Privacy Policy

Please take the time to review this notice carefully.  As required by the privacy regulations created by the Health Insurance Portability and Accountability Act (HIPAA), this notice describes how health information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your Individually Identifiable Health Information… from here on referred to as ‘info’.

Our commitment to your privacy

First, we will never sell your information, or use your information for marketing campaigns, targeting or other poor behavior. We respect your decision to choose us for the correction of your foot problems, and consider it a privilege to be of service to you.

We are dedicated to maintaining the privacy of your info.  In conducting our practice, we will create records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and the privacy policies that we maintain in our practice concerning your info.  By federal and state law, we must follow the terms of the notice of privacy policies that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

  1. How we may use and disclose your info

  2. Your privacy rights in your info

  3. Our obligations concerning the use and disclosure of your info

The terms of this notice apply to all records containing your info that are created or retained by our practice.  We reserve the right to revise or amend this privacy policy.  Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past and any future records.

If you have questions about this notice please contact us at privacy@evofoot.com or the physical address listed at the end of this document.

The following describe the different ways we may use and disclose your info

Treatment
We may use your info to treat you. For example, we may ask you to have laboratory tests and use the results to help us reach a diagnosis.  We might use your info in order to write a prescription for you and might disclose your info to the pharmacy when ordering your prescription.  People who work in our practice – including but not limited to doctors and/or nurses – may use or disclose your info in order to treat you or to assist others in your treatment.  Additionally, we may disclose your info to others who may assist in your care such as: spouse, children, or parents.

Payment
We may use and disclose your info in order to bill and collect payment for services and items you may receive from us.  For example, we may contact your health insurer to certify eligibility and benefits.  We may provide your insurer with details regarding your treatment to determine if your insurers will cover/pay for your treatment.  We may also use and disclose your info to obtain payment from third parties that may be responsible for such costs, such as family members.  We may also use your info to bill you directly for services and items.

Health Care Operations
We may use and disclose your info to operate our business.  For example, our practice may use your info to evaluate the quality of care you received from us and/or conduct cost-management and business planning activities for our practice.

Appointment Reminders
We may use and disclose your info to contact you and remind you of an appointment.

Treatment Options
We may use and disclose your info to inform you of potential treatment options or alternatives.

Health Related Benefits and Services
We may use and disclose your info to inform you of health related benefits or services that may be of interest to you.

Release of Information to Family/Friends
We may release your info to a friend or family member that is involved in your care, or who assists in taking care of you.  For example, a parent may ask that a babysitter take their child to the pediatrician for treatment of a cold.  The babysitter may have access to this child’s medical information.

Disclosures Required by Law
We will use and disclose your info when we are required to do so by federal, state or local law.

The following describe special circumstances in which we may use or disclose your info

Public Health Risks
We may disclose your info to public health authorities that are authorized by law to collect information for the purposes of:

  1. Maintaining vital records, such as births and deaths

  2. Reporting child abuse or neglect

  3. Preventing or controlling disease, injury, disability

  4. Notifying a person regarding potential exposure to a communicable disease

  5. Notifying a person regarding potential risk for spreading/contracting disease or condition

  6. Reporting reaction to drugs or problems with products or devices

  7. Notifying individuals if a product or device has been recalled

  8. Notifying appropriate government agency and authority regarding the potential abuse of an adult patient (including domestic violence). We will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information

  9. Notifying your employer under limited circumstances related primarily to workplace injury/illness or medial surveillance

Health Oversight Activities
We may disclose you info to a health oversight agency for activities authorized by law.  Oversight activities can include:  investigations, inspections, audits, surveys, licensure and disciplinary actions.  Civil/criminal procedures or actions, compliance with civil right laws and health care systems in general.

Lawsuits and Similar Proceedings
We may use and disclose your info in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  Additionally in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement
We may release info if asked to do so by law enforcement:

  1. Regarding a crime victim in certain situations, if we are unable to obtain a person’s agreement

  2. Concerning death we believe is result of criminal conduct

  3. Regarding criminal conduct at our offices

  4. In response to a warrant, summons, court order, subpoena, legal process

  5. To identify/locate a suspect, material witness, fugitive, missing person

  6. In an emergency, to report a crime

Deceased Patients
We may release info to medical examiner/coroner to identify a deceased individual or to identify the cause of death.  If necessary release information in order for funeral directors to perform their jobs.

