| NOTICE OF PRIVACY PRACTICES |
Christopher V. Flores MD, A Medical Corporation
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Click here to download Spanish Version.
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.
This notice describes the privacy practices of Dr. Christopher Flores’ medical office regarding your protected health
information. Your protected health information (“PHI”) is health information that contains information that reveals who you
are, such as your name and Social Security. For example, your medical information is PHI because it includes your name
and other information that reveals who you are. This notice is effective October 17, 2005.
OUR PLEDGE REGARDING YOUR PHI
Dr. Flores is committed to protecting the privacy of your PHI. This notice tells you about the ways in which we may use and
disclose your PHI. This notice also describes your rights and certain obligations we have regarding the use and disclosure
of your PHI.
By law we must:
• Protect the privacy of your PHI;
• Give you this notice describing your rights and our legal duties and privacy practices with respect to your PHI; and
• Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR PHI
Generally we are required to obtain your written authorization (“permission”), before using or disclosing your PHI. However,
the law permits us to use and disclose your PHI without your permission for a few specific purposes. In the following
sections, we briefly describe different ways we may use or disclose your PHI and give you some examples. Although not
every use or disclosure is listed below, all of the ways we are permitted to use or disclose your PHI will fall within one of the
following categories.
• Treatment. We may use and disclose your PHI to provide you with medical treatment or services. For example, we
may use or disclose PHI about you to treat your illness or injury; or to give you information about treatment alternatives or
other health-related benefits and services that may interest you. We may also disclose PHI about you to people outside of
our office who may be involved in your continuing medical care, such as other health care providers (for example, a
specialist or dentist) or others individuals you tells us about (for example, friend, family member, care giver or personal
representative).
• Payment. We may use and disclose your PHI to obtain payment for health care services that we or others provide to
you. For example, we may need to give information to your health plan about health care services provided at our office so
that your health plan will pay us (if applicable) or reimburse you. We may also need to tell your health plan about a proposed
treatment to help you determine whether or not your health plan will cover such treatment.
• Health Care Operations. We may use and disclose PHI about you for certain health care operations, such as internal
administration and planning that improve the quality and cost effectiveness of the care that we provide you; or to evaluate the
quality and competence of our health care providers, trainees, nurses or other workers.
• Appointment Reminders. We may use or disclose your PHI in order to contact you about appointments for treatment
or other health care you may need.
• Business Associates. We may contract with business associates to perform certain functions or activities on our
behalf, such as payment and health care operations. These business associates must agree to safeguard your PHI.
• Communications with Family Members and Others. Sometimes a family member or other person involved in your
care will be present when we are discussing your PHI with you. If you object, please tell us and we won’t discuss your PHI
or we will ask the person to leave. In addition, there may be times when it is necessary to disclose your PHI to a family
member or other person involved in your care because there is an emergency, you are not present, or you lack the decision
making capacity to agree or object. In those instances, we will use our professional judgment to determine if it is in your
best interest to disclose your PHI. If so, we will limit the disclosure to the PHI that is directly relevant to the person’s
involvement with your health care. For example, we may allow someone to pick up a medication or prescription for you.
• Disclosure to Parents as Personal Representatives of Minors. In most cases, we will disclose your minor child’s
PHI to you. In some situations, however, we are permitted or even required by law to deny you access to your minor child’s
PHI. For example, we must deny access to parents when minors have adult rights to make their own health care decisions
and such minors have not given us permission to disclose their PHI to their parents. These minors include, for example,
minors who were or are married or who have a declaration of emancipation from a court.
• Disclosure in Case of Disaster Relief. We may disclose basic information, such as your name, city of residence, age,
gender, and general condition to a public or private disaster relief organization to assist disaster relief efforts, unless you
object at the time.
• Public Health Activities. Public health activities cover many functions performed or authorized by government
agencies to promote and protect the public’s health. By law, we may be permitted or required to use or disclose your PHI for
public health purposes. For example, we may disclose your PHI as part of our obligation to report to public health authorities
certain diseases, injuries, conditions, or vital events such as births. In some situations, we may disclose your PHI as part
of our obligation to someone you may have exposed to a communicable disease or who may otherwise be at risk of getting
or spreading the disease. We may use and disclose your PHI to the U.S. Food and Drug Administration or other authorized
persons or organizations regarding certain medicines or medical devices, such as pacemakers or hip replacements, you
may be using. We may use your PHI as necessary to comply with federal and state laws that govern workplace safety.
• Victims of Abuse, Neglect or Domestic Violence. By law, we may disclose PHI to the appropriate authority to report
suspected child abuse or neglect or to identify suspected victims of abuse, neglect, or domestic violence.
• Health Oversight Activities. As health care providers, we may be inspected by federal and state agencies. These
agencies may review or investigate the manner in which we run the clinic, and, in that process, they may review your PHI.
• Military Activity and National Security. We may sometimes use and disclose the PHI of armed forces personnel to
the applicable military authorities when they believe it is necessary to properly carry out military missions. We may also use
and disclose your PHI to authorized federal officials as necessary for national security and intelligence activities or for
protection of the president and other government officials and dignitaries.
• Lawsuits and Other Legal Disputes. We may use and disclose your PHI in responding to a court or administrative
order, a subpoena, or a discovery request. We may also use and disclose your PHI without your permission to the extent
permitted or required by law in any judicial or administrative proceedings.
• Law Enforcement. We may disclose your PHI to police or others who enforce the laws for law enforcement purposes,
for example, to report a crime on our premises, to respond to a search warrant, or help identify or locate someone.
• Coroners, Medical Examiners and Funeral Directors. Under certain circumstances, we may disclose your PHI to a
coroner, a medical examiner or a funeral director as required by law. For example, we may disclose PHI to the coroner to
help identify someone who has died or to establish a cause of death.
