The Saban Free Clinic complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  The Saban Free Clinic protects confidential health care information, known as “Protected Health Information” (PHI).  Below is a summary of your privacy rights under HIPAA.  The Saban Free Clinic legal duties and privacy practices regarding your PHI are also included in this Summary Notice. 

Summary of Your Privacy Rights
The Saban Free Clinic may use and give your health information to:
• Treat you
• Get paid
• Operate health care services

The Saban Free Clinic may use and give your health information for:
• Law enforcement requests
• Judicial and administrative proceedings related to legal actions
• Healthcare fraud and abuse detection or compliance with the law
• Use by another healthcare provider treating you
• Government health oversight activities
• Reports required by law related to births, deaths or diseases
• Reports required by law related to neglect and abuse, or domestic violence
• Notifying a party about exposure to a possible communicable disease
• Use by another healthcare provider for payment to that provider
• Military, national defense and security or other governmental functions
• Workers’ compensation purposes and in compliance with related laws
• Averting a serious threat to public health and safety

You have the right to:
• Inspect or get a copy of your medical record
• Change information on your medical record if you think it is incorrect
• Get a list of persons whom The Saban Free Clinic shared your PHI
• Ask The Saban Free Clinic to limit the information it shares
• Ask for a copy of your privacy notice
• Write a letter of complaint to The Saban Free Clinic or the federal government

If you have any questions or if you wish to file a complaint, or exercise any rights listed in this Summary or the complete Notice, please contact one of The Saban Free Clinic Privacy Officers at the telephone number listed below.

Claudia Portillo                       Margarita Rodriquez                   Tunya Wall
Clinic Manager, Beverly Site     Clinic Manager, HWHC & WAC      Clinic Manager, Hollywood Site
(323) 330-1688                       (323) 337-1804                            (323) 337-1705



Revised 04/2008