Your Information.
Your Rights.
Our Responsibilities.
This notice describes how medical information about you may be used and disclosed as directed by the Health Information Portability and Accountability Act of 1996 (HIPPA) Privacy Rule Please review it carefully.
You have the right to:
⢠Privacy and Confidentiality of your Personal Health Information (PHI)
⢠Get a copy of your paper or electronic medical record
⢠Correct your paper or electronic medical record
⢠Request confidential communication
⢠Ask us to limit the information we share
⢠Get a list of those with whom weâve shared your information
⢠Choose someone to act for you
⢠File a complaint if you believe your privacy rights have been violated
You have some choices in regards to how we
use or share your information:
⢠If we tell family and friends about your medical care
⢠Who we disclose your medical information to (except in cases of emergencies and/or continuity of care necessities)
We may use and share your information as we:
⢠Treat you
⢠Run our organization & bill for your services
⢠Help with public health and safety issues
⢠In the event of a medical emergency
⢠Respond to organ and tissue donation requests
⢠Reports required by law related to birth, death, or diseases
⢠Address workersâ compensation, law enforcement, and other government requests
⢠Comply with the law, respond to lawsuits and respond to legal actions
⢠Reports required by law related to neglect or abuse
⢠For continuity of care with other health professionals that may be treating you
Patient Right and PrivacyÂ
Kheir Clinic is committed to protecting the privacy and dignity of every patient. Patient health records contain personal health information, the confidentiality of which is protected under both federal and California state law. Kheir complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the California Confidentiality of Medical Information Act (CMIA).
As a patient of Kheir Clinic, you have the right to:
- Receive care with dignity and respect, regardless of race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, gender identity, immigration status, or ability to pay.
- Receive information about your diagnosis, treatment options, and prognosis in a language you understand.
- Access free language assistance services in English, Bengali, Korean, Spanish, and Thai.
- Inspect and request a copy of your medical records.
- Request corrections to your medical records.
- Request restrictions on how your health information is used or shared.
- Receive a Notice of Privacy Practices describing how your information may be used and disclosed.
- File a complaint or grievance without fear of retaliation, and receive a written response.
- Refuse treatment to the extent permitted by law and be informed of the consequences.
- Participate in decisions about your care, including the right to advance directives.
As a patient, you are also asked to:
- Provide accurate and complete information about your health history, medications, and insurance.
- Treat staff, providers, and other patients with civility and respect, in person and in all virtual or digital communications.
- Keep scheduled appointments or provide timely notice of cancellation.
- Follow the treatment plan agreed upon with your provider, or communicate concerns if you cannot.
To request a copy of Kheirâs full Notice of Privacy Practices, to access your medical records, or to file a privacy-related complaint, please contact info@lakheir.org. Complaints may also be filed with the U.S. Department of Health and Human Services Office for Civil Rights.