Notice of Privacy Practices

This notice describes how health information about you as a patient of Head and Neck Associates may be used and disclosed, your rights as a patient and how you can access your health information. This notice is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our Commitment To Your Privacy

Head and Neck Associates is dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information as prescribed by HIPAA. These HIPAA guidelines are summarized below for your information and understanding.

Use and Disclosure Of Your Health Information

The following circumstances may require Head and Neck Associates to use or disclose your health information.

1. To comply with requests from public health authorities and health oversight agencies which are required by law to collect health information.
2. Law suits and similar proceedings in response to a court or administrative order.
3. If required to do so by a law enforcement official.
4. When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Head and Neck Associates will only make such disclosures to a person or organization able to prevent the threat.
5. If you are a member of U.S. or foreign military forces, including veterans, and if required by the appropriate authorities.
6. To federal government officials for intelligence and national security activities required by law.
7. To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
8. For Worker’s Compensation and similar programs.

Your Rights Regarding Your Health Information

1. You can request that Head and Neck Associates communicate with you about your health related issues in a particular manner or at a certain location. Therefore, you may ask to be contacted at home rather than work, via personal fax or cell telephone for appointment confirmations or related scheduling matters, for results of specific diagnostic tests, and such reasonable requests will be accommodated.
2. You can request a restriction regarding the use or disclosure of your health information for treatment, payment, or health care operations by Head and Neck Associates.
3. You have the right to request that Head and Neck Associates restrict our disclosure of your health information to only certain individuals involved in your care or the payment of your care, such as a family member or friend. However, Head and Neck Associates is not required to agree to your requests, but if we do agree, Head and Neck Associates is bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you.
4. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical and billing records, with the exception of psychotherapy notes. You must submit your request in writing to Head and Neck Associates, Attn: Beth Page, HIPAA Privacy Officer, at 26726 Crown Valley Pkwy., Suite 200, Mission Viejo, CA 92691. Obtain a request form from one of the Front Desk receptionists.
5. You may ask Head and Neck Associates to amend your health information if you believe it is incorrect or incomplete as long as the information is kept by or for Head and Neck Associates. To request an amendment, make your request in writing with a supporting reason for the amendment to your health information to Head and Neck Associates, Attn: Beth Page, HIPAA Privacy Officer, at 26726 Crown Valley Pkwy., Suite 200, Mission Viejo, CA 92691. Obtain a request form from one of the Front Desk If you have any questions regarding this Notice of Privacy Practices or Head and Neck Associates’ health information privacy policies, please contact Beth Page, HIPAA Privacy Officer at Head and Neck Associates, 26726 Crown Valley Pkwy., Suite 200, Mission Viejo, CA 92691.