5363 Balboa Boulevard, Suite 540 · Encino, CA 91316
EMAIL firstname.lastname@example.org · PHONE 818.905.6600 · FAX 818.905.6610
Your privacy is of the utmost importance to us and we are committed to protecting it. You are welcome to explore our website without providing any information about yourself. When you visit and navigate our Web site, we will not collect personal information about you unless you provide us that information voluntarily. By "personal information" we mean data that is unique to an individual, such as a name, address, e-mail address, or telephone number.What information does Beverly Hills Gastroenterology collect from me?
Our web server automatically recognizes your domain name. Our web server does not recognize your e-mail address. Most of our website has been designed to not require the use of any personal identifiers (such as name, address, telephone number, or e-mail address).Cookies
A cookie is a piece of information that is stored on your computer's hard drive, not on our site.
All of the information you choose to provide us is absolutely confidential and voluntary. We will never give, sell, rent, or reveal your name or address (including e-mail) to any outside party without your express consent. Brynie Slome Collins MD Inc. will not disclose your personally identifiable information to independent third parties other than those who help us operate our site.Links to Other Web Sites
This site contains links to other sites. BHG is not responsible for the privacy practices or the content of such web sites.
This notice describes how information about you may be used and disclosed and how you can get access to this information. Please read it carefully.Introduction
We are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect and how and when we use or disclose the information. It also describes your rights as they relate to your protected health information. This Notice is effective 07-01-11 and applies to all protected health information as defined by federal regulations.Understanding Your Health Record/Information
Each time you visit Dr. Collins, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and plans for future care of treatment. This information, often referred to as your health or medical record, serves as a:
Basis for planning your care and treatment
Means of communication among the many health professionals who contribute to your care
Legal document describing the care you received
Means by which you or a third-party payer can verify that services billed were actually provided
A tool in educating health professionals
A source of data for medical research
A source of information for public health officials charged with improving the health of this state and the nation
A source of data for our planning and marketing
A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why other may access your health information, and make more informed decisions when authorizing disclosure to others.Your Health Information Rights
Although your health record is the physical property of Brynie Slome Collins MD Inc, the information belongs to you. You have the right to:
Obtain a paper copy of this notice of information practices upon request
Inspect and copy your health record as provided for in 45 CFR 164.524
Amend your health record as provided for in 45 CFR 164.528
Obtain an accounting of disclosures of your health information for in 45 CFR 164.528
Request communications of your health information by alternative means or at alternative locations
Request a restriction on certain uses/ disclosures of your information as provided for in 45 CFR 164.522
Revoke your authorization to use of disclose health information except to the extent that action has already been taken
Brynie Slome Collins MD Inc is required to:
Maintain the privacy of your health information
Provide you with this notice as to our legal duties and privacy practices with the respect to information we collect and maintain about you
Abide by the terms of this notice
Notify you if we are unable to agree to a requested restriction
Accommodate reasonable request you may have to communicate health information by alternative means or at alternative locations
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us, or if you agree, we will email the revised notice to you.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.For More Information or to Report a Problem
If you have questions and would like additional information, you may contact the practice’s Privacy Officer at 310-659-1300.
If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer or with the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the OCR.Office for Civil Rights:
U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 509F, HHH Building
Washington, D.C. 20201