THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Introduction At Clínica Romero we are committed to treating and using protected health information about you responsibly. This Notice of Privacy Policies describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice applies to all protected health information as defined by federal regulations. Understanding Your Health Record/Information Each time you visit Clínica Romero, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or 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 in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others 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 Clínica Romero, 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 in 45 CFR 164.528,
- Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
- Request communications of your health information by alternative means or at alternative locations,
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
Our Responsibilities Clínica Romero is required to:
- Maintain the privacy of your health information,
- Provide you with this notice as to our legal duties and privacy practices with 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, and
- Accommodate reasonable requests 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 disclosure of 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 Clínica Romero (213) 989-7700. If you believe your privacy rights have been violated, you can file a complaint with Clínica Romeroor with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below: 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 Examples of Disclosures for Treatment, Payment and Health Operations We will use your health information for treatment. For example: Information obtained by a nurse, physician, or other members of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you’re discharged from this health center. We will use your health information for payment. For example:, A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We will use your health information for regular health operations. For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information In your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide. Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information. Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. Communication with family: Health professionals, using their best judgment, may disclose to a family member, another relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties. Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Fund-raising: We may contact you as part of a fund-raising effort. Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement. Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law. Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
|English||ATTENTION: If you speak any of the languages below, language assistance services, free of charge, are available to you. Please notify the patient service representative.|
|Spanish||ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.|
|Vietnamese||CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.|
|Tagalog||PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.|
|Korean||주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.|
|Armenian||ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ:|
|Persian||توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما|
|Russian||ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.|
|Arabic||ملاحظة: إذا كنت تتحدث اللغة العربية، فإن خدمة الترجمة متوفرة مجاناً.|
|Punjabi||ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ।|
|Mon-Khmer, Cambodian||ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។|
|Hmong||LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj.|
|Hindi||ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं।|
Sliding Fee Scale
Clínica Romero will see all patients regardless of the ability to pay. We offer a Sliding Fee discount based on family size and income. Please ask for more information at the nearest registration desk. We will be happy to help you.
Clínica Romero atenderá a todos los pacientes independientemente de su capacidad de pago. Ofrecemos un descuento de cargo variable según el tamaño y los ingresos de la familia. Solicite más información en la mesa de registro del centro más cercano. Estaremos encantados de brindarle ayuda.
Paglilingkuran ng Clínica Romero ang lahat ng pasyente nang hindi alintana ang kakayahan nilang magbayad. Nagbibigay kami ng diskwentong Sliding Fee batay sa laki at kita ng pamilya. Mangyaring humingi ng higit pang impormasyon sa pinakamalapit na registration desk. Ikalulugod naming tulungan ka.
ਕ੍ਲਿਨਿਕਾ ਰੋਮੇਰੋ (Clínica Romero) ਭੁਗਤਾਨ ਕਰਨ ਦੀ ਸਮਰੱਥਾ ਦੀ ਪਰਵਾਹ ਕੀਤੇ ਬਿਨਾ ਸਾਰੇ ਮਰੀਜ਼ਾਂ ਨੂੰ ਦੇਖੇਗੀ। ਅਸੀਂ ਪਰਿਵਾਰ ਦੇ ਆਕਾਰ ਅਤੇ ਆਮਦਨੀ ਦੇ ਆਧਾਰ ਤੇ ਅਸਥਾਈ ਫੀਸ ਛੋਟ ਪੇਸ਼ ਕਰਦੇ ਹਾਂ। ਕਿਰਪਾ ਕਰਕੇ ਨਜ਼ਦੀਕੀ ਰਜਿਸਟ੍ਰੇਸ਼ਨ ਡੈਸਕ ਤੇ ਹੋਰ ਜਾਣਕਾਰੀ ਲਈ ਪੁੱਛੋ। ਅਸੀਂ ਤੁਹਾਡੀ ਮਦਦ ਕਰਕੇ ਖੁਸ਼ ਹੋਵਾਂਗੇ।
无论病人的支付能力，Clínica Romero 都会接诊病人。 根据家庭规模和收入，我们提供变动费用折扣。 请前往最近的登记处了解详细信息。 很高兴为您服务。
Discrimination is Against the Law
Clínica Romero complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The U.S. Department of Health and Human Services (HHS) nondiscrimination notice lists the services available to you and how to file a complaint if you feel that Omni Family Health has failed to provide these services or discriminated in another way. Clínica Romero:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information is written in other languages
If you need these services, please contact Clínica Romero at (213) 989-7700. If you believe that Clínica Romero has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a complaint with our corporate office at 1-800-300-6664. You can file a grievance in person at or by mail at 123 South Alvarado St. Los Angeles CA 90033, fax, or email. If you need help filing a grievance, staff are available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)
Save yourself some time! Clínica Romero is happy to fill out forms. Providers require two weeks for completion.