Privacy Policy

Physicians Medical Group of San Jose in partnership with Regional Medical Center, and O'Connor Hospital work together... more>>

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Notice of Privacy Practices

Notice of Privacy Practices in pdf format

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 .

Purpose of this Notice
In the normal course of doing business, this office and its business associates—Physicians Medical Group and EXCEL MSO, LLC—gather and retain personal health information about our patients/members for the purpose of providing medical care, billing, and health plan-related issues. Our physician(s) and staff respect the privacy of your personal information and understand the importance of keeping this information confidential and secure. This Notice describes how this office, along with Physicians Medical Group of San Jose and EXCEL MSO, LLC, protects the confidentiality of the personal health information we receive.

What is “Personal Health Information”?
“Personal Health Information” is private, protected 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 given to you, or past, present, or future payment(s) for the provision of health care given to you. Personal Health Information does not include information about you that is publicly available, or that is available or reported in summary form but does not identify who you are.

Types of Uses and Disclosures of Personal Information
Federal law allows this office and/or Physicians Medical Group of San Jose and EXCEL MSO, LLC to use and disclose your personal information 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 participating physicians. Federal law also allows this office, in conjunction with its business partners, to use and disclose your personal information as necessary in connection with usual and customary health care operations. For example, this office—along with Physicians Medical Group of San Jose and EXCEL MSO, LLC— may use your personal healthcare information in order to obtain authorized referrals to specialists, to review the quality of care provided to you and receive payment for services given. Your personal healthcare information may also be used by these entities in connection with any grievance or appeal that you file, either with us or with your health plan (your health insurance company). Certain governmental oversight agencies may also request access to your personal information in order to monitor the activities of certain physicians or providers, or to monitor your health plan or insurance company.

Physicians Medical Group with Excel MSO LLC and/or your health plan may use your personal health information in evaluating physician compliance with any applicable disease management programs or medical care guidelines. Required rules of privacy are observed.

This office, along with PMG/EXCEL MSO LLC, is also allowed by law to use and disclose your personal information without your consent or authorization for the following purposes:

When required by law, such as court-ordered subpoenas
For public health activities, such as reports about communicable diseases or work-related health issues (privacy of identity is utilized);
In reports about child abuse, domestic violence, or neglect;
For health oversight activities, such as reports to governmental agencies that are
responsible for licensing physicians or other health care providers;
In connection with court proceedings or proceedings before administrative agencies;
For tissue or organ donation;
For research, with the approval of certain oversight entities; otherwise, use and
disclosure of your personal information required for research requires your authorization;
To avert a serious threat to the health or safety of a person or of the public;
For national security and intelligence activities, including the protection of the President.

Access to Personal Information
As a matter of federal and state law, you have the right to review and/or receive a copy of the personal information received, created and retained (i.e. medical records) by this office. If you request to inspect or receive a copy of your health information held by this office, time to inspect and/or a copy will be provided. This office may reserve the right to charge a reasonable administrative fee, in addition to a per page copy fee for copying your personal information as allowed by applicable law. Under California law, this office has up to five working days to comply with a request for inspection and/or 15 days after receipt to comply with a copy request.

Right to Amend Personal Information
You have the right to request amendments to the personal health information (medical records) created by this office. A request to amend your personal information must be submitted to this office in writing, and the requested change must be no longer than 250 words in length. This office will attach the request for amendment to your medical record. You will be notified within in 30 days of receipt of request of our decision to amend or not amend the medical record. Either way, your request for amendment(s) becomes part of your medical record. This office, in it’s discretion, may choose to submit the request for amendment(s) to Physicians Medical Group’s Quality Management Committee (via EXCEL MSO, LLC), the operating body designated to carry out the federal HIPAA privacy oversight function for this office.

Right to Receive an Accounting of Disclosures
You have the right to request an accounting of all disclosures of the personal information made by this office and/or Physicians Medical Group/EXCEL MSO LLC that are not directly related to your treatment, payment for treatment or health care operations as outlined above. You must request this accounting in writing. This office will provide the accounting to you within a reasonable period of time after your request and in accordance with applicable law(s).

Right to Request Restrictions on Disclosures of Personal Health Information
You may request restrictions on the use and disclosure of your personal health information by this office. This office has the right to accept or reject your request for restrictions. All requests for restrictions must be made in writing. All requests for restrictions will be made part of your medical record. After receipt of your request, and within 30 days of receipt, this office will notify you in writing of its decision to accept or reject the request. Acceptance of restrictions will be in effect until any written notice to the contrary. If you should decide to terminate with this office or with Physicians Medical Group of San Jose, your personal health information will be used in accordance with applicable State and Federal law, with the most restrictive rule being in effect in the event of any contradiction.

Right to Receive this Notice
You have the right to request and receive a copy of this Notice in written or electronic form. You may contact this office, or Physicians Medical Group Member Services at (408) 937-3642 for a copy. A copy will be provided to you at no charge.

Right to Confidential Communications
You have the right to request that your personal health information be sent to you in a confidential manner. For example, you may request that this office sends your personal information by alternate means or to an alternate address, such as by telephone to a different telephone number or to an office address rather than your home address.

Right to Complain
This office, as well as its business associates, are obligated to comply with the privacy practices set forth in this Notice. If you believe that this office, or one of its business associates has violated this privacy policy, you have the right to file a complaint with Physicians Medical Group of San Jose (408) 937-3642, your Health Plan, the California Department of Managed Care or the United States Department of Health and Human Service, Office of Civil Rights.

Contacting Physicians Medical Group Regarding Your Rights
If you should have any questions regarding your rights, or wish to make a request or complaint, you may direct your inquiries to:

Member Services
Physicians Medical Group of San Jose/EXCEL MSO LLC
1565 Mabury Road , Suite D
San Jose, CA 95133
(408) 937-3642

Rights Reserved
This office, Physicians Medical Group of San Jose , and EXCEL MSO, LLC reserve the right to amend or change the terms of this Notice at any time and to make the provisions of the new notice effective for all personal health information we maintain. You may request updates to this Notice at this office and at the above address for Physicians Medical Group/EXCEL MSO LLC.

*Per the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)

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