患者隐私声明

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 CAREFULLY.

如果你 have any questions ab出 this notice, please contact the facility Privacy Officer, 泰瑞康伦: phone (626) 307-2108; e-mail teri.conlon@ahmchealth.com.

WHO WILL FOLLOW THIS NOTICE

这 notice describes our 医院's practices and that of:

Any health 护理 professional authorized to enter 信息 into your 医院 chart.
All departments and units of the 医院.
Any member of a volunteer group we allow to help you while you are in the 医院.
All employees, staff and other 医院 personnel.
All 门诊治疗 staff members
All these entities, sites and locations follow the terms of this notice. 除了, these entities, sites and
locations may share medical 信息 with each other for treatment, payment or health 护理 operations
purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical 信息 ab出 you and your health is personal. We are committed to protecting
medical 信息 ab出 you. We create a record of the 护理 and services you receive at the 医院. 我们需要
this record to provide you with quality 护理 and to comply with certain legal requirements. 本通告适用于
to all of the records of your 护理 generated by the 医院, whether made by 医院 personnel or your personal
医生. Your personal 医生 may have different policies or notices regarding the 医生's use and disclosure of
your medical 信息 created in the 医生's office or clinic.

这 notice will tell you ab出 the ways in which 我们可能 use and disclose medical 信息 ab出 you. We
also describe your rights and certain obligations we have regarding the use and disclosure of medical
信息.

We are required by law to:

Make sure that medical 信息 that identifies you is kept private (with certain exceptions);
Give you this notice of our legal duties and privacy practices with respect to medical 信息 ab出 you;
Follow the terms of the notice that is currently in effect; and
Notify you as required by law following a breach of your unsecured protected health 信息.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical 信息. 为每一个
category of uses or disclosures we will explain what we mean and try to give some 例子s. 不是每一次使用或
disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose
信息 will fall within one of the categories.

DISCLOSURE AT YOUR REQUEST

我们可能会披露 信息 when 请求ed by you. 这 disclosure at your 请求 may require a written
您的授权.

治疗

We may use medical 信息 ab出 you to provide you with medical treatment or services. 我们可能会披露
medical 信息 ab出 you to 医生s, 护士, 技术人员, 保健专业学生, or other 医院 personnel who are involved in taking 护理 of you at the 医院. 例如, a 医生 treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. 除了, the 医生 may
need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. 不同的
departments of the 医院 also may share medical 信息 ab出 you in order to coordinate the different
things you need, 这样的 as prescriptions, lab work and X-rays. We also may disclose medical 信息 ab出
you to people 出side the 医院 who may be involved in your medical 护理 after you leave the 医院, 这样的
as skilled nursing facilities, home health agencies, and physicians or other practitioners. 例如，我们可以
give your physician access to your health 信息 to assist your physician in treating you.

商业伙伴: We may share your health 信息 with our business associates
so they can perform the job we have asked them to do. Some services provided by our
business associates include a billing service, record storage company, or legal or accounting
咨询顾问. To protect your health 信息, we have written contracts with our business
associates requiring them to safeguard your 信息.

Health Information Exchange: We, along with other health 护理 providers in the Los Angeles area, may participate in one or more Health Information Exchanges (HIE). An HIE is a community-wide 信息 system used by participating health 护理 providers to share health 信息 ab出 you for treatment purposes. Should you require treatment from a health 护理 provider that participates in one of these exchanges who does not have your medical records or health 信息, that health 护理 provider can use the system to gather your health 信息 in order to treat you. 例如, he or she may be able to get laboratory or other tests that have already been performed or find 出 ab出 treatment(s) that you have already received. 我们将 include your health 信息 in this system. 如果你 would prefer your 信息 not be shared with the HIE (opt-出) or have previously opted 出 of HIE participation and would like to share your 信息 with the HIE (opt-in), please notify your registration staff or the business office at the facility where you obtain health 护理.
The staff can help you change your preference using the HIE Change of Sharing Status form.

付款

We may use and disclose medical 信息 ab出 you so that the treatment and services you receive at the
医院 may be billed to and payment may be collected from you, an insurance company or a third party. 为
例子, 我们可能 need to give 信息 ab出 surgery you received at the 医院 to your health plan so it
will pay us or reimburse you for the surgery. 我们也可以 tell your health plan ab出 a treatment you are going
to receive to obtain prior approval or to determine whether your plan will cover the treatment. 我们也可以
provide basic 信息 ab出 you and your health plan, insurance company or other source of payment to
practitioners 出side the 医院 who are involved in your 护理, to assist them in obtaining payment for services
他们提供给你.

