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.
Canby Community Clinic, formerly Pura Vida Community Clinic, keeps a record of the care we provide. This notice says how we may use and share that information, and what you can ask us to do.
How we may use and share it
- Treatment. To provide a checkup, screening, follow-up, or medicine review, and to coordinate a test or a referral.
- Payment. To bill you or a health plan, if you are using insurance.
- Clinic operations. To schedule visits, train the people who work here, and improve how the clinic runs.
We may also share information when the law requires it, for public health, for health oversight, to avert a serious threat, or for workers’ compensation. We do not sell your medical information. We do not use it for marketing unless you sign an authorization.
This website
When you submit a website form, the website server and email service send the information to the clinic office. Registration includes the demographic and insurance details you provide. Please use other contact forms only for general requests, without medical records or private health details.
Your rights
- See or get a copy of the record we keep about you.
- Ask us to correct something you think is wrong.
- Ask for a list of certain times we shared your information.
- Ask us to limit what we share. We will say yes when the law requires it.
- Ask us to contact you in a particular way, or at a particular place.
- Get a paper copy of this notice. Ask at the clinic or call us.
- File a complaint if you think your privacy was not protected. We will not retaliate.
California law, including the Confidentiality of Medical Information Act, also limits how medical information may be shared.
Our duties
We must keep your medical information private, give you this notice, and follow it. If the law requires us to tell you about a breach of unsecured medical information, we will. We may change this notice. The new notice will apply to information we already have, and we will post it here.
Complaints and questions
Privacy Officer, Canby Community Clinic, 7601 Canby Ave #6B, Reseda, CA 91335. Call (818) 674-4414 or email info@canbycc.org.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/hipaa/filing-a-complaint or 1-800-368-1019.