Privacy Policy
NOTICE OF PRIVACY PRACTICES
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
DEFINITION OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION:
"Individually Identifiable Health Information" means any information, including demographic information, collected from an individual that:
is created or received by a medical practice, its healthcare providers, employees, or business associates;
relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
identifies the individual, or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.
Individually Identifiable Health Information includes, but is not limited to:
Names;
All geographic subdivisions smaller than a state, including street address, city, county, precinct, and zip code;
All elements of dates (except year) directly related to an individual, including birth date, admission date, discharge date, and date of death;
Telephone numbers;
Fax numbers;
Email addresses;
Social Security numbers;
Medical record numbers;
Health plan beneficiary numbers;
Account numbers;
Certificate/license numbers;
Vehicle identifiers and serial numbers, including license plate numbers;
Device identifiers and serial numbers;
Web Universal Resource Locators (URLs);
Internet Protocol (IP) address numbers;
Biometric identifiers, including fingerprints and voiceprints;
Full-face photographic images and any comparable images; and
Any other unique identifying number, characteristic, or code.
This definition is consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), its implementing regulations, and applicable California state laws, including but not limited to the California Confidentiality of Medical Information Act (CMIA) and the California Consumer Privacy Act (CCPA), as amended by the California Privacy Rights Act (CPRA), which may impose additional or more stringent privacy requirements. Where California law provides greater privacy protections or privacy rights than HIPAA, this Medical Practice will follow California law.
OUR COMMITMENT TO YOUR PRIVACY:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important information:
how we may use and disclose your IIHI
your privacy rights in your IIHI
our obligations concerning the use and disclosure of your IIHI
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will always post a copy of our current Notice in our office in a visible location, and you may request a copy of our most current Notice at any time.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Dobro Consultative Medicine
Attn: Privacy Officer
2342 Shattuck Ave #873
Berkeley, CA 94704
WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS:
The following categories describe the different ways in which we may use and disclose your IIHI, unless you object:
Treatment. Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you, or we might disclose your IIHI to a pharmacy when we order a prescription for you. We may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may, with your express or implied consent, disclose your IIHI to others who may assist in your care, such as other healthcare providers, your spouse, your children or your parents.
Payment. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may use and disclose your IHII to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services and items.
Health Care Operations. Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your IIHI to evaluate the quality of care you received from us, to develop protocols and clinical guidelines, to develop training programs, and to aid in credentialing, medical review, legal services and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.
Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind you of an appointment.
Treatment Options. Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.
Health-Related Benefits and Services. Our practice may use and disclose your IIHI to inform you of health-related benefits or services that may be of interest to you.
Release of Information to Family/Friends. Our practice may release your IIHI to a friend or family member to whom you have given us permission to release that information, to someone that is actively and explicitly involved in your care, or to someone who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information and we may assume that we can release this information to the babysitter because that person was actively present at your child’s appointment.
Disclosures Required by Law. Our practice will use and disclose your IIHI when we are required to do so by federal, state, or local law.
USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
Public Health Risks. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
maintaining vital records, such as births and deaths
reporting child abuse or neglect
preventing or controlling disease, injury, or disability
notifying a person regarding potential exposure to a communicable disease
notifying a person regarding a potential risk for spreading or contracting a disease or condition
reporting reactions to drugs or problems with products or devices
notifying individuals if a product or device they may be using has been recalled
notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
Health Oversight Activities. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:
regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
concerning a death we believe has resulted from criminal conduct
regarding criminal conduct at our offices
in response to a warrant, summons, court order, subpoena or similar legal process
to identify/locate a suspect, material witness, fugitive or missing person
in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs.
Organ and Tissue Donation. Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
Research. Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your IIHI is being used only for the research and (iii) the researcher will not remove any of your IIHI from our practice; or (c) the IIHI sought by the researcher only relates to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the IIHI of the decedents.
Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
National Security. Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
Inmates. Our practice may disclose your IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/ or (c) to protect your health and safety or the health and safety of other individuals.
Workers’ Compensation. Our practice may release your IIHI for workers’ compensation and similar programs.
YOUR RIGHTS REGARDING YOUR IIHI:
The health and billing records we maintain are the physical property of Dobro Consultative Medicine. The information in it, however, belongs to you. You have a right to:
Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to the Privacy Officer, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in writing to the Privacy Officer. Your request must describe in a clear and concise fashion:
the information you wish restricted;
whether you are requesting to limit our practice’s use, disclosure or both; and
to whom you want the limits to apply.
Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to the Privacy Officer in order to inspect and/or obtain a copy of your IIHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and copy; or (d) not created by our practice.
Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment or operations purposes. Use of your IIHI as part of the routine patient care in our practice is not required to be documented (for example, the doctor sharing information with the nurse). In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer.
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact:
Dobro Consultative Medicine
Attn: Privacy Officer
2342 Shattuck Ave #873
Berkeley, CA 94704
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note: we are required to retain records of your care.
G. MINORS' HEALTH INFORMATION AND PARENTAL ACCESS RIGHTS
We respect the privacy rights of minors while recognizing the legal rights of parents and guardians to access certain health information about their minor children. This section outlines how we handle minors' health information and parental access rights in accordance with California law.
Parental Access to Minor's Health Information. Parents and legal guardians generally have the right to access their minor child's health information and to authorize the use and disclosure of such information, except as limited by California law.
Limitations on Parental Access. Under California law, parental access to a minor's health information may be limited in the following circumstances:
When a minor has consented to their own care and parental consent is not legally required;
When a minor has the legal right to consent to care and has consented to such care, including but not limited to reproductive health services, sexually transmitted infection testing and treatment, mental health treatment, substance abuse treatment, or sexual assault treatment;
When the healthcare provider determines that parental access would have a detrimental effect on the provider's professional relationship with the minor patient, the minor's physical safety, or the minor's psychological well-being;
When the minor is 12 years of age or older and the healthcare provider determines the minor is mature enough to participate intelligently in their own medical treatment; or
As otherwise provided by California law.
