Christopher V. Flores MD, A Medical Corporation
Click here to download Spanish Version

Effective Date: January 11, 2015 (3rd Amended)
Co-Privacy Officers: Maricela C. Fernandez & Christopher V. Flores MD
Telephone (760) 568-4483

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.

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information.
We make a record of the medical care we provide and may receive such records from others. We use these records to
provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you
as allowed by your health plan (if applicable) and to enable us to meet our professional and legal obligations to operate
this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide
individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify
affected individuals following a breach of unsecured protected health information. This notice describes how we may use
and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical
information. If you have any questions about this Notice, please contact our Privacy Officer(s) listed above.

TABLE OF CONTENTS

A. How This Medical Practice May Use or Disclose Your Health Information

B. When This Medical Practice May Not Use or Disclose Your Health Information

C. Your Health Information Rights

1. Right to Request Special Privacy Protections
2. Right to Request Confidential Communications
3. Right to Inspect and Copy
4. Right to Amend or Supplement
5. Right to an Accounting of Disclosures
6. Right to a Paper or Electronic Copy of this Notice

D. Changes to this Notice of Privacy Practices

E. Complaints


A. How This Medical Practice May Use or Disclose Your Health Information

The medical record is the property of this medical practice, but the information in the medical record belongs to you. The
law permits us to use or disclose your health information for the following purposes:

1.       
 Treatment.  We use medical information about you to provide your medical care. We disclose medical information to
our employees and others who are involved in providing the care you need. For example, we may share your medical
information with other physicians or other health care providers who will provide services that we do not provide or we may
share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a
test. We may also disclose medical information to members of your family or others who can help you when you are sick or
injured, or following your death.

2.       
 Payment.  We use and disclose medical information about you to obtain payment for the services we provide. For
example, we may give your health plan the information it requires for payment either to us or to you in the form of a
reimbursement. We may also disclose information to other health care providers to assist them in obtaining payment for
services they have provided to you.

3.        
Health Care Operations.  We may use and disclose medical information about you to operate this medical practice.
For example, we may use and disclose this information to review and improve the quality of care we provide, or the
competence and qualifications of our professional staff. Or we may use and disclose this information to get your health
plan to authorize services or referrals. We may also use and disclose this information as necessary for medical reviews,
legal services and audits, including fraud and abuse detection and compliance programs and business planning and
management. We may also share your medical information with our "business associates,"  that perform administrative
services for us. We have a written contract with each of these business associates that contains terms requiring them and
their subcontractors to protect the confidentiality and security of your medical information. Although federal law does not
protect health information which is disclosed to someone other than another healthcare provider, health plan, healthcare
clearinghouse, or one of their business associates, California law prohibits all recipients of healthcare information from
further disclosing it except as specifically required or permitted by law.  We may also share your information with other
health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this
information to help them with their quality assessment and improvement activities, their patient-safety activities, their
population based efforts to improve health or reduce health care costs, protocol development, case management or care
coordination activities, their review of competence, qualifications and performance of health care professionals, their
training programs, their accreditation, certification or licensing activities, their activities related to contracts of health
insurance or health benefits, or their health care fraud and abuse detection and compliance efforts.

4.        
Appointment Reminders & Other Communications.  We may use and disclose medical information to contact you
about appointments and other matters by mail, telephone, fax or email.  If you are not home, we may leave this information
on your answering machine, on a cell phone voicemail, or in a message left with the person answering the phone.  We will
honor any reasonable request you make to receive an appointment reminder in a different way. We may also contact you to
follow up regarding test results, care received, or to notify you about treatment options or health-related products or
services that may interest you.

5.        
Sign-in Sheet.  We may use and disclose medical information about you by having you sign in when you arrive at our
office. We may also call out your name when we are ready to see you.

6.       
 Notification and Communication with Family.  We may disclose your health information to notify or assist in notifying
a family member, your personal representative or another person responsible for your care about your location, your
general condition or, unless you have instructed us otherwise, in the event of your death. In the event of a disaster, we may
disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose
information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or
object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this
information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances.
If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication
with your family and others.

