Mi Salud Medical Clinic
Effective Date: September 25, 2026

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.

Our Responsibilities

Mi Salud Medical Clinic is required by law to protect your health information, provide this notice of our legal duties and privacy practices, and follow the notice currently in effect.

This notice applies to information that identifies you and relates to your health, healthcare, or payment for healthcare, including information from in-person and telehealth services.

We will notify you following a breach of your unsecured protected health information when required by law.

How We Use and Share Your Information

Treatment. We may use and share information to provide and coordinate your care. For example, we may send a prescription to your pharmacy or share relevant medical information with another provider treating you.

Payment. We may use and share information to bill for services and obtain payment. For example, we may provide information about your visit to your insurance company to process a claim.

Healthcare operations. We may use and share information to operate our clinic and improve care. For example, we may review medical records to evaluate the quality of our services. Organizations that handle information on our behalf must meet applicable privacy requirements.

Care-related communications. We may contact you about appointments, results, prescriptions, treatment alternatives, and services related to your care. You may request a different way for us to contact you.

Family, caregivers, and disaster relief. When permitted by law, we may share relevant information with people involved in your care or payment, or with disaster-relief organizations. You may tell us your preferences or object. If you cannot express your preferences, we may share limited information when professional judgment indicates it is in your best interests.

Other legally permitted or required disclosures. Subject to applicable legal conditions, we may share information for:
– Public health reporting, medication or product safety, reporting suspected abuse or neglect, and preventing a serious and imminent threat to health or safety.
– Authorized healthcare oversight, including audits, licensing, inspections, and investigations.
– Research that meets applicable privacy and approval requirements.
– Organ or tissue donation, and the work of coroners, medical examiners, or funeral directors.
– Workers’ compensation matters, permitted law-enforcement requests, and authorized military, national-security, or correctional functions.
– Court or administrative proceedings and other disclosures required by law, including compliance reviews by the U.S. Department of Health and Human Services.

A request or subpoena does not automatically permit disclosure. We apply the required legal safeguards and any additional confidentiality protections described below.

When Your Written Permission Is Required

We obtain your written authorization when required for marketing, the sale of protected health information, and most uses or disclosures of separately maintained psychotherapy notes.

Uses and disclosures not described in this notice require your written authorization.

You may revoke an authorization by contacting our privacy contact in writing. Revocation does not undo actions already taken in reliance on your authorization.

Your Rights

Contact the privacy contact below to exercise these rights. We may need to verify your identity and request certain instructions in writing.

Access Your Records

You may request to inspect or receive a paper or electronic copy of medical and billing information you are entitled to access. We respond within applicable legal time limits. Any fees will comply with the law. If access is denied, we will explain the reason and any available review rights.

Request a Correction

You may ask us to amend information you believe is incorrect or incomplete. Explain what needs correction and why. If we deny your request, we will explain our decision in writing and your right to submit a statement of disagreement.

Request Confidential Communications

You may ask us to contact you in a particular way or at a different location. We will accommodate reasonable requests.

Request Restrictions

You may ask us to limit certain uses or disclosures for treatment, payment, healthcare operations, or involvement of others in your care. We are not required to agree to every restriction.

However, when you or someone other than your health plan pays for a service in full, you may ask us not to disclose information about that service to your health plan for payment or healthcare operations. We must honor that request unless disclosure is required by law.

Request a Disclosure Accounting

You may request a list of certain disclosures made during the previous six years. The list generally excludes treatment, payment, healthcare operations, and other legally excluded disclosures.

One accounting within a 12-month period is free. We will notify you before charging a permitted fee for an additional request.

Receive a Paper Notice

You may request a paper copy of this notice at any time, even if you previously accepted an electronic copy.

Use an Authorized Representative

A person with verified legal authority may exercise applicable rights on your behalf, subject to legal limitations.

Additional Confidentiality Protections

When California or other applicable law provides greater privacy protection than HIPAA, we follow those additional requirements.

HIV test results. Identifiable HIV test results generally require specific written authorization before disclosure unless a legal exception permits or requires disclosure.

Minors’ records. Parents and guardians do not automatically have access to all records of care a minor may legally consent to. We follow California restrictions on parental access and other legally protected confidential services.

Substance use disorder records. If we receive or maintain records protected by 42 CFR Part 2, those records—and testimony describing their contents—cannot be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying court order.

The court-order process must provide the required notice and opportunity to be heard. An order authorizing disclosure must also be accompanied by a subpoena or another legal requirement compelling disclosure. These protections limit the general disclosure categories above.

Privacy Questions and Complaints

To ask questions about this notice, exercise your privacy rights, or file a privacy complaint, contact:
Mi Salud Medical Clinic — Clinic Administration**
Telephone: 909-572-8077
Mailing Address: 9653 Alder Ave, Fontana, CA 92335

When calling, ask for the person responsible for HIPAA privacy questions and complaints.

You may submit a written complaint by mail or in person at the address above, addressed to Clinic Administration — Privacy Complaint. Describe your concern and how we can reach you.

You may also file a complaint directly with the U.S. Department of Health and Human Services, Office for Civil Rights, through its online complaint portal:
[HHS Office for Civil Rights Complaint Portal](https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf)

You do not have to complain to Mi Salud first.
We will not retaliate against you for filing a complaint or exercising your privacy rights.

Changes to This Notice

We may revise this notice and, when permitted by law, apply the revised practices to information we already maintain and information we receive in the future.

The current notice will be available on our website, at our clinic, and upon request. Each version will identify its effective date.