ASSOCIATED 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 CAREFULLY.

About Us

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” or “PHI”?

“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, Elaine Zirger, 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 legal duties.
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’ compensation laws.

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 their permission.

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.


Authorizations

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 form.

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: