The privacy of our members is very important to us.
This NOTICE OF PRIVACY PRACTICES defines our stringent privacy practices.
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NOTICE OF PRIVACY PRACTICES
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Vantage Medical Group (VMG) must use and disclose your health information to
provide information:
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To you or someone who has legal right to act for you (your personal
representative)
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To the secretary of the Department of Health and Human Services, if necessary,
to make sureyour privacy is protected
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When required by law.
VMG has the right to use and disclose health information to pay for your health
care services and operate our business. For example, we may use your health
information:
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For Payment. To process claims for health care services you receive.
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For Treatment. VMG may disclose health information to your doctors or
hospitals to help them provide medical care to you.
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For Health Care Operations. VMG may use or disclose health information
as necessary to operate and manage our business and to help manage your health
care coverage. For example, VMG might talk to your doctor to suggest wellness
programs that could help improve your health.
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For Notification of Authorization Status. We may use health information
to contact you in regard to status of authorization requested with providers
who provide medical care to you.
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For Eligibility Verification. We may disclose to a health care provider
your eligibility status.
VMG may use or disclose your health information for the following purposes
under limited circumstances:
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For Public Health Activities such as reporting disease outbreaks.
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For Recording Victims of Abuse, Neglect or Domestic Violence to
government authorities, including a social service or protective service
agency.
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For Compliance and Oversight Activities such as government audits and
fraud and abuse investigations.
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For Judicial or Administrative Proceedings such as in response to a
court order, search warrant or subpoena.
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For Law Enforcement Purposes such as providing limited information to
locate a missing person.
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To Avoid a Serious Threat to Health or Safety by, for example,
disclosing information to public health agencies.
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For Workers Compensation including disclosures required by state workers
compensation laws of job related injuries.
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HIGHLY CONFIDENTIAL INFORMATION
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Federal and applicable state laws may require special privacy protections for
highly confidential information about you. "Highly confidential information"
may include confidential information under Federal law governing alcohol and
drug abuse information as well as state laws that often protect the following
types of information:
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HIV/AIDS
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Mental health
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Genetic tests
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Alcohol and drug abuse
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Sexually transmitted diseases and reproductive health information
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Child or adult abuse or neglect, including sexual assault.
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WHAT ARE YOUR RIGHTS
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The following are your rights with respect to your health information.
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You have the right to ask to restrict uses or disclosures of your information
for treatment, payment, or health care operations. You also have the right to
ask to restrict disclosures to family members or to others who are involved in
your health care or payment for your health care. We may also have policies on
dependent access that may authorize certain restrictions. Please note that
while we try to honor your request and will permit requests consistent with its
policies, we are not required to agree to any restrictions.
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You have the right to ask to receive confidential communications of information
in a different manner or at a different place (for example, by sending
information to a P.O. Box instead of your home address)
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You have the right to see and obtain a copy of health information that may be
used to make decisions about you such as claims and case or medical management
records. You also may receive a summary of this health information. You must
make a written request to inspect and copy your health information. In certain
limited circumstances, we may deny your request to inspect and copy your health
information.
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You have the right to ask to amend information we maintain about you if you
believe the health information about you is wrong or incomplete. If we deny
your request, you may have a statement of your disagreement added to your
health information.
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EXCERCISING YOUR RIGHTS
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Contact your Health Plan. If you have any questions about this notice or
want to exercise any of your rights, please call telephone number on your ID
card.
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Filing a Complaint. If you believe your privacy rights have been
violated, you may file a complaint with us at the address:
Vantage Medical Group
Compliance Officer
P.O. Box 85909
San Diego, CA 92186-5909
You may also notify the Secretary of the U.S. Department of Health and Human Services of your
complaint. We will not take any action against you for filing a complaint.
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