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Patient Information

HIPAA Information

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


Your Rights as a Palmeira Patient


When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right to an electronic or paper copy of your medical record.

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

You have the right to ask us to correct your medical record.

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

You have the right to request confidential communications about your care.

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

You have the right to 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 to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

You have the right to receive a list of those with whom we’ve shared information.

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

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

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

You have the right to 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 your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

You have the right to file a complaint if you feel your rights are violated.

  • You can complain if you feel we have violated your rights by contacting us using the information on the last page of this document.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
  • We will not retaliate against you for filing a complaint.
Your Choices

You have some choices in the way that we use and share information as we:

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In the following instances, we never share your information unless you give us written permission:

  • Marketing purposes

Sale of your information

Our Uses and Disclosure

We may use and share your information as we:

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health 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 many conditions in the law before we can share your information for these purposes. For more information see:

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Business Associates

In some cases our organization uses third parties, or business associates, to provide services that may require the disclosure of our patients’ health information, for example translator services and billing services. Business associates are required by contract and by law to implement appropriate safeguards to protect your health information.

Via Electronic health record (s)

Palmeira uses technology that allows us to create, maintain and share our patients’ health information among Palmeira personnel as well as with other community health care providers and various insurance companies. We may share your health information electronically with physicians or other providers participating in your care and/or with your insurance carrier as part of coordinating your treatment or facilitating the payment of services. Information related to HIV, substance abuse, and other sensitive diagnoses could be shared with these covered entities if part of your record. From time to time, other health care providers grant Palmeira access to their Electronic Health records for the coordination of care. Your records could be accessed in another provider’s EHR or received electronically to coordinate your care. As with other forms of information, we are required to maintain the privacy and confidentiality of our patients’ electronic health information to the fullest extent of the law at all times. If you have any questions or concerns about the sharing or exchange of your information, please discuss them with your provider or with Palmeira administration.

Our Responsibilities
  • We are required by law to maintain the privacy and security of your protected 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 this notice.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:

Changes to the Terms of this Notice


We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

To Contact Us:

This Notice of Privacy Practices applies to Palmeira Health Services and its operating subsidiaries. For more information or to lodge a complaint, please contact:

Palmeira Health Services
1028 W. Town and Country Road
Orange, CA 92868

(714) 406-2025
(844) 472-5634
(844) 333-0623 Fax


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Palmeira Home + Health
1028 W Town & Country Road
Orange, CA 92868

Phone: 844.4PALMEIRA