Notice Of Privacy Practices - Molina Medical Group


Molina Medical Group (“Molina” or “we”) uses and shares protected health information about you for treatment, payment and health care operations. We also use and share your information for other reasons as allowed and required by law. We have the duty to keep your health information private. We have policies in place to obey the law. The effective date of this notice is June 1, 2009.

PHI stands for these words, protected health information. PHI means health information that includes your name, member number or other identifiers, and is used or shared by Molina.

Why does Molina use or share your PHI?

We use or share your PHI to provide you with medical services. Your PHI is used or shared for treatment, payment, and health care operations.

For Treatment.

Molina may use or share your PHI to give you, or arrange for, your medical care. This treatment also includes referrals between your doctors or other health care providers. For example, your doctor will record information in your medical record that is related to your treatment. This information is necessary for your doctor and other providers to determine what treatment you should receive. For example, we may share information about your health condition with a specialist. This helps the specialist talk about your treatment with your doctor.

For Payment.

Molina may use or share PHI about you for the purpose of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations.

Molina may use or share PHI about you for operations and administrative purposes. For example, your health information may be shared with quality improvement personnel. Health care operations involve many daily business needs. It includes, but is not limited to, the following:

  • Improving quality
  • Actions in health programs to help patients with certain conditions (such as asthma)
  • Conducting or arranging for medical review
  • Legal services, including fraud and abuse programs
  • Actions to help us obey laws
  • Address patient needs, including solving complaints

We may also use your PHI to give you reminders about your appointments. We may use your PHI to give you information about other treatment, or other health-related benefits and services.

When can Molina use or share your PHI without getting written authorization (approval) from you?

The law allows Molina to use and share your PHI for the following other purposes:

Required by law.

We will use or share information about you as required by law. We will share your PHI when required by the Secretary of the Department of Health and Human Services (DHS). This may be for a court case, other legal review, or when required for law enforcement purposes.

Public Health.

Your PHI may be used or shared for public health activities. This may include helping public health agencies to prevent or control disease.

Health Care Oversight.

Your PHI may be used or shared with government agencies. They may need your PHI for audits.


Your PHI may be used or shared for research in certain cases.

Law Enforcement.

Your PHI may be used or shared with police to help find a suspect, witness or missing person.

Health and Safety.

PHI may be shared to prevent a serious threat to public health or safety.

Government Functions.

Your PHI may be shared with the government for special functions. An example would be to protect the President.

Victims of Abuse, Neglect or Domestic Violence.

Your PHI may be shared with legal authorities if we believe that a person is a victim of abuse or neglect.

Workers Compensation.

Your PHI may be used or shared to obey Workers Compensation laws.

Other Disclosures.

PHI may be shared with funeral directors or coroners to help them to do their jobs.

When does Molina need your written authorization (approval) to use or share your PHI?

Molina needs your written approval to use or share your PHI for a purpose other than those listed in this notice. You may cancel a written approval that you have given us. Your cancellation will not apply to actions already taken by us because of the approval you already gave to us.

What are your health information rights?

You have the right to:

  • Request Restrictions on PHI Uses or Disclosures (Sharing of Your PHI)

    You may ask us not to share your PHI to carry out treatment, payment or health care operations. You may also ask us to not to share your PHI with family, friends or other persons you name who are involved in your health care. Generally, we are not required to agree to your request; however, in certain cases, when you pay out of pocket in full for your care, we must accept your request not to disclose your PHI to a health plan. You will need to fill out a form to make your request.

  • Request Confidential Communications of PHI

    You may ask Molina to give you your PHI in a certain way or at a certain place to help keep your PHI private. We will accommodate reasonable requests. You will need to fill out a form to make your request.

  • Review and Copy Your PHI

    You have a right to review and get a copy of your PHI held by us. This may include the medical records and billing records and other records used to decisions about you. You will need to fill out a form to make your request. We may charge you a reasonable fee for copying and mailing the records. In certain cases we may deny the request.

  • Amend Your PHI

    You may ask that we amend (change) your PHI. This involves only those records kept by us about you as a patient. You will need to fill out a form to make your request. You may file a letter disagreeing with us if we deny the request.

  • Receive an Accounting of PHI Disclosures (Sharing of your PHI)

    You may ask that we give you a list of certain parties that we shared your PHI with during the six years prior to the date of your request. The list will not include PHI shared as follows:

    • for treatment, payment or health care operations;
    • to persons about their own PHI;
    • sharing done with your authorization,
    • incident to a use or disclosure otherwise permitted or required under applicable law;
    • as part of a limited data set for research or public health activities;
    • PHI released in the interest of national security or for intelligence purposes;
    • to correctional institutions having custody of an inmate; or
    • shared prior to April 14, 2003

We will charge a reasonable fee for each list if you ask for this list more than once in a 12-month period. You must fill out a form to request a list of PHI disclosures.

You may make any of the requests listed above, or may get a paper copy of this Notice. Please speak with the Administrator of the Molina Medical Group facility where you receive your medical care.

What can you do if your rights have not been protected?

You may complain to Molina and to the Department of Health and Human Services if you believe your privacy rights have been violated. We will not do anything against you for filing a complaint. Your care will not change in any way.

You may complain to us by contacting our Privacy Official at:

(Toll Free) 1-866-665-4629

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services at:

Secretary of the U.S. Department of Health and Human Services
Office for Civil Rights
U.S. Department of Health & Human Services
50 United Nations Plaza - Room 322
San Francisco, CA 94102
(415) 437-8310; (415) 437-8311 (TDD)
(202) 619-3818 FAX

What are the duties of Molina?

Molina is required to:

  • Keep your PHI private
  • Give you written information such as this on our duties and privacy practices about your PHI
  • Follow the terms of this Notice

This Notice is Subject to Change

Molina reserves the right to change its information practices and terms of this notice at any time. If we do, the terms and practices contained in the notice currently in effect will then apply to all PHI we keep. If we make any material changes, a new notice will be posted at Molina Medical Group facilities. It will also be available on our website or upon request at our facilities and by mail.

Contact Information

If you have any questions about the matters covered by this notice, please contact the following office:

Privacy Official
(Toll Free) 1-866-665-4629

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