FOR HEALTH CARE OPERATIONS

We may use and disclose medical 信息 ab出 you for health 护理 operations. 这些 uses and disclosures
are necessary to run the 医院 and make sure that all of our patients receive quality 护理. 例如，我们
may use medical 信息 to review our treatment and services and to evaluate the performance of our staff
为了照顾你. 我们也可以 combine medical 信息 ab出 many 医院 patients to decide what additional services the 医院 should offer, what services are not needed, and whether certain new treatments are effective. 我们也可以 disclose 信息 to 医生s, 护士, 技术人员, 医学专业的学生, and other 医院 personnel for review and learning purposes. 我们也可以 combine the medical 信息 we have with medical 信息 from other 医院s to compare how we are doing and see where we can make improvements in the 护理 and services we offer. We may remove 信息 that identifies you from this set of
medical 信息 so others may use it to study health 护理 and health 护理 delivery with出 learning who the
具体的病人有.

筹款活动

We may use 信息 ab出 you, or disclose 这样的 信息 to a foundation related to the 医院, to
contact you in an effort to raise money for the 医院 and its operations. You have the right to opt 出 of
receiving fundraising communications. 如果你 receive a fundraising communication, it will tell you how to opt
出.

医院目录

We may include certain limited 信息 ab出 you in the 医院 directory while you are a patient at the
医院. 这 信息 may include your 名字, location in the 医院, your general condition (e.g.,很好,
公平的,等.) and your religious affiliation. Unless there is a specific written 请求 from you to the contrary, this
目录信息, except for your religious affiliation, may also be released to people who ask for you by
名字. Your religious affiliation may be given to a member of the clergy, 这样的 as a priest or rabbi, 即使他们
不要叫你的名字. 这 信息 is released so your family, friends and clergy can visit you in the
医院 and generally know how you are doing.

市场推广及销售

Most uses and disclosures of medical 信息 for marketing purposes, and disclosures that constitute a sale
of medical 信息, require your authorization.

TO INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE

We may release medical 信息 ab出 you to a friend or family member who is involved in your medical
护理. 我们也可以 give 信息 to someone who helps pay for your 护理. Unless there is a specific written
请求 from you to the contrary, 我们可能 also tell your family or friends your condition and that you are in the
医院.

除了, 我们可能 disclose medical 信息 ab出 you to an organization assisting in a disaster relief
effort so that your family can be notified ab出 your condition, status and location. 如果你到了
emergency department either unconscious or otherwise unable to communicate, we are required to attempt to
contact someone we believe can make health 护理 decisions for you (e.g., a family member or agent under a
health 护理 power of attorney).

为研究

Under certain circumstances, 我们可能 use and disclose medical 信息 ab出 you for research purposes.
例如, a research project may involve comparing the health and recovery of all patients who received one
medication to those who received another, for the same condition. All research projects, 然而, are subject to
a special approval process. 这 process evaluates a proposed research project and its use of medical
信息, trying to balance the research needs with patients' need for privacy of their medical 信息.
Before we use or disclose medical 信息 for research, the project will have been approved through this
research approval process, 但是我们可以, 然而, disclose medical 信息 ab出 you to people preparing to
conduct a research project, 例如, to help them look for patients with specific medical needs, 只要…
the medical 信息 they review does not leave the 医院.

按照法律的要求

我们将 disclose medical 信息 ab出 you when required to do so by federal, state or local law.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY

We may use and disclose medical 信息 ab出 you when necessary to prevent a serious threat to your
health and safety or the health and safety of the public or another person. Any disclosure, 然而, would only
be to someone able to help prevent the threat.

特殊情况

器官及组织捐赠

We may release medical 信息 to organizations that handle organ procurement or organ, 眼睛或组织
移植 or to an organ donation bank, as necessary to facilitate organ or tissue donation and
移植.

军人和退伍军人

如果你 are a member of the armed forces, 我们可能 release medical 信息 ab出 you as required by military
当局命令. 我们也可以 release medical 信息 ab出 foreign military personnel to the
appropriate foreign military authority.

工人的补偿

We may release medical 信息 ab出 you for workers' compensation or similar programs. 这些
programs provide benefits for work-related injuries or illness.

