Effective Date: June 12, 2025
Takara Hospice – San Diego, California
Phone: (760) 932-4887
Email: info@takarahospice.com

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.

1. Our Responsibilities

Takara Hospice is required by law to:

• Maintain the privacy of your protected health information (PHI)
• Provide you with this notice of our legal duties and privacy practices
• Abide by the terms of this notice currently in effect

2. Your Rights

You have the right to:

• Get a copy of your medical record
• Request corrections to your record
• Request confidential communication (e.g., only contact you at a certain number)
• Ask us to limit what we use or share
• Get a list of those with whom we’ve shared your information
• Choose someone to act for you (e.g., healthcare proxy)
• File a complaint if you believe your rights are violated

To exercise any of these rights, contact our Privacy Officer at:
(760) 932-4887
info@takarahospice.com

3. How We May Use and Share Your Health Information

We are allowed to use your PHI:

• For Treatment – e.g., sharing information with doctors, nurses, or specialists involved in your care
• For Payment – e.g., submitting information to Medicare, Medi-Cal, or your insurance for reimbursement
• For Healthcare Operations – e.g., quality assurance, staff training, licensing, or audits

4. Other Ways We May Share Your Information

We may also use or disclose your PHI:

• When required by federal, state, or local law
• For public health and safety (e.g., disease reporting, abuse, neglect)
• For health oversight activities (e.g., licensing inspections)
• In response to a court order, subpoena, or law enforcement request
• To medical examiners or funeral directors as necessary
• For organ and tissue donation
• For research, with your authorization or under certain waivers
• For workers’ compensation claims
• To avert a serious threat to health or safety
• To government agencies for special functions (e.g., military, national security)

5. Disclosures That Require Your Authorization

We will not share your PHI for the following without your explicit written permission:

• Marketing purposes
• Sale of your health information
• Most sharing of psychotherapy notes
• Certain uses of substance use treatment records (42 CFR Part 2)

You may revoke your authorization at any time in writing.

6. Our Duties if a Breach Occurs

If a breach compromises the privacy or security of your PHI, we are required by law to notify you without unreasonable delay, as mandated by the HIPAA Breach Notification Rule.

7. Your California Privacy Rights

In addition to federal protections, California law may grant you additional rights related to your medical information, including:

• Stronger confidentiality for mental health, HIV/AIDS, and substance use records
• More control over the use of your medical information for marketing or fundraising

8. Changes to This Notice

We reserve the right to change this notice at any time. Any changes will apply to all the PHI we maintain. The revised notice will be posted on our website and available upon request.

9. Questions or Complaints

If you believe your privacy rights have been violated, you may file a complaint:

With Us:
Takara Hospice
Attn: Privacy Officer
(760) 932-4887
info@takarahospice.com

With the U.S. Department of Health & Human Services (HHS):
Visit www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be retaliated against for filing a complaint.