Patient Portal

Notice of Privacy Practices


Notice of Privacy Practices Form in English

Notice of Privacy Practices- Form in Spanish

About This Notice

We are required by law to maintain the privacy of Protected Health Information and to give you this Notice explaining our privacy practices with regard to that information. You have certain rights – and we have certain legal obligations – regarding the privacy of your Protected Health Information, and this Notice also explains your rights and our obligations. We are required to abide by the terms of the current version of this Notice.

What is Protected Health Information? 

“Protected Health Information” is information that individually identifies you and that we create or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse and that relates to (1) your past, present, or future physical or mental health or conditions, (2) the provision of health care to you, or (3) the past, present, or future payment for your health care.

How We May Use and Disclose Your Protected Health Information 

We maintain and share health and financial related records about you in both paper and electronic form.  We use this information and disclose it to others for the following purposes:

Treatment.  We use your health information to provide health care to you and to coordinate your health care with other providers, and we disclose it to other health care providers electronically to enable them to provide health care services to you.  For example, if we refer you to a specialist physician we send all or a part of your health record to the specialist to assist him or her in evaluating and treating you.  If your provider is a Participant of a Health Information Exchange your records will visible to other providers that are Participants in the Exchange.

Payment.  We use and disclose your health information to obtain payment for health care services we provide to you, including determining your eligibility for benefits.  For example, we may send a claim to your insurer that contains information about the services we provided to you, or we may send a bill to a family member who is responsible for paying for your care.

Health care operations.  We use and disclose your health information as necessary to enable us to operate our medical practice.  For example, we use our patients’ claims information for our internal financial accounting activities, and we review health records to ensure quality.

We also disclose health information to our Business Associates who assist us in these functions, but we obtain a confidentiality agreement from them before we make such disclosures for payment or operational purposes.  For example, companies that provide or maintain our computer systems may have access to computerized health information in the course of providing services to us.

Contacting you.  We may contact you to provide appointment reminders or information about treatment options available to you.  We may also contact you about other health-related services that may interest you. 

Others involved in your care.  Unless you object, we may disclose medical information to a friend or family member who is involved in your care, to the extent we judge necessary for their participation.

Other Disclosures.  We may disclose health information without your authorization to government agencies and private individuals and organizations in a variety of circumstances in which we are required or authorized by law to do so.  Here are the general kinds of disclosures we may be required or allowed to make without your authorization:

Limitations.   In some circumstances, your health information may be subject to restrictions that may limit or preclude some uses or disclosures described above.  For example, government health benefit programs may limit the disclosure of health information for purposes unrelated to the program.  In addition, there are special restrictions on the disclosure of health information relating to HIV/AIDS status, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment.  We comply with these restrictions in our use of your health information.

Authorization.  Except as described above, we will not permit other uses and disclosures of your health information without your written authorization, which you may revoke at any time in the manner described in our authorization form.

Your Rights Regarding Your Protected Health Information 

You have the following rights, subject to certain limitations, regarding your Protected Health Information:

The foregoing is a general statement of your rights.  They are subject to all limitations permitted or required by law.

How do I exercise these rights?  You can exercise any of your rights by sending a written request to our Privacy Official at the address below. We encourage you to call our office and speak to us if you have any questions or concerns.

Clinic Manager, Santa Cruz Women’s Health Center, 250 Locust Street, Santa Cruz, CA 95060. Call 831-427-3500

To file a complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201. Call (202) 619-0257 (or toll free (877) 696-6775) or go to the website of the Office for Civil Rights,, for more information. There will be no retaliation against you for filing a complaint.