公共卫生活动

我们可能会披露 medical 信息 ab出 you for public health activities. 这些 activities generally include
以下几点:

To prevent or control disease, injury or disability;
To report births and deaths;
To report regarding the abuse or neglect of children, elders and dependent adults;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. 我们将 only make this disclosure if you agree or when required or authorized by law;

To notify emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws.

HEALTH OVERSIGHT ACTIVITIES

我们可能会披露 medical 信息 to a health oversight agency for activities authorized by law. 这些
oversight activities include, 例如, audits, investigations, inspections, and licensure. 这些活动是
necessary for the government to monitor the health 护理 system, government programs and compliance with
民权法.

诉讼与争议

如果你 are involved in a lawsuit or a dispute, 我们可能 disclose medical 信息 ab出 you in response to a
court or administrative order. 我们也可以 disclose medical 信息 ab出 you in response to a subpoena,
发现请求, or other lawful process by someone else involved in the dispute, but only if efforts have been
made to tell you ab出 the 请求 (which may include written notice to you) or to obtain an order protecting the
信息要求.

执法

We may release medical 信息 if asked to do so by a law enforcement official:

In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
关于 the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's
协议;
关于 a death we believe may be the result of criminal conduct;
关于 criminal conduct at the 医院; and
In emergency circumstances to report a crime, the location of the crime or victims, 或者恒等式, description or location of the person who committed the crime.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS

We may release medical 信息 to a coroner or medical examiner. 这 may be necessary, 例如, to
identify a deceased person or determine the cause of death. 我们也可以 release medical 信息 ab出
patients of the 医院 to funeral directors as necessary to carry 出 their duties.

NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES

We may release medical 信息 ab出 you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.

PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS

我们可能会披露 medical 信息 ab出 you to authorized federal officials so they may provide protection
致总统, other authorized persons or foreign heads of state or conduct special investigations.

犯人

如果你 are an inmate of a correctional institution or under the custody of a law enforcement official, 我们可能
disclose medical 信息 ab出 you to the correctional institution or law enforcement official. 这
disclosure would be necessary: 1) for the institution to provide you with health 护理; 2) to protect your health
and safety or the health and safety of others; or 3) for the safety and security of the correctional institution.

MULTIDISCIPLINARY PERSONNEL TEAMS

我们可能会披露 health 信息 to a multidisciplinary personnel team relevant to the prevention,
识别, management or treatment of an abused child and the child's parents, or elder abuse and neglect.

SPECIAL CATEGORIES OF INFORMATION

在某些情况下, your health 信息 may be subject to restrictions that may limit or preclude some
uses or disclosures described in this notice. 例如, there are special restrictions on the use or disclosure of
certain categories of 信息 -- e.g., tests for HIV or treatment for mental health conditions or alcohol and
药物滥用. Government health benefit programs, 这样的 as Medi-Cal, may also limit the disclosure of beneficiary
信息 for purposes unrelated to the program.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical 信息 we maintain ab出 you.

RIGHT TO INSPECT AND COPY

You have the right to inspect and obtain a copy of medical 信息 that may be used to make decisions
关于你的护理. Usually, this includes medical and billing records, but may not include some mental health
信息.

To inspect and obtain a copy of medical 信息 that may be used to make decisions ab出 you, 你必须
submit your 请求 in writing to the Release of Information Clerk. To obtain a 请求 form call (626) 300-
0263. 如果你 请求 a copy of the 信息, 我们可能 charge a fee for the costs of copying, 邮寄或其他
supplies associated with your 请求. You may 请求 an electronic copy of your records if available.

We may deny your 请求 to inspect and obtain a copy in certain very limited circumstances. 如果你被拒绝
access to medical 信息, you may 请求 that the denial be reviewed. Another licensed health 护理
professional chosen by the 医院 will review your 请求 and the denial. The person conducting the review
will not be the person who denied your 请求. 我们将 comply with the 出come of the review.

修改权

如果你 feel that medical 信息 we have ab出 you is incorrect or incomplete, you may ask us to amend the
信息. You have the right to 请求 an amendment for 只要… the 信息 is kept by or for the
医院.

要求修改, your 请求 must be made in writing and submitted to [insert contact 信息].
除了, 你必须 provide a reason that supports your 请求.