3. Minor Consent and Confidentiality Rights. California law permits minors to consent to certain healthcare services without parental knowledge or consent, including but not limited to:
Reproductive health services, including contraception and pregnancy-related care;
Testing and treatment for sexually transmitted infections;
Mental health treatment (outpatient) for minors 12 years or older;
Substance abuse counseling and treatment; and
Sexual assault diagnosis and treatment.
4. Confidentiality Protections. When a minor consents to their own care as permitted by California law, we will maintain the confidentiality of the minor's health information related to such care and will not disclose such information to parents or guardians without the minor's written authorization, except as required by law or in emergency situations.
5. Communication with Minors. We will communicate directly with minor patients regarding their healthcare when appropriate based on the minor's age, maturity, and the nature of the healthcare services provided. For healthcare services to which a minor has legally consented, communications regarding such services will be directed to the minor rather than the parent or guardian, unless the minor requests otherwise or emergency circumstances require parental notification.
6. Electronic Access to Minor's Health Information. Parents or guardians may be granted electronic access to their minor child's health information through our patient portal or other electronic means, subject to the limitations described in this section. Electronic access may be restricted for information related to services for which the minor has provided legal consent or as otherwise required by California law.
Again, if you have questions regarding this notice or our health information privacy policies, please contact the Privacy Officer listed above.
Privacy Policy Explanation
At Dobro Consultative Medicine, we are committed to protecting your privacy. Your health information is personal and sensitive, and it is protected by federal and California law. This summary explains—clearly and simply—how your information may be used, when it may be shared, how it is protected, and the rights you have as a patient.
This document is a patient-friendly summary of our official Notice of Privacy Practices, which complies with the Health Insurance Portability and Accountability Act (HIPAA) and applicable California privacy laws, including laws that provide additional protections beyond HIPAA.
What Information is Protected?
Your protected health information includes any information that identifies you and relates to your health or care. This may include your name, contact information, medical history, diagnoses, test results, prescriptions, billing records, photographs, and electronic data. When California law provides greater privacy protection than federal law, we follow the stricter standard.
How We Use and Share Your Health Information
We use your health information to give you excellent care. This includes diagnosing and treating illness, coordinating your care with other professionals, ordering tests or prescriptions, and following up on your progress. We may also use your information to manage clinic operations, such as quality improvement, staff training, and record keeping. If applicable, we may use it for billing or administrative purposes. Dobro Consultative Medicine will only share the minimum necessary information to perform these functions. Your information may also be shared—with your consent or as permitted by law—with trusted professionals involved in your care, such as labs, pharmacies, or specialists. With your permission—or when someone is clearly involved in your care—we may share relevant information with family members, friends, or caregivers. You may restrict or revoke this sharing at any time.
Special Situations Where Information May Be Shared
In certain cases, we may share information without your written authorization when required or permitted by law.
Examples include:
Reporting communicable diseases or reactions to medications.
Responding to legal requests such as subpoenas or court orders.
Working with health oversight agencies (for example, audits or compliance reviews).
Reporting suspected abuse or neglect.
Responding to law enforcement requests or emergencies involving public safety.
Assisting with organ donation, medical research (under strict conditions), or workers’
compensation programs.
Outside of these limited cases, we will always ask your permission before sharing your health information.
Minors’ Privacy Rights (California Law)
California law allows minors to consent to certain healthcare services—such as reproductive health care, STI testing and treatment, certain mental health services, substance use treatment, and sexual assault care—without parental consent.
When a minor legally consents to their own care:
Information related to that care is kept confidential
Parents or guardians may not have access unless authorized by the minor or required by law
Electronic portal access may be limited to protect the minor’s privacy
We follow California law and act in the best interests of minor patients while respecting parental rights where applicable.
Your Rights as a Member
You have important rights when it comes to your health information:
Access and Copies: You can request a copy of your medical records or ask that they be sent to another provider.
Amendments: You can ask us to correct or add to information you believe is incomplete or inaccurate.
Restrictions: You can request limits on how we share your information or who can access it.
Confidential Communications: You can ask us to contact you in a specific way—such as by phone, email, or secure text—or at a specific location.
Accounting of Disclosures: You can request a list of certain disclosures we’ve made that weren’t related to treatment, payment, or clinic operations.
Authorization for Other Uses: We will obtain your written authorization before using or disclosing your information for purposes not described in this notice, and you may revoke that authorization at any time.
Paper Copies: You can request a printed copy of our full privacy notice at any time.
If you’d like to exercise any of these rights, simply contact our Privacy Officer—we’ll walk you through the process.
How We Protect Your Information
We take your privacy seriously. Dobro Consultative Medicine uses secure electronic systems, encrypted communication, and internal safeguards to keep your health information safe. Only clinicians and staff directly involved in your care or clinic operations can access your records. While we take every reasonable measure to protect your data, no system can be guaranteed to be completely free from risk. By receiving care through Dobro Consultative Medicine, you acknowledge this small but inherent risk and understand that absolute security cannot be guaranteed.
If You Have Concerns or Questions
If you ever have questions about how your information is handled—or believe your privacy
rights have been violated—you can contact our Privacy Officer directly:
Dobro Consultative Medicine
Attn: Privacy Officer
Street Address: 2342 Shattuck Ave #873
City, St, Zip: Berkeley CA 94704
Email: admin@sarahdobromd.com
You can also file a complaint with the U.S. Department of Health and Human Services. You will never be penalized for filing a complaint.
You can request the full Notice of Privacy Practices at any time by contacting our office or visiting our website.