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                                             SAN FRANCISCO LUNG & SLEEP




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.


Understanding Your Health Record/Information


Each time you visit a hospital, physician or other healthcare provider, 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 is often referred to as your health or medical record, or private health information or PHI, 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 the nation
  • a source of data for facility 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 of what is in your record and how your health information is used to help you to:
    • ensure its accuracy
    • better understand who, what, when, where, and why others may access your health information
    • make more informed decisions when authorizing disclosure to others.


Your Health Information Rights


Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you.  You have the right to:


  • request a restriction on certain uses and disclosures of your information as provided  by 45 CFR 164.522
  • obtain a paper copy of the 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 heath information as provided in 45 CFR 164.528
  • request communications of your health information by alternative means or at alternative locations
  • revoke your authorization to use or disclose health information except to the extent that action has already been taken


Our Responsibilities


This organization is required to


  • maintain the privacy of your health information
  • provide you with a 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
  • 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.


We will not use or disclose your health information without your authorization, except as described in this notice.


For More Information or to Report a Problem


If you have questions and would like additional information, you may contact the director of health information at 415-923-3421.


If you believe your privacy rights have been violated, you can file a complaint with the director of health information management or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.


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 member of your healthcare team will be recorded in your record and used to determine the course or treatment that should work best for you.  Your physician will document in your record his or her expectations of the members of your health care team.  Members of your health care 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 health care provider with copies of various reports that should assist him or her in treating you.


We will use your health information for payment.


For example: A bill may be sent to you for a third-party payer.  The information on our 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 health care and services we provided.


Business Associates:  There are some services provided to our organization through contacts with Business Associates.  Examples include diagnostic services, certain laboratory tests, and our billing company.  When these services are contracted, we may disclose your health information to our business associates 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 sign a “business associates” agreement which requires them to protect the confidentiality of your private health information.


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, other relative, 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 the established protocols to ensure the privacy of the 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 or 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.


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.


Correctional institutions: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety or other individuals.


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.


Effective Date:  10/15/02 Revised 6/17/2011

San Francisco Lung & Sleep 

1100 Van Ness Avenue

Suite 1005

San Francisco, CA 94109

415 923-3421

415-243-8666 (Fax)


Business Hours

Mon-Fri, 9AM - 5PM

Comprehensive Programs

Patient Information

Information about appointments and directions to our practice.


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