Fair Oaks (916) 844-7800 - Santa Cruz (831) 304-0700 - Fax (916) 436-9054
PRIVACY NOTICE OF PATIENT INFORMATION PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
THAT MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO INFORMATION. PLEASE REVIEW IT CAREFULLY.
Impakt Medical is required by law to protect the privacy of your personal health information, provide this notice about our information practices, and follow the information practices that are described herein.
USES AND DISCLOSURES OF HEALTH INFORMATION
Impakt Medical uses your personal health information primarily for treatment; obtaining payment for treatment; conducting internal administrative activities and evaluating the quality of care that we provide. For example, Impakt Medical may use your personal health information to contact you to provide appointment reminders, or information about treatment alternatives or other health-related benefits that could be of interest to you. Impakt Medical may also use or disclose your personal health information without prior authorization for public health purposes, for auditing purposes, for research studies and for emergencies. We also provide information when required by law.
In any other situation, Impakt Medical’s policy is to obtain your written authorization before disclosing your personal health information. If you provide us with a written authorization to release your information for any reason, you may later revoke that authorization to stop future disclosures at any time. Impakt Medical may change its policy at any time. When changes are made, a new Notice of Information Practices will be posted in the office area and will be provided to you on your next visit. You may also request an updated copy of our Notice of Information Practices at any time.
PATIENT INDIVIDUAL RIGHTS
You have the right to review or obtain a copy of your personal health information at any time. You have the right to request that we correct any inaccurate or incomplete information in your records. You also have the right to request a list of instances where we have disclosed your personal health information for reasons other than treatment, payment, or other related administrative purposes. You may also request in writing that we not use or disclose your personal health information for treatment, payment, and administrative purposes except when specifically authorized by you, when required by law or in emergency circumstances.
Impakt Medical will consider all such requests on a case-by-case basis, but Impakt Medical is not legally required to accept them.
CONCERNS AND COMPLAINTS
If you are concerned that Impakt Medical may have violated your privacy rights of if you disagree with any decisions we have made regarding access or disclosure of your personal health information, please contact us at the below address. You may also send a written complaint to the US Department of Health and Human Services. Please contact the below organizations if you feel the need to contact them regarding Impakt Medical.
Medicare: (866) 243-7272 Medi-Cal: (800) 541-5555
Attention: Corporate Compliance Officer
9722 Fair Oaks Blvd, Suite B
Fair Oaks, CA
Phone (916) 844-7800