We may deny your 请求 for an amendment if it is not in writing or does not include a reason to support the
请求. 除了, 我们可能 deny your 请求 if you ask us to amend 信息 that:

不是我们创造的吗, unless the person or entity that created the 信息 is no longer available to make the amendment;
Is not part of the medical 信息 kept by or for the 医院;
Is not part of the 信息 which you would be permitted to inspect and copy; or
准确和完整.
Even if we deny your 请求 for amendment, you have the right to submit a written addendum, 不超过
250个单词, with respect to any item or statement in your record you believe is 不完整或不正确. 如果你
clearly indicate in writing that you want the addendum to be made part of your medical record we will attach it
to your records and include it whenever we make a disclosure of the item or statement you believe to be
不完整或不正确.

RIGHT TO AN ACCOUNTING OF DISCLOSURES

You have the right to 请求 an "accounting of disclosures." 这 is a list of the disclosures we made of
medical 信息 ab出 you other than for our own uses for treatment, payment and health 护理 operations
(as those functions are described above), and with other exceptions pursuant to the law.
To 请求 this list or accounting of disclosures, 你必须 submit your 请求 in writing to the facility Privacy
Officer, 泰瑞康伦: phone (626) 307-2108 or e-mail teri.conlon@ahmchealth.com. 你的请求
must state a time period which may not be longer than the six previous years and may not include dates before
2003年4月14日. 你的请求 should indicate in what form you want the list (例如, on paper or
电子). The first list you 请求 within a 12-month period will be free. 为 additional lists, 我们可能
charge you for the costs of providing the list. 我们将 notify you of the cost involved and you may choose to
withdraw or modify your 请求 at that time before any costs are incurred.

RIGHT TO REQUEST RESTRICTIONS

You have the right to 请求 a restriction or limitation on the medical 信息 we use or disclose ab出 you
for treatment, payment or health 护理 operations. You also have the right to 请求 a limit on the medical
信息 we disclose ab出 you to someone who is involved in your 护理 or the payment for your 护理, 就像一个
家人或朋友. 例如, you could ask that we not use or disclose 信息 ab出 a surgery
你有.

We are not required to agree to your 请求, except to the extent that you 请求 us to restrict disclosure to a
health plan or insurer for payment or health 护理 operations purposes if you, or someone else on your behalf
(other than the health plan or insurer), has paid for this item or service 出 of pocket in full. 即使你要求
这个特殊的限制, we can disclose the 信息 to a health plan or insurer for purposes of treating you.
If we agree to another special restriction, we will comply with your 请求 unless the 信息 is needed to
provide you emergency treatment.

请求限制, 你必须 make your 请求 in writing to the facility Privacy Officer, 泰瑞康伦:
phone (626) 307-2108 or e-mail teri.conlon@ahmchealth.com. In your 请求, 你必须 tell us 1) what
信息 you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you
want the limits to apply, 例如, disclosures to your spouse.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS

You have the right to 请求 that we communicate with you ab出 medical matters in a certain way or at a
特定的位置. 例如, you can ask that we only contact you at work or by mail.

To 请求 confidential communications, 你必须 make your 请求 in writing to the facility Privacy Officer,
泰瑞康伦: phone (626) 307-2108 or e-mail teri.conlon@ahmchealth.com. 我们不会问你的
请求的理由. 我们将 accommodate all reasonable 请求s. 你的请求 must specify how or where
你希望被联系.

RIGHT TO A PAPER COPY OF THIS NOTICE

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website: http://www.montereyparkhosp.com. 获得论文
copy of this notice contact the facility Admitting Department at (626) 570-5720.

本通知的更改

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective
for medical 信息 we already have ab出 you as well as any 信息 we receive in the future. 我们将
post a copy of the current notice in the 医院. The notice will contain the effective date on the first page, in
在右上角. 除了, each time you register at or are admitted to the 医院 for treatment or
health 护理 services as an inpatient or 出patient, we will offer you a copy of the current notice in effect.

投诉

如果你 believe your privacy rights have been violated, you may file a complaint with the 医院 or with the
美国国务卿.S. Department of Health and Human 服务. To file a complaint with the 医院, contact
the facility Privacy Officer, 泰瑞康伦: phone (626) 307-2108 or e-mail teri.conlon@ahmchealth.com.

All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical 信息 not covered by this notice or the laws that apply to us will be
made only with your written permission. 如果你 provide us permission to use or disclose medical 信息
ab出 you, you may revoke that permission, in writing, at any time. 如果你 revoke your permission, this will stop
any further use or disclosure of your medical 信息 for the purposes covered by your written
authorization, except if we have already acted in reliance on your permission. You understand that we are
unable to take back any disclosures we have already made with your permission, and that we are required to
retain our records of the 护理 that we provided to you.