THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Elite Family Medicine is required by law to protect the privacy of your health information, to give you this notice explaining our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
This notice applies at both our offices — Upland and Rancho Cucamonga — and to everyone who works here.
Your rights
Get a copy of your medical record
You can ask to see or get a copy of your medical and billing records. Ask us and we will normally respond within 30 days. We may charge a reasonable, cost-based fee.
Ask us to correct your record
If you believe something in your record is wrong or incomplete, you can ask us to amend it. We may say no, and if we do we will tell you why in writing within 60 days.
Ask for confidential communications
You can ask us to contact you in a specific way — a particular phone number, or mail sent to a different address. We will say yes to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say no if it would affect your care.
We must say yes to one request. If you pay for a service or item in full, out of your own pocket, you can tell us not to share that information with your health insurer, and we will not.
Get a list of who we have shared it with
You can ask for a list — an “accounting” — of the times we shared your health information in the six years before your request, who we shared it with, and why. Some disclosures are not included, such as those for treatment, payment and our own operations. We will provide one accounting a year for free and may charge a reasonable fee after that.
Get a paper copy of this notice
You can ask for a paper copy at any time, even if you agreed to receive it electronically. We will give you one promptly.
Choose someone to act for you
If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise these rights for you. We will verify their authority first.
Be told if your information is breached
We will notify you if a breach occurs that compromises the privacy or security of your health information.
File a complaint
You can complain if you believe your rights have been violated. See Complaints below. We will never retaliate against you for filing one.
Your choices
For certain information, you can tell us what you want us to do. If you have a clear preference, tell us and we will follow your instructions.
You can tell us whether to:
- share information with your family, close friends, or others involved in your care;
- share information in a disaster relief situation;
- include your information in a hospital directory.
If you are not able to tell us your preference — for example, if you are unconscious — we may share information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.
We never share your information for marketing purposes, and we never sell your information, unless you give us written permission.
How we typically use or share your health information
To treat you
We use your health information to care for you, and share it with others involved in your care.
For example: if we refer you to a cardiologist, we send the relevant history, test results and medication list so they are not starting from nothing.
To run our practice
We use your information to manage the practice and improve the care we give.
For example: we review records to check that the care we provide meets the standard we expect of ourselves.
To bill for your services
We use and share your information to bill and receive payment from health plans and others.
For example: we send your diagnosis and the services you received to your insurance plan so your visit can be covered.
How else we may use or share your information
We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet conditions in the law before we can share your information for these purposes.
- Public health and safety — preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
- Research — for health research, under conditions set by law.
- Complying with the law — when state or federal law requires it, including with the U.S. Department of Health and Human Services if it wants to check that we are complying with federal privacy law.
- Organ and tissue donation requests.
- Working with a medical examiner or funeral director when a person dies.
- Workers’ compensation, law enforcement, and other government requests — including for workers’ compensation claims, law enforcement purposes, and special government functions such as military and national security.
- Responding to lawsuits and legal actions — in response to a court or administrative order, or a lawful subpoena.
Information with extra protection
Some kinds of information are protected more strictly than the rest, by laws beyond HIPAA. Where those laws are stricter, we follow the stricter rule.
Substance use disorder treatment records
If you receive substance use disorder treatment from us, those records are protected by an additional federal law (42 CFR Part 2). In general we need your written consent before we can share them, including with other providers, and they generally cannot be used against you in a legal proceeding without your consent or a court order.
Reproductive health care
We will not use or share your health information for the purpose of investigating, or bringing legal action against, you or anyone else for seeking, obtaining, providing or facilitating lawful reproductive health care. If someone requests information that could relate to reproductive health care, we require a signed attestation that it will not be used for those purposes.
California law
California’s Confidentiality of Medical Information Act gives you protections in addition to HIPAA, and in several areas it is stricter. Where it is, we follow it.
Our responsibilities
- We are required by law to keep the privacy and security of your health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us in writing that we may. If you tell us we may, you can change your mind at any time — let us know in writing.
Changes to this notice
We can change the terms of this notice, and the changes will apply to all information we hold about you. The new notice will be available on request, in our offices, and on this website.
Complaints
If you believe your privacy rights have been violated, you can complain.
To us: contact our Office Manager at (909) 931-1368, or ask at the front desk at either office.
To the federal government: you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
- By mail: 200 Independence Avenue SW, Washington, D.C. 20201
- By phone: 1-877-696-6775
- Online: hhs.gov/hipaa/filing-a-complaint
We will not retaliate against you for filing a complaint. Your care will not be affected in any way.
Questions about this notice
Contact our Office Manager at (909) 931-1368, or ask at the front desk at either office. If you would like this notice explained in Spanish or Arabic, tell us and we will go through it with you.
Effective date
This notice is effective 24 August 2026.