Notice of Privacy Practices

Jerry Hsieh, M.D.
Pulmonary | Critical Care | Sleep

Effective Date: April 7, 2025 | Last Revised: April 4, 2025

Purpose of This Notice

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.

Who Will Follow This Notice

This notice applies to all employees, staff, and other personnel of Jerry Hsieh, M.D., including:

• Any health care professional authorized to enter information into your health record
• All employees, staff, and personnel
• Volunteer group members who assist you while at our practice

How We May Use and Disclose Medical Information About You

1. Disclosure at Your Request

We will disclose your health information when you provide us with written authorization to do so. You may revoke your authorization at any time in writing.

2. For Treatment

We may use your medical information to provide you with medical treatment and services. We may disclose medical information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you. Different departments of our practice may share medical information about you to coordinate your care. We may also disclose medical information about you to outside facilities for continuing care.

3. For Payment

We may use and disclose your medical information to bill and collect payment for services provided to you. We may disclose information to your health plan, insurance company, or other practitioners involved in your care for payment purposes.

4. For Health Care Operations

We may use and disclose your medical information for health care operations, including quality review, staff performance evaluation, business planning, and administrative services. This may involve sharing information with outside companies that perform services for us.

5. Fundraising Activities

We may contact you to raise money for clinic operations and expansion. You have the right to opt out of receiving fundraising communications.

6. Marketing and Sale

Most marketing uses of your health information require your written authorization.

7. Individuals Involved in Your Care

We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also notify authorized persons during disaster relief efforts.

8. Research

We may use and disclose your medical information for research projects, subject to special approval processes that protect patient privacy.

9. As Required by Law

We will disclose your medical information when required to do so by federal, state, or local law.

10. Public Health Activities

We may disclose your medical information for public health activities to:

• Prevent or control disease, injury, or disability
• Report births and deaths
• Report child abuse or neglect
• Notify people about recalls of products they may be using
• Alert people who may have been exposed to a disease or at risk of contracting or spreading a disease

11. Health Oversight Activities

We may disclose medical information to health oversight agencies for activities authorized by law, such as audits, investigations, inspections, and licensure.

12. Lawsuits and Disputes

We may disclose medical information about you in response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process.

13. Law Enforcement

We may release medical information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process.

14. National Security and Intelligence Activities

We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

15. Protective Services for the President and Others

We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state.

16. Inmates

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.

Your Rights Regarding Medical Information About You

Right to Inspect and Copy

You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy your medical information, you must submit your request in writing to our Privacy Officer. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice. To request an amendment, submit your request in writing to our Privacy Officer.

Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures" - a list of certain disclosures we made of medical information about you. To request this list, submit your request in writing to our Privacy Officer.

Right to Request Restrictions

You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. We are not required to agree to your request, except in certain situations where you have paid out of pocket in full.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our office and on our website.

Complaints

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 and Human Services. To file a complaint with our practice, contact our Privacy Officer at:

You will not be penalized for filing a complaint.