HIPAA Notice of Privacy Practices
of
The Organized Health Care Arrangement of Allied Anesthesia Medical Group, Inc.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (Notice) describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare 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. Protected health information (PHI) about you is maintained as a written and/or electronic record of your contacts or visits for healthcare services. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present, or future physical or mental health condition and related healthcare services.
Your Rights Under the Privacy Rule
Following is a statement of your rights, under the HIPAA Privacy Rule, in reference to your PHI.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices – We are required by law to maintain the privacy of your PHI and abide by the terms of this Notice. We may change the terms of this Notice at any time. Any revised Notice would be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice. You may request that a revised copy be sent to you in the mail or electronically by submitting a request to us via our contact information listed at the end of this Notice. A copy of our current Notice is posted on our website at www.alliedanesthesia.com.
You have the right to authorize other use and disclosure – This means you have the right to authorize any use or disclosure of PHI that is not specified within this Notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, regarding how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.
You have the right to inspect and copy your PHI – This means you may inspect and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI – This means you may ask us, in writing, not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket.
You have the right to request an amendment to your PHI – This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.
You have the right to request a disclosure accountability – This means that you may request a listing of disclosures of your PHI that we have made to entities or persons outside of our practice.
You have the right to receive a privacy breach notice – You have the right to receive written notification if we discover there has been a breach of your unsecured PHI and determined, through a risk assessment, that notification is required. If you have questions regarding your privacy rights, please feel free to contact us.
You have the right to choose someone to act for you – If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
How We May Use or Disclose PHI
The following are examples of uses and disclosures of your PHI that we are permitted to make. These examples are not meant to be exhaustive but to describe possible types of uses and disclosures.
Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions.
Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our practice, for fundraising activities, or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such special notice will include instructions for opting out.
If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you a clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your part 2 information.
Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you (e.g., making a determination of eligibility or coverage for insurance benefits).
Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.
Health Information Organization – The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.
To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person, that you identify, your PHI that directly relates to that person’s involvement in your healthcare or payment for your healthcare. If you bring someone with you into a treatment room, you are hereby notified that you will have identified that person to us as being so involved in your care, and we may discuss your PHI in their presence in front of you. If you are unable to agree or object to such a disclosure, we may disclose such information, as necessary, if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services.
Based upon Your Written Authorization
Other uses and disclosures of your PHI will be made only with your signed, written authorization, unless otherwise permitted or required by law or as described below. For example, we will not sell your PHI or use or disclose it for marketing purposes without getting a signed authorization from you to do so. In all cases, including those listed herein, to the extent we have substance use disorder records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent, or (2) a court order and a subpoena.
You Have the Right to Revoke Your Authorization
You may revoke your authorizations at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization.
This Notice of Privacy Practices Applies Jointly to the Following Organizations
Various Allied Anesthesia entities are part of an Organized Health Care Arrangement, referred to as the Organized Health Care Arrangement of Allied Anesthesia Medical Group, Inc. (AAMG OHCA), which is an organized system of affiliated healthcare providers who participate in joint activities and share PHI with each other to carry out treatment, payment, or healthcare operations. The AAMG OHCA is comprised of the below listed entities and any other covered entities (as defined under HIPAA) that now, or in the future, are affiliated with Allied Anesthesia Medical Group as well as their healthcare provider employees, volunteers, contractors, students, agents, and other members of their workforce who are healthcare providers:
· Allied Anesthesia Medical Group, Inc.
· Fullerton Allied Anesthesia, a California general partnership
· Orange Allied Anesthesia, a California general partnership
· Upland Allied Anesthesia, a California general partnership
Contacting Us or Making Complaints
For questions about this Notice, your rights, or to make a complaint, please reach out to us at:
Privacy Officer of AAMG OHCA
400 N Tustin Ave. Ste 270
Santa Ana, CA 92705
corporate@alliedanesthesia.com
We will not retaliate against you for filing a complaint.
You may also file a complaint with the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. The U.S. Department of Health & Human Services Office for Civil Rights can be reached via phone at 1-877-696-6775; via U.S. mail at 200 Independence Avenue, S.W., Washington, D.C. 20201; or by visiting https://www.hhs.gov/hipaa/filing-a-complaint
Notice of Privacy Practices Last Updated: February 16, 2026