SYHealth HIPAA Notice of Privacy Practices ENG June 2020 - Page 3

corrected record in our records. • The record is accurate and complete. If we deny your request to correct your medical information we will tell you why in writing within 60 days. If we grant the request, we will make the correction and distribute the correction to the appropriate individuals and any whom you would like to receive the corrected information. • Addendum: To submit an addendum, the addendum must be made in writing and submitted to the Medical Records Department - SYHealth – 1601 Precision Park Lane, San Diego, CA 92173. An addendum must not be longer than 250 words per alleged incomplete or incorrect item in your record. • Accounting of “non-routine” uses and disclosures: You have the right to receive a list of certain disclosures we have made of your Health Information. To request this accounting of disclosures, you must submit your request in writing to the Medical Records Department - SYHealth - 1601 Precision Park Lane, San Diego, CA 92173. Your request must state a time period that may not be longer than the six previous years. We must provide the accounting within 60 days. The accounting must include: • Date of each disclosure. • Name and address of the organization or person who received the PHI. • Brief description of the information disclosed. • Brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, in lieu of such statement, a copy of your written authorization or copy of the written request for disclosure. The first accounting in any 12-month period is free. Thereafter, we reserve the right to charge a reasonable, cost-based fee. • Right to Revoke Your Authorization: You may revoke (take back) any written authorization obtained by us for use and disclosure of your PHI, except to the extent that we have taken action in reliance upon it. Your revocation must be in writing and sent to the Medical Records Department - SYHealth - 1601 Precision Park Lane, San Diego, CA 92173 or to whoever is indicated on your authorization. • Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. To request a restriction, you must make your request in writing to the Medical Records Department - SYHealth, 1601 Precision Park Lane, San Diego, CA 92173. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, only to you and your spouse. We are not required to agree to your request except in the limited circumstance described below. If we do agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency care. We are required to agree to a request not to share your information with your health plan if the following conditions are met: 1. We are not otherwise required by law to share the information; SYHealth | HIPAA - NPP 2