorization
Treatment; Payment; Health Care Operations
Federal and state law allows us to use and disclose your
PHI in order to provide health care services to you, as
well as to bill and collect payments for the health care
services provided to you by our participating physicians.
For example, we may use your PHI to authorize referrals
to specialists and to review the quality of care provided
by your participating physician. We may disclose your PHI
to health plans or other responsible parties to receive
payment for the services provided to you by our participating
physicians. For example, if your account to sent to a collections\
agency, they would need your information in order to do
their job of collecting our fee.
We may also use or disclose your PHI, for example, to recommend
to you treatment alternatives, to inform you about health-related
benefits and services that we offer, or to contact you to
remind you of your appointments. We conduct these activities
to provide health care to you, and not as marketing.
Federal and state law also allows us to use and disclose
your PHI as necessary in connection with our health care
operations. For example, we may use your PHI for resolution
of any grievance or appeal that you file if you are unhappy
with the care you have received. We may also use your PHI
in connection with population-based disease management programs.
We may use or disclose your PHI to perform certain business
functions to our business associates, who must also agree
to safeguard your PHI as required by law. For example, our
practice management software vendor is able to see patient
information when assisting us with computer problems.
We are also allowed by law to use and disclose your PHI
without your authorization for the following purposes:
1. When required by law – In some circumstances,
we are required by federal or state laws to disclose certain
PHI to others, such as public agencies for various reasons.
2. For public health activities – Such as reports
about communicable diseases, defective medical devices to
the FDA or work-related health issues.
3. Reports about child and other types of abuse or neglect,
or domestic violence.
4. For health oversight activities – Such as
reports to governmental agencies that are responsible for
licensing physicians or other health care providers.
5. For lawsuits and other legal disputes –
In connection with court proceedings or proceedings before
administrative agencies, or to defend us or our participating
physicians in a legal dispute.
6. For law enforcement purposes –Such as responding
to a warrant, or reporting a crime.
7. Reports to coroners, medical examiners, or funeral
directors – To assist them in performance of their
8. For tissue or organ donations – To organ
procurement or transplant organizations to assist them.
9. For research – To medical researchers with
an approval of an institutional review board (IRB) or privacy
board that oversees studies on human subjects. Researchers
are also required to safeguard your PHI.
10. To avert a serious threat to the health or safety
of you or other members of the public.
11. For national security and intelligence/military activities
– Such as protection of the President or foreign dignitaries.
12. In connection with services provided under workers’
We may disclose your PHI, without your written authorization,
to your family members or other persons if they are involved
in your care or payment for that care. We may also notify
disaster relief organizations to assist them with their
relief efforts. When you are a patient at a hospital or
medical facility with which we are affiliated, we may create
a directory that includes your name, your location at the
facility, your general condition and your religious affiliation.
Information in this directory may be disclosed to visitors
and clergy. However, we must first provide you with an opportunity
to agree or object to such disclosure. If you cannot agree
or object because you are incapacitated or otherwise unavailable,
we will use our professional judgment.
You, as a parent, can generally control your minor child’s
PHI. In some cases, however, we are permitted or even required
by law to deny your access to your child’s PHI, such
as when your child can legally consent to medical services
without your permission.
If you are a minor child, your parent can generally control
you PHI. In some cases, we are permitted or even required
by law to deny your parent(s) access to your PHI, such as
when you can legally consent to medical services without
There are some types of PHI, such as HIV test results or
mental health information, which are protected by stricter
laws. However, even such PHI may be used or disclosed without
your written authorization if required or permitted by law.
All other uses and disclosures of your PHI must be made
with your written authorization. If you wish to have a copy
of your chart sent to another provider, you must sign an
authorization form. If you wish us to provide information
to an insurance company because you are applying for life
or disability insurance, you must sign an authorization
If you need an authorization form, we will send you one
for you or your personal representative to complete, or
you can download the form and print it out (transfer
records TO AIMMG; transfer
records FROM AIMMG). When you receive the form, please
fill it out and send it to the following address:
Associated Internal Medicine Medical Group, Inc.
350 30th Street, #320
Oakland CA 94609
If you have questions on how to complete
this form, the Oakland office phone number is 510-465-6700.
You may revoke or modify your authorization at any time
by writing to us at the same address. Please note that
your revocation or modification may not be effective in
some circumstances, such as when we have already taken
action relying on your authorization.
Your Rights Regarding Your PHI
Access to Your PHI
You have the right to review and copy your PHI we
maintain. If you wish to access to your PHI, please write
to us at the above addresses. We will respond to your
request and tell you when and where you can review your
PHI in our possession within our normal business hours.
If you would like a copy of the information we have, please
write to us at the same address. If we provide you with
a copy, we will charge a reasonable administrative fee
for copying your PHI to the extent permitted by applicable
law. If we deny your request for review or copy of your
PHI, we will explain the reason in writing. If we don't
have your PHI, but know who does, we will tell you whom
Right to Amend Your PHI
You have the right to request amendments to your PHI.
If you wish to have your PHI corrected or updated, please
write to us and tell us what you want changed and why.
We will respond to you in writing, either accepting or
denying your request. If we deny your request, we will
explain why. You may also send us an addendum that is
no longer than 250 words in length for each item you believe
is incorrect. Please clearly indicate that you want the
addendum to be included in your PHI. We will attach your
addendum to the record(s) of your PHI. Your amended PHI
will be available for your review upon request.
Right to Receive an Accounting of Disclosures of
You have the right to request an accounting of certain
disclosures that we make of your PHI. You can request
an accounting by writing to us. Please note that certain
disclosures, such as those made for treatment, payment,
or health care operations, need not be included in the
accounting we provide to you. We will respond to your
request within a reasonable period of time, but no later
than 60 days after we receive your written request.
Right to Receive a Copy of This Notice
You have the right to request and receive a paper
copy of this Notice.
Right to Request Restrictions
You have the right to request restrictions on how
we use and disclose your PHI for our treatment, payment,
and health care operations. All requests must be made
in writing. Upon receipt, we will review your request
and notify you whether we have accepted or denied your
request. Please note that we are not required to accept
your request for restrictions. Your PHI is critical for
providing you with quality health care. We believe we
have taken appropriate safeguards and internal restrictions
to protect your PHI, and that additional restrictions
may be harmful to your care.
Right to Confidential Communications
You have the right to request that we provide your
PHI to you in a confidential manner. For example, you
may request that we send your PHI by an alternate means
(e.g., sending by a sealed envelope, rather than a post
card) or to an alternate address (e.g., calling you at
a different telephone number, or sending a letter to you
at your office address rather than your home address).
We will accommodate any reasonable requests, unless they
are administratively too burdensome, or prohibited by
Right to Complain
We must follow the privacy practices set forth in
this Notice while in effect. If you have any questions
about this Notice, wish to exercise your rights, or file
a complaint, please direct your inquiries to:
Elizabeth Diaz, Privacy Officer
Associated Internal Medicine Medical Group, Inc.
350 30th Street, # 320
Oakland CA 94609
You may contact your Health Plan or the California Department of Managed Care with your concerns as well. You also have the right to directly complain to the Secretary of the United States Department of Health and Human Service. We will not retaliate against you for filing a complaint against us.
We will use and disclose your PHI to the fullest extent authorized by law. We reserve the rights as expressed in this Notice. We reserve the right to revise our privacy practices consistent with law and make them applicable to your entire PHI we maintain, regardless of when it was received or created. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Unless law requires the changes, we will not implement material changes to our privacy practices before we revise our Notice. You may request updates to this Notice at any time.
The effective date of this Notice is April 14, 2003.