ARMEN Y. NERCESSIAN, D.O.

NOTICE OF PRIVACY PRACTICES

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.

Armen Nercessian, D.O. is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

This notice applies to all of the clinics of Armen Nercessian, D.O. The clinics will share patients’ health information as necessary for the purposes of treatment, payment or health care operations.

Disclosure of Your Health Care Information Treatment 

We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. “On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Armen Nercessian, D.O..” “It is our policy to provide a substitute health care provider, authorized by Armen Nercessian, D.O. 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.”

Payment 

We may disclose your health information to your insurance provider for the purpose of payment or health care operations. “As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Armen Nercessian, D.O. for health care services rendered. If you pay for your health care services personally, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to you. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received.”

Workers’ Compensation 

We may disclose your health information as necessary to comply with state Workers’ Compensation Laws.

Emergencies 

We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

Public Health 

As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Judicial and Administrative Proceedings 

We may disclose your health information in the course of any administrative or judicial proceeding.

Law Enforcement 

We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Deceased Persons

We may disclose your health information to coroners or medical examiners.

Organ Donation 

We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Research 

We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

Public Safety 

It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.


ARMEN Y. NERCESSIAN, D.O.

Specialized Government Agencies We may disclose your health information for military, national security, prisoner and government benefits purposes.

Marketing We may contact you for marketing purposes or fundraising purposes, as described below: (example) “If we need to contact in regards to your appointment or health care we might call. 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 thanto ask that you call our clinic.”

Change of Ownership In the event that Armen Nercessian, D.O. is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that the Armen Nercessian, D.O. is not required to agree to the restriction that you requested.

You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.

You have a right to request that the Armen Nercessian, D.O. amend your protected health information. Please be advised, however, that the Armen Nercessian, D.O. is not required to agree to amend your protected health information. 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 Armen Nercessian, D.O.

You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices Armen Nercessian, D.O. 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, Armen Nercessian, D.O. is required by law to comply with this Notice. Armen Nercessian, D.O. 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.

Questions/ Complaints If you have questions about any part of this notice or if you want more information about your privacy rights, or you wish to file a complaint about your Privacy rights or how Armen Nercessian, D.O. has handled your health information please contact:

Compliance Officer Armen Nercessian, D.O. Azusa Way Family Medical Center

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

This notice is effective as of 11/15/2013.

I have read the Privacy Notice and understand my rights contained in the notice. By way of my signature, I provide University of Western States with my authorization and consent to use and disclosed my protected health care information for the purposes of treatment, payment and health care operations as described in the Privacy Notice.

You have the right to inspect and copy your health information.