7.        
Marketing. Provided we do not receive any payment for making these communications, we may contact you to
encourage you to purchase or use products or services related to your treatment, case management or care coordination,
or to direct or recommend alternative treatments, therapies, health care providers or settings of care that may be of interest
to you. We may similarly describe a health-related product or service (or payment for such product or service) provided by
this practice and tell you which health plans we participate in (if any).  We may receive financial compensation to talk with
you face-to-face, to provide you with small promotional gifts, or to cover our cost of reminding you to take and refill your
medication or otherwise communicate about a drug or biologic that is currently prescribed for you, but only if any financial
remuneration we receive is reasonably related to our cost of making the communication. We will not otherwise use or
disclose your medical information for marketing purposes or accept any payment for other marketing communications
without your prior written authorization. The authorization will disclose whether we receive any financial compensation for
any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization.
(
Note: In this context, the definition of payment or other similar words is limited and does not include payment for treatment
of the patient.)

8.        Sale of Health Information. We will not sell your health information without your prior written authorization. The
authorization will disclose that we will receive compensation for your health information if you authorize us to sell it, and we
will stop any future sales of your information to the extent that you revoke that authorization. (Note: The term “sale of health
information “is specifically defined by law and does not include certain disclosures, including disclosures for public health
, research, treatment and payment, and change of ownership purposes.)

9.        
Required by Law.  As required by law, we will use and disclose your health information, but we will limit our use or
disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence,
or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the
requirement set forth below concerning those activities.

10.        
Public Health.  We may, and are sometimes required by law, to disclose your health information to public health
authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent
adult 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. When we report suspected elder or dependent
adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best
professional judgment, we believe the notification would place you at risk of serious harm or would require informing a
personal representative we believe is responsible for the abuse or harm.

11.        
Health Oversight Activities.  We may, and are sometimes required by law to disclose your health information to
health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings,
subject to the limitations imposed by federal and California law.

12.        
Judicial and Administrative Proceedings.  We may, and are sometimes required by law, to disclose your health
information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or
administrative order. We may also disclose information about you in response to a subpoena, discovery request or other
lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your
objections have been resolved by a court or administrative order.

13.       
 Law Enforcement.  We may, and are sometimes required by law, to disclose your health information to a law
enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person,
complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.

14.        
Coroners.  We may, and are often required by law, to disclose your health information to coroners in connection
with their investigations of deaths.

15.        
Organ or Tissue Donation.  We may disclose your health information to organizations involved in procuring,
banking or transplanting organs and tissues.

16.       
 Public Safety.  We may, and are sometimes required by law, 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 the
general public.

17.        
Proof of Immunization.  We will disclose proof of immunization to a school where the law requires the school to
have such information prior to admitting a student if you have agree to the disclosure on behalf of yourself or your
dependent.

18.        
Specialized Government Functions.  We may disclose your health information for military or national security
purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

19.        
Workers' Compensation. We may disclose your health information as necessary to comply with workers'
compensation laws. For example, to the extent your care is covered by workers' compensation, we will make periodic
reports to your employer about your condition. We are also required by law to report cases of occupational injury or
occupational illness to the employer or workers' compensation insurer.

20.        
Change of Ownership. In the event that this medical practice is sold or merged with another organization, your
health information/record will become the property of the new owner, although you will maintain the right to request that
copies of your health information be transferred to another physician or medical group.

21.        
Breach Notification.  In the case of a breach of unsecured protected health information, we will notify you as
required by law. If you have provided us with a current email address, we may use email to communicate information
related to the breach. In some circumstances our business associate may provide the notification. We may also provide
notification by other methods as appropriate

22.        
Psychotherapy Notes.  We will not use or disclose your psychotherapy notes (if we have any copies) without your
prior written authorization except for the following: (1) your treatment, (2) for training our staff, students and other trainees,
(3) to defend ourselves if you sue us or bring some other legal proceeding, (4) if the law requires us to disclose the
information to you or the Secretary of HHS or for some other reason, (5) in response to health oversight activities
concerning your psychotherapist, (6) to avert a serious threat to health or safety, or (7) to the coroner or medical examiner
after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or
disclosing these notes.

23.        
Research.  We may disclose your health information to researchers conducting research with respect to which your
written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with
governing law.

