Notice of Privacy
Practices
Effective Date: April 14, 2003
We are committed to protecting your personal health information
in compliance with the Federal law. We may use or disclose
your personal health information for these purposes:
For Treatment, Payment, Health Care Operations, Appointment
Reminders, Health Related Services and Treatment Alternatives,
Fundraising Activities, Individuals Involved in Your Care
or Payment for Your Care, Research, Organ and Tissue Donation,
As Required By Law, To Avert a Serious Threat to Health or
Safety, Military and Veterans, Workers’ Compensation,
Public Health Activities, Health Oversight Activities, Lawsuits
and Disputes, Law Enforcement, Coroners, Health Examiners
and Funeral Directors., National Security and Intelligence
Activities. Protective Services for the President and Others,
and Inmates.
You have certain rights with respect to your personal health
information:
Right to Inspect and Request a Copy, Right to Amend,
Right to Receive an Accounting of Disclosures, Right to Request
Restrictions, Right to Receive Confidential Communications,
Right to a Paper Copy of this Notice.
Changes to this Notice:
We reserve the right to change this notice and to make
the changed notice effective for all of the health information
that we maintain about you, whether it is information that
we previously received about you or information we may receive
about you in the future. We will have available a copy of
our current notice in our facility. Our notice will indicate
the effective date on the first page, in the center of page.
We will also give you a copy of our current notice upon request.
Complaints:
If you believe your privacy rights have been violated,
you may file a complaint with us or with the Secretary of
the Department of Health and Human Services. You may file
a complaint by mailing us a written description of your complaint
or by telling us about your complaint in person or over the
telephone:
Sophia Sosa, Chief Operations Officer or George Johnston,
Human Resources Director
Community Health Centers of the Central Coast, Inc.
150 Tejas Place
Nipomo, CA 93444
(805) 929-3211
If you would like a full copy of this notice or would like
to review it, please ask and we would be more than happy to
provide you with the document.
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