This notice describes how medical information about you may be used and disclosed and how you may get access to this information. Please review it carefully.

At TOPA, we have always kept your health information secure and confidential. We are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We have prepared the following explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

HIPAA permits us to use or disclose your health information to those involved in your treatment. For example, we may release a copy of your laboratory report to a physician who is involved in your care.

We may use or disclose your health information in order to process the payment for your services. For example, we may send a laboratory report to your insurance company upon their request.

We may use or disclose your health information as part of our normal healthcare operations. For example, a member of our staff may enter your information into our computer.

We may use your information for the purpose of contacting you. For example, we may need to call you in order to verify information. If you are not home, we may leave our name and phone number on your answering machine or with the person who answers the phone.

We may release some or all of your health information when required by law.

Any other uses and disclosures will be made only with your written authorization.

You may request in writing that we not use or disclose your health information as described above. If you make such a request, we will let you know if we can fulfill it.

As we will need to contact you from time to time, we will use whatever address or telephone number you prefer.

You have the right to know of any uses or disclosures that we make with your health information beyond the above normal uses.

You have the right to receive a copy of your health information. To request, please contact TOPA at 805-373-8582 and complete and sign our form Request for Access to Medical Records.

You have the right to request to amend or change your health information. Give us your request in writing. We may or may not make the changes you request, but we will be happy to include your statement in your file. If we agree to the amendment, we will not remove or alter earlier documents; we will add the new information.

You have the right to receive a copy of this notice.

You may file a complaint with the U.S. Department of Health and Human Services, Office of Civil Rights, DHHS, 90 7th Street, Suite 4-100, San Francisco, CA 94103; Phone (415) 437-8310; Fax: (415) 437-8329; TDD: (415) 437-8311. You will not be retaliated against for filing such complaint. However, before filing a complaint, or for more information or assistance regarding your health information, please contact our Privacy Officer at 805-373-8582.

This notice is effective as of April 14, 2003 and we are required to abide by the terms of the Notice of Privacy Practices that are currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all health information that we maintain. You may request a written copy of the revised Notice of Privacy Practices from this office.