Effective July 20, 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.
This notice applies to KeyTone Medical, the practice of Kemesha Delisser, MD, and to the staff and personnel who handle your health information here.
Treatment. We use your health information to provide your care and may share it with other clinicians involved in that care — for example, a physical therapist or a referring physician.
Payment. We may use and disclose your information to bill and collect payment — for example, preparing a superbill at your request for you to submit to your health plan.
Health care operations. We may use your information to run the practice — quality review, scheduling, and administration — and may share it with business associates, such as our scheduling management company, who are required by contract to protect it.
Workers' compensation and medico-legal evaluations. We may disclose health information as authorized by and as necessary to comply with workers' compensation laws. If you are seen for a QME, AME, or SIBTF evaluation, the information gathered is compiled into a report that California law requires us to provide to the parties to your claim; those evaluations are performed under the workers' compensation system rather than as treatment.
Appointment contact. We may contact you to confirm or reschedule appointments and to respond to your requests, including waitlist availability.
As required or permitted by law. We may disclose information when law requires or permits it, including: public health reporting; health oversight activities; judicial and administrative proceedings in response to a valid order, subpoena, or discovery request; to law enforcement in limited circumstances; to avert a serious threat to health or safety; and to coroners or medical examiners.
Other uses. Uses and disclosures not described in this notice, including most uses of psychotherapy notes, marketing uses, and any sale of your information, happen only with your written authorization, which you may revoke in writing at any time.
You have the right to: inspect and receive a copy of your health record, in electronic or paper form, usually within 30 days of a written request (a reasonable, cost-based fee may apply); request corrections to your record, in writing, with a reason; receive an accounting of disclosures we made for purposes other than treatment, payment, operations, or those you authorized, for the six years before your request; request restrictions on how we use or share your information (we are not required to agree, except that if you pay for a service in full out of pocket, you may require us not to disclose that service to your health plan); request confidential communications — that we reach you at a specific phone, address, or email; receive a paper copy of this notice on request even if you accepted it electronically; and be notified of a breach of unsecured health information affecting you.
We are required by law to keep your health information private and secure, to give you this notice of our duties and practices, and to follow the notice currently in effect. If we change this notice, the revised version will apply to information we already hold, will be posted on this page and in the office, and will carry a new effective date.
If you believe your privacy rights have been violated, you may file a complaint with us — Privacy Officer, KeyTone Medical, admin@thekeytone.com, (650) 229-7395 — or with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/complaints or 1-800-368-1019. We will not retaliate against you for filing a complaint.
Privacy Officer, KeyTone Medical · admin@thekeytone.com · (650) 229-7395.