• Organ and Tissue Donation. We may use and disclose PHI to organizations that assist with organ, eye, or tissue
donation, banking or transplant so that we can facilitate the donation and transplantation.
• Health or Safety. We may disclose PHI to prevent a serious threat to your health and safety or the health and safety of
the public or another person.
• Research. Our office may engage in research. Some of our research may involve medical procedures and some may
be limited to collection and analyses of health data. Research of all kinds may involve the use or disclosure of your PHI.
Your PHI can generally be used or disclosed for research without your permission if an Institutional Review Board (“IRB”)
approves such use or disclosure. An IRB is a committee that is responsible, under federal law, for reviewing and approving
human subjects research to protect the safety of the participants and the confidentiality of PHI.
• Marketing. We may provide you with marketing materials in a face-to-face encounter, without obtaining authorization.
We are also permitted to give you a promotional gift of nominal value, if we so choose, without obtaining your authorization.
We will ask your permission before we use your health information for any other marketing activities.
• Workers’ Compensation. We may disclose PHI as authorized by and to the extent necessary to comply with laws
relating to workers’ compensation or other similar programs or as required under laws relating to workplace injury or
illness. For example, we may communicate your medical information regarding a work-related injury or illness to claims
administrators, insurance carriers, and others responsible for evaluating your claim for workers’ compensation benefits.
• Specific Types of PHI. There are stricter requirements for use and disclosure of some types of PHI, for example,
mental health and drug and alcohol abuse patient information, HIV tests, and genetic testing information. Generally, we will
need your permission to disclose these types of information. However, there are still circumstances in which these types of
information may be used or disclosed without your permission.
• As Required by Law. We may disclose PHI when required to do so by any other law not already referred to in the
preceding categories.
For any other purpose other than the ones described above, we may only use or disclose your PHI when you give us your
written authorization.
YOUR RIGHTS REGARDING YOUR PHI
This section tells you about your rights regarding your PHI, for example your medical and billing records. It also describes
how you can exercise these rights.
• Your Right to See and Receive Copies of Your PHI. In general, you have a right to see and receive copies of your PHI,
such as your medical and billing records. If you would like to see or receive a copy of such record, please write to us. After
we receive your letter, we will let you know when and how you can see or obtain a copy of your record. We may charge you a
reasonable fee for the copies. In limited situations, we may be required by law to deny some or your entire request to see or
receive copies of such records. If we deny your request, we will tell you why you can not see or get copies of such records
and whether you have a right to appeal this denial and, if so, how to appeal.
• Your Right to Amend Your PHI. You have the right to request that we change the information contained in your PHI.
Please write a letter telling us what you think we need to correct or add to your record and why we should make the
correction or addition. We will comply with your request unless we believe that the information that would be amended is
already accurate and complete or other special circumstances apply. If we deny your request, we will tell you why and
explain to you that you have a right to add a statement to your record regarding each item in your health record that you think
is incorrect or incomplete. Your statement must be limited to 250 words for each item in your record that you think is
incorrect or incomplete. You must clearly tell us in writing if you want us to include your statement in future disclosures we
make of that part of your record. We may include a summary of your statement in the record instead of your actual statement.
• Your Right to Revoke Your Authorization. You may revoke (take back) any written authorization (permission) obtained
by us for use and disclosure of your PHI, except to the extent that we have taken action in reliance upon it. This means that
your revocation would not apply to any authorized use or disclosure of your PHI that took place before we received your
revocation. Your revocation must be in writing and delivered to this office.
• Your Right to an Accounting of Disclosures of Your PHI. You may ask for a list of disclosures of your PHI. The list we
give you will include certain disclosures made by us. However an accounting does not include certain disclosures, for
example disclosures to carry out treatment, payment and health care operations; disclosures that occurred prior to April 14,
2003; disclosures made pursuant to your authorization; disclosures of your PHI to you; disclosures for notifications for
disaster relief purposes; or disclosures to persons involved in your care and persons acting on your behalf. The period of
your request for an accounting cannot exceed six years. If you request an accounting more than once during a twelve (12)
month period, we may charge you a reasonable fee.
• Your Right to Request How Information Is Provided to You. You may request, and we will try to agree to any
reasonable written request for you to receive PHI in certain ways (for example, by fax instead of regular mail) or at a different
address (for example, to your work address instead of your home address).
• Your Right to Request Restrictions on the Use of Your PHI. You may request that we limit our uses and disclosures of
your PHI for certain things, including treatment, payment and health care operations purposes. All requests for such
restrictions must be made in writing. While we will consider a request for additional restrictions carefully, by law we are not
required to agree to such request. Because we strongly believe that this information is needed to appropriately manage the
care of our patients, is our policy not to agree to such restrictions.
• Your Right To Receive A Paper Copy Of This Notice. You have the right to receive a paper copy of this notice. All you
have to do is ask our office for a copy of the notice.
We may change the terms of this notice and our privacy practices at any time, as long as the change is consisted with the
law. If we change this notice, we may make the new notice terms effective for all PHI that we hold, including any information
created or received prior to issuing the new notice. If we change this notice, we will post the revised notice in our office and
on our website (www.drchrisflores.com). You may also obtain any revised notice by contacting our office.
If you have any questions about this notice, or want to lodge a complaint about our privacy practices, please let us know by
calling our office at (760) 568-4483. You may also contact us in person at our office which is located at 44331 Monterey Ave,
Suite C & D, Palm Desert, CA 92260. You also may notify the Secretary of the Department of Health and Human Services.
We will not retaliate against you if you file a complaint about our privacy practices.
| CHANGES TO THIS NOTICE |
| HOW TO CONTACT US ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES |
| CHRISTOPHER FLORES, MD NOTICE OF PRIVACY PRACTICES |