24.        
Fundraising.  We may use or disclose your demographic information, the dates that you received treatment, the
department of service, your treating physician, outcome information and health insurance status in order to contact you for
our fundraising activities. If you do not want to receive these materials, notify the Privacy Officer listed at the top of this
Notice of Privacy Practices and we will stop any further fundraising communications. Similarly, you should notify the Privacy
Office if you decide you want to start receiving these solicitations again.

B. When This Medical Practice May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not
use or disclose health information which identifies you without your written authorization. If you do authorize this medical
practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any
time.

C. Your Health Information Rights

1.        Right to Request Special Privacy Protections.  You have the right to request restrictions on certain uses and
disclosures of your health information by a written request specifying what information you want to limit, and what
limitations on our use or disclosure of that information you wish to have imposed. If you tell us not to disclose information
to your commercial health plan concerning healthcare items or services for which you paid for in full out-of-pocket, we will
abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to
accept or reject any other request, and will notify you of our decision.

2.        
Right to Request Confidential Communications. You have the right to request that you receive your health
information in a specific way or at a specific location. For example, you may ask that we send information to a particular
email account or to your work address. We will comply with all reasonable requests submitted in writing which specify how
or where you wish to receive these communications.  

3.        
Right to Inspect and Copy.  You have the right to inspect and copy your health information, with limited exceptions. To
access your medical information, you must submit a written request detailing what information you want access to,
whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will provide
copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find
acceptable, or if  we can't agree and we maintain the record in an electronic format, your choice of a readable electronic or
hardcopy format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee
which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an
explanation or summary, as allowed by federal and California law. We may deny your request under limited circumstances.
If we deny your request to access your child's records or the records of an incapacitated adult you are representing
because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a
right to appeal our decision. If we deny your request to access your psychotherapy notes, you will have the right to have
them transferred to another mental health professional.

4.        
Right to Amend or Supplement.  You have a right to request that we amend your health information that you believe is
incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information
is inaccurate or incomplete. We are not required to change your health information, and will provide you with information
about this medical practice's denial and how you can disagree with the denial. We may deny your request if we do not have
the information, if we did not create the information (unless the person or entity that created the information is no longer
available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the
information is accurate and complete as is. If we deny your request, you may submit a written statement of your
disagreement with that decision, and we may, in turn, prepare a written rebuttal. You also have the right to request that we
add to your record a statement of up to 250 words concerning anything in the record you believe to be incomplete or
incorrect. All information related to any request to amend or supplement will be maintained and disclosed in conjunction
with any subsequent disclosure of the disputed information.

5.       
 Right to an Accounting of Disclosures.  You have a right to receive an accounting of disclosures of your health
information made by this medical practice, except that this medical practice does not have to account for the disclosures
provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3
(health care operations), 6 (notification and communication with family) and 18 (specialized government functions) of
Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct
patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures
to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that
agency or official that providing this accounting would be reasonably likely to impede their activities.

6.        
Right to a Paper or Electronic Copy of this Notice.  You have a right to notice of our legal duties and privacy practices
with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have
previously requested its receipt by email.  

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these
rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.

D. Changes to this Notice of Privacy Practices

We reserve the right to amend our privacy practices and the terms of this Notice of Privacy Practices at any time in the
future. Until such amendment is made, we are required by law to comply with this Notice.  After an amendment is made,
the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when
it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be
available at each appointment. We will also post the current notice on our website.

E. Complaints

Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be
directed to our Privacy Officer listed at the top of this Notice of Privacy Practices. If you are not satisfied with the manner in
which this office handles a complaint, you may submit a formal complaint to:

Region IX
Office for Civil Rights
U.S. Department of Health & Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
(800) 368-1019; (800) 537-7697 (TDD)

The complaint form may be found at
www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf .
You will not be penalized in any way for filing a complaint.

CHRISTOPHER V. FLORES, MD
A MEDICAL CORPORATION
Mailing Address:  PO Box 752, Rancho Mirage, CA 92270
Tel:  (760) 568-4483  Fax:(760) 568-6810
www.drchrisflores.com

NOTICE OF PRIVACY PRACTICE