Notice of Privacy Practices for Protected Health Information (HIPAA) Effective Date: April 14, 2003

Your Health Information Rights and Our Responsibilities


City of Berkeley Public Health Division
1947 Center Street, Second Floor, Berkeley, CA 94704
Map to Public Health Division

510-981-5300 (Phone)   510-981-5395 (Fax)   510-981-6903 (TDD)
PublicHealth@cityofberkeley.info

Monday - Friday: 8:00am - 5:00pm



Your Health Information Rights

The health and billing records we maintain are the physical property of public health. You have the following rights with respect to your Protected Health Information:

  1. Right to request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office—we are not required to grant the request but we will comply with any request granted;

  2. Right to confidential communication by requesting that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we give you upon request;

  3. Right to obtain a paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office;

  4. Right to inspect and copy your health record and billing record—you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request and; appeal a denial of access to your protected health information except in certain circumstances;

  5. Right to request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request.  The clinician or designee is not required to make such amendments.  You may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;

  6. Right to receive an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request.  An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care; and,

  7. Right to file complaints without fear of retaliation.  By law, the City cannot penalize you for filing a complaint.  If you believe that the City has violated your privacy rights, you may file a complaint during normal business hours with the Complaint Officer where you received services or with the U.S. Department of Health and Human Services.

Our Responsibilities

Public Health is required to:

  • Maintain the privacy of your health information as required by law;

  • Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;

  • Abide by the terms of this Notice;

  • Notify you if we cannot accommodate a requested restriction or request; and

  • Accommodate your reasonable requests regarding methods to communicate health information with you.

  • Accommodate your request for an accounting of disclosures.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain.  If our information practices change, we will amend our Notice.  You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy. 

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