Notice of Privacy Practices (HIPAA)

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.

Effective Date: January 1, 2025

Who We Are

Seen Health San Gabriel Valley, LLC ("Seen Health," "we," "us," or "our") is a Program of All-Inclusive Care for the Elderly (PACE) organization. We are required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of Privacy Practices, and to follow the terms of the notice currently in effect.

Your Protected Health Information

Protected health information (PHI) is information that identifies you and relates to your past, present, or future physical or mental health condition, the provision of health care to you, or payment for health care services. We collect and maintain PHI so that we can provide you with quality care and comply with certain legal requirements.

How We May Use and Disclose Your PHI

We may use and disclose your PHI for the following purposes:

• Treatment: We may use or disclose your PHI to provide, coordinate, or manage your health care and related services. This includes coordinating or managing your care with third-party providers and specialists involved in your care.

• Payment: We may use or disclose your PHI to obtain payment for health care services we provide to you, including billing and collection activities and utilization review.

• Health Care Operations: We may use or disclose your PHI for our internal operations, including quality assessment and improvement activities, case management, care coordination, training programs, licensing, credentialing, and business planning.

• As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law.

• Public Health Activities: We may disclose your PHI for public health activities, such as reporting diseases, injuries, vital events, and conducting public health surveillance or investigations.

• Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure actions.

• Abuse, Neglect, or Domestic Violence: We may disclose your PHI to a government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence.

• Judicial and Administrative Proceedings: We may disclose your PHI in response to a court order or in certain circumstances in response to a subpoena or discovery request.

• Law Enforcement: We may disclose your PHI to law enforcement officials for certain law enforcement purposes.

• To Avert a Serious Threat to Health or Safety: We may use or disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety or the health or safety of the public or another person.

• Workers' Compensation: We may disclose your PHI as authorized by and to the extent necessary to comply with workers' compensation laws.

• Research: Under certain circumstances, we may use or disclose your PHI for research purposes, provided certain conditions are met.

• Organ and Tissue Donation: If you are an organ donor, we may disclose your PHI to organizations that handle organ procurement or transplantation.

• Coroners, Medical Examiners, and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director as necessary for them to carry out their duties.

• Military and Veterans: If you are a member of the armed forces, we may disclose your PHI as required by military command authorities.

• Correctional Institutions: If you are an inmate of a correctional institution, we may disclose your PHI to the institution or its agents for your health care, the health and safety of others, or the administration and maintenance of the safety and security of the institution.

Uses and Disclosures That Require Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes other than those described above, including:

• Marketing purposes
• Sale of your PHI
• Most uses and disclosures of psychotherapy notes

You may revoke your authorization at any time in writing, except to the extent that we have already taken action in reliance on the authorization.

Your Rights Regarding Your PHI

You have the following rights regarding PHI we maintain about you:

• Right to Access: You have the right to inspect and obtain a copy of your PHI maintained in our records. To request access, submit a written request to our Privacy Officer.

• Right to Amend: If you believe that PHI we have about you is incorrect or incomplete, you may request that we amend the information. To request an amendment, submit a written request to our Privacy Officer explaining why the amendment is needed.

• Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI that we have made. To request an accounting, submit a written request to our Privacy Officer.

• Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request, except in certain circumstances.

• Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a particular way or at a certain location.

• Right to a Copy of This Notice: You have the right to obtain a paper copy of this Notice upon request.

Changes to This Notice

We reserve the right to change the terms of this Notice at any time. The new Notice will be effective for all PHI we maintain at that time. We will make the revised Notice available on our website and at our PACE center.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer. We will not retaliate against you for filing a complaint.

U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Toll-free: 1-877-696-6775

Contact Information

Seen Health San Gabriel Valley, LLC 1839 W Valley Blvd, Alhambra, CA 91803 Phone: 1-855-832-2688 (TTY: 711)

To contact our Privacy Officer, please call 1-855-832-2688 or email privacy@seenhealth.org.

Non-Discrimination Notice

Seen Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Seen Health does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Report Fraud, Waste & Abuse

If you suspect fraud, waste, or abuse, please call our compliance hotline at 1-855-491-0733.