Organ/Tissue Donation
We may release your info to organizations that handle organ, eye or tissue procurement/transplantation, if you are an organ donor.

Serious Threats to Health or Safety
We may use and disclose your info when necessary to reduce or prevent a serious threat to your health or safety, another individual or the public.  Under these circumstances we will only make disclosures to a person or organization able to help prevent the threat.

Military
We may disclose your info if you are a member of the U.S. or foreign military forces (including veterans) if required by the appropriate authorities.

National Security
We may disclose your info to federal officials for intelligence and national security activities authorized by law, in order to protect the President, other officials or foreign heads of state or to conduct investigations.

Inmates
We may disclose your info to correctional institutions or law enforcement officials if you are an inmate or under custody of a law enforcement official.  Disclosure necessary:  for the institution to provide health care services, for the safety/security of the institution, to protect your health and safety and the health and safety of other individuals.

Workers Compensation
We may release your info for use of diagnosis, treatment or claims regarding workers compensation.

Your rights regarding your info

Confidential Communications
You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may request that we contact you at home rather than work.  In order to request a specific type of confidential communication you must make a written request to us at the address listed at the end of this document.

Please specify the requested method of contact and/or location to be contacted.  Our practice will try to accommodate reasonable requests.  You do not need to give a reason for your request.

Requesting Restrictions
You have the right to request a restriction in our use or disclosure of your info for treatment, payment or health care operations.  Additionally, you have the right to request that we restrict our disclosure to only certain individuals involved in your care or payment for your care, such as family/friends.  We are not required to agree to your request.   If we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you.  In order to request a restriction in our use or disclosure of your info, you must make your request in writing to us at the address listed at the end of this document.

Your request must describe in a clear and concise fashion:

  1. The information you wish restricted

  2. Whether you are requesting to limit our practice’s use, disclosure or both

  3. To whom you want the limits to apply

Inspection and Copies
You have the right to inspect and obtain a copy of the info that may be used to make decisions about you, including medical records and billing.  You must submit your request in writing to us at the address listed at the end of this document.

In order to inspect and/or obtain a copy of your info.  Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances.  Your may request a review of our denial.  Another licensed health care professional chosen by us will conduct the review.

Amendment
You may ask us to amend your health information if you believe it is incorrect or incomplete.  You may request an amendment for as long as the information is kept by or for our practice.  To request an amendment it must be in writing and submitted to us at the address listed at the end of this document.

You must provide us with a reason that supports your request.  Our practice will deny your request if you fail to submit your request in writing.  We may deny your request if you ask us to amend information that is in our opinion (a) accurate/complete  (b) not part of the info kept by or for our practice  (c) not part of the info that you would be permitted to inspect/copy (d) not created by our practice

Accounting of Disclosures
All of our patients have the right to request an “accounting of disclosures.”  An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your info for non-treatment or operations purposes.  Use of your info as part of the routine patient care in our practice is not required to be documented.  For example, doctor sharing information with a nurse, billing department using your information to file an insurance claim.  In order to obtain an accounting of disclosures you must submit your request in writing to us at the address listed at the end of this document.

All requests must state a time period which may not be longer than six years from the date of disclosure and may not include dates before April 14, 2003.  The first list you request within a 12-month period is free of charge but our practice may charge you for additional lists within the same time period.  Our office will notify you of the costs involved with additional requests and you may withdraw your request before you incur any costs.

Right to a Paper Copy of this Notice
You are entitled to receive a paper copy of our notice of privacy policies.  You may ask us to give you a copy of this notice at any time.  To obtain a copy contact us at the address listed at the end of this document.

Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health & Human Services.  To file a complaint with our practice by mailing it to the address listed at the end of this document.  Please sure to address the letter c/o Dr. Ali Sadrieh.

All complaints must be submitted in writing.  You will NOT be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures
We will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your info may be revoked at any time in writing.  After you revoke your authorization we will no longer use or disclose your info for the reasons described in the authorization.  Please note:  We must retain records of your care.

Mailing address to contact us:

Evo Advanced Foot Surgery
PO Box 1316
Studio City, CA 91614