“On occasion, it may be necessary to seek consultation regarding your condition from other health care providers referred to or associated with Aegis.”

“It is our policy to provide a substitute health care provider, authorized by Aegis to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.”

“As a courtesy to our patients, we will submit an itemized billing statement to Medi-Cal or your insurance carrier so we may bill and collect for health care services rendered. If you pay for your health care services personally, we may, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to you. The billing statement will contain medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received.”

“As a courtesy to our patients, it is our policy to call your home on the evening prior to your scheduled appointment to remind you of your appointment time. If you are not at home, we leave a reminder message on your answering machine or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment.”

“It is our practice to participate in charitable events to raise awareness, food donations, gifts, money, etc. During these times, we may send you a letter, post card, invitation or call your home to invite you to participate in the charitable activity. We will provide you with information about the type of activity, the dates and times, and request your participation in such an event. It is not our policy to disclose any personal health information about your condition for the purpose of Aegis Medical Systems Inc / Nationwide Medical Group sponsored fund-raising events.”

• Except for the circumstances described above, other uses or disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law.
  
  
• You have the right to revoke or cancel an authorization at any time in writing. You may request restrictions on certain uses and disclosures of your health information. Unless required by law, Aegis may not be required to agree to the restrictions requested, and any such agreement must be in writing.
  
  
• You have the right to inspect and copy your health information. This right may be limited by the days or hours of access, and our right to charge for any copies or mailings you request. If your request for information or copying is denied by Aegis, you will receive a written explanation, and a right to have any denial of access reviewed by Aegis internal procedures, in addition to any other legal rights you may have related thereto.
  
  
• You have a right to request that Aegis amend by correcting or supplementing your protected health information where your medical information is incomplete or inaccurate. You must state your reasons for requesting an amendment in writing. Aegis is not required to amend your protected health information a) if the information was not created by Aegis, b) is not part of the medical information you have a legal right to see and copy, or such information is already accurate and complete. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.
  
  
• You have a right to receive an accounting of disclosures of your protected health information made by Aegis. These disclosures will not include our disclosures related to your treatment, payments or health care operations, or disclosures authorized by you.
  
  
• You have a right to a paper copy of this Notice of Privacy Practices at any time upon request. A copy of this Notice of Privacy Practices will be posted on our website at www.aegismed.com and also posted in our waiting rooms.

Changes to this Notice of Privacy Practices - Aegis reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Aegis is required by law to comply with this Notice.

Information Regarding Privacy Practices

Aegis Medical Systems Inc / Nationwide Medical Group is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: the HIPAA Compliance Officer by calling this office at 818-206-0360. If the Compliance Officer is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

Complaints

Complaints about your Privacy rights, or how your health information was handled, should be directed to Aegis HIPAA Complaint Officer Karl Kop [Steven Karlton Kop] by calling the toll free Privacy Hotline at 866- 447-7280 and faxing your request or complaint in writing to:

Steven Karlton Kop
10719 Ashton Avenue
Los Angeles, CA 90024

Phone: 866-447-7280
Fax: 310-470-9443
Email: karl@aegismed.com

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, DC 20201