San Gabriel Health Clinic

Notice of Privacy Practices (NPP)

This Notice Describes How Medical Information About You May Be Used And Shared And How You Can Get This Information Please Review It

San Gabriel Health Clinic is required by law to protect the privacy of the information we have about you.  We must give you this Notice of how the law allows us to use and share your health information and what your rights are.  This notice will also be used for all programs pay to San Gabriel Health Clinic to provide medical services to all patients.

How We May Use And Share Information About You

We use this information and share it with others for the following reasons:

  • For Payment: San Gabriel Health Clinic and its approved payment programs, approve and pay for health care for your medical care that San Gabriel Health submits to them

  • For health care operations: All Programs with in the San Gabriel Health Clinic may use information in your health record in audits or fraud investigations, or for planning and general administration.

Some Other Ways We May Share Your Information

The law also allows all Health Care Programs under the San Gabriel Health Clinic to use or give out information we have about you for the following purposes:

  • For legal and administrative reasons, such as lawsuits

  • For legal reasons, such as workers’ compensation

  • To agencies that operate the health care system, for audits or investigations

  • To the federal government when it is checking on how we are meeting privacy laws

  • To gather information that can no longer be traced back to you

We may give out health information about you to organizations, such as EDS, Family Pact, CHDP and others which help us in our programs.  If we do, we will make sure that they protect the privacy of information we share with them.

Some state laws limit sharing information listed above.  For example, there are special laws, which protect information about HIV/AIDS status, mental health treatment, disabilities, and drug and alcohol abuse care.  We will obey these laws.

When Written Permission Is Needed

Before the San Gabriel Health Clinic will use your personal information for any reason not listed above, it will get written permission from you.  If you do give us written permission to use or share your information for other reasons, you may take back your permission in writing at any time.

What Are Your Privacy Right Under The Laws

You have the right to:

  • Ask us not to use or share your personal health care information in the ways described above.  We may not be able to agree with your request.

  • Ask us to contact you only in writing or at a different address, post office box, or telephone number. We will accept reasonable requests when necessary to protect your safety.

  • To see and get a copy of information with the San Gabriel Health Clinic has about you. You may have someone else see and get a copy of the information the San Gabriel Health Clinic has about you.  You may be charged a fee for the costs of copying and mailing records. We may keep you from seeing all or parts of your record for reasons allowed by law. If we do, we will give you information on how to appeal of our decision.

  • To change the records if you believe some information we have about you is wrong.  We may deny your request if the information is not made of kept by us, or is already correct and complete.  If your request is denied, you may send in a letter disagreeing with our decision that will be kept with your records.

  • You have the right to request a list of the times when we have shared your health information.  The list will tell you what information we shared, with whom, when, and for what reasons the information was shared.  The list will not include when we gave information to you, or with your permission, or shared it for treatment, payment, or health care operations.

  • You have a right to get a written copy of this Notice of Privacy Practices when you request it in writing.

How do you contact us to use your rights or to complain?

If you want to use any of the privacy rights explained in this Notice, or, if you believe that we have not protected you privacy and wish to complain, please write to us at:  San Gabriel Health Clinic, 2630 San Gabriel Blvd., Suite 105, Rosemead, CA 91770-5240.


You may file a complaint by calling or writing the Privacy Officer, CA Department of Health Service, at the address and telephone number above. You may also contact the Secretary of the Department of Health and Human Service at 200 Independence Avenue, S. W., Room 615 F, Washington, D.C.20201. Or may call the U.S. Office of Civil Right at 866-OCR-PRIV (866-627-7748) or 866788-4989 TTY

The San Gabriel Health Clinic cannot take away your health care benefits nor do anything to hurt you in any way if you file a complaint or use of the privacy rights in this Notice.

If you have any questions about this Notice, and want further information, please contact the Privacy Officer, California Department of Health Services, at the address and phone number above.