Summary:
San Francisco Department of Public Health
Notice of Privacy Practices

This Notice describes how medical information about you may be used and disclosed in the San Francisco Department of Public Health (and how you can get access to this information). Please review this Notice carefully.

Department of Public Health Pledge: Employees of the San Francisco Department of Public Health (DPH), its affiliates and contract providers understand that information about you and your health is personal. They are committed to protecting your health information.

Who will follow the rules in this notice: All DPH and contract provider employees, as well as staff assigned to DPH by the University of California at San Francisco, must follow these rules.

You have the right to: (please see possible restrictions in the full Notice)

• Ask to see, read and/or obtain a copy of your health record (charges may be necessary).
• Ask to correct information that you believe is wrong in your health record.
• Ask that your health information not be shared with certain individuals.
• Ask that your health information not be used for certain purposes; for example, research.
• Ask DPH to send copies of your health record to whomever you wish (charges may be necessary).
• Be informed about who has read your record (for reasons other than treatment, payment and program improvement purposes).
• Specify where and how DPH employees may contact you.
• Receive a paper copy of the attached DPH Notice of Privacy Practices.

DPH may use and disclose your health information to improve your treatment.

To improve the quality of care you receive, health information may be shared by providers within DPH and between DPH and its contract providers - including health information regarding mental health, substance abuse, HIV/AIDS, sexually transmitted diseases (STD), and developmental disabilities.

There are circumstances when health information about you will not be shared unless you first give your permission for it to be shared; such as when you receive services in a substance abuse treatment agency or at the City Clinic (Municipal STD Clinic).

See the 'Notice of Privacy Practices' for more information. If you have concerns about how your health information might be (or has been) shared, please speak with your provider or call the DPH Privacy Officer directly at 415-206-2354.

If you believe your privacy rights have NOT been maintained while receiving DPH services, you may file a complaint with the DPH or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the DPH, send the complaint to the DPH Privacy Officer at 2789 25th St., San Francisco, CA 94110, or call 415-206-2354. To file a complaint with the Secretary, the address is U.S. Dept. of Health and Human Services, Office of Civil Rights, Attn: Regional Manager, 50 United Nations Plaza, Rm. 322, San Francisco, CA 94103. You will not be penalized in any way for filing a complaint.

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