Notice of Privacy Practices

Public Notice Regarding Liability Protection

The Health Resources and Services Administration (HRSA) considers One Community Health and its officers, governing board members, full- and part-time employees, providers, and contractors to be Federal Public Health Service employees. As such, these covered individuals are granted liability protection under the Federal Tort Claims Act (FTCA). With this coverage in place, any malpractice-liability limits that may be required by other entities are met. 

Notice of Nondiscrimination & Language Access 

One Community Health complies with applicable federal and California civil-rights laws and does not unlawfully discriminate, exclude people, or treat them differently. We provide care to every eligible patient, and we welcome people of all backgrounds and identities. 

We do not discriminate on the basis of race, color, national origin, ancestry, ethnicity, immigration status, age, religion, pregnancy or related conditions, marital status, genetic information, disability or medical condition (including HIV/AIDS status, mental health, or substance use), or source of payment for care. 

This commitment reflects our obligations under Section 1557 of the Affordable Care Act; Title VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation Act; the Age Discrimination Act; the Americans with Disabilities Act (ADA); and California law, including the Unruh Civil Rights Act and Government Code section 11135. 

Help in Your Language — Free of Charge 

Free language assistance is available. We provide qualified interpreters and translated written materials at no cost to you. You have the right to receive information about your care in a language you understand. You do not have to bring a friend or family member to interpret. 

To request an interpreter or translated documents, tell any staff member or call (916) 443-3299. 

Help for People with Disabilities — Free of Charge 

We provide free aids and services to people with disabilities to help them communicate effectively with us, such as qualified sign-language interpreters, and written information in other formats (large print, audio, accessible electronic formats, and other formats). To request an accommodation, tell any staff member or call (916) 443-3299. 

If You Believe We Have Discriminated Against You 

You may file a civil-rights grievance with our Section 1557 / Civil Rights Coordinator at any time, in person, by mail, or by phone. You will not be penalized or retaliated against for filing a grievance. 

Civil Rights / Section 1557 Coordinator 
One Community Health 
1500 21st Street, Sacramento, CA 95811 
Phone: (833) 969-2549 

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (contact information appears in the Complaints section of this packet), or with the California Civil Rights Department. 

Notice of Privacy Practices 

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. 

If you have any questions about this Notice, please contact One Community Health’s Privacy Officer at (833) 969-2549. 

One Community Health does not intimidate, threaten, coerce, discriminate against, or take any other retaliatory action against an individual for exercising any right established — or for participating in any process provided — under the HIPAA Privacy Rule, the ONC information-blocking provisions of the 21st Century Cures Act, the California Confidentiality of Medical Information Act (CMIA), or any other applicable federal or state law. 

Our Pledge Regarding Medical Information

We understand that information about you and your health is personal, and we are committed to protecting its confidentiality. We create a record of the care and services you receive at One Community Health, and we may receive such records from others. We use these records to provide you with quality care and to comply with certain legal requirements. This Notice tells you about the ways we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your information. 

We are required by law to: 

• make sure that medical information that identifies you is kept private; 
• give you this Notice of our legal duties and privacy practices with respect to medical information about you; 
• follow the terms of the Notice that is currently in effect; and 
• notify you if a breach occurs that may have compromised the privacy or security of your information. 

Who Will Follow This Notice

This Notice describes One Community Health’s practices and those of:

• any health-care professional authorized to enter information into your medical chart;
• One Community Health Pharmacy, and;
• all employees, contractors, volunteers, students, staff, and other One Community Health personnel.

How We May Use or Disclose Your Health Information

The following categories describe the different ways we may lawfully use and disclose medical information. These examples are not an all-inclusive list; they describe, in general, the types of uses and disclosures we may make. 

1. For Treatment: We may use medical and social-services information about you to provide you with comprehensive medical, dental, pharmacy, behavioral-health, and social services. For example, we may disclose health information to One Community Health doctors, nurses, technicians, case workers, and other personnel involved in your care. We may also share your protected health information with a non–One Community Health provider or entity to provide or coordinate care, such as ordering outside lab work or imaging. 
   
2. For Payment: We may use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us, and we may contact a health plan or third-party payor about a treatment or service you are going to receive to obtain prior approval or to determine coverage. 
   
3. For Health Care Operations: We may use and disclose protected health information to operate our health center and ensure that all of our patients receive quality care — for example, to review our treatment and services, evaluate the staff caring for you, conduct training, make operational decisions, or compare our performance with other organizations to make improvements. We may remove information that identifies you so that others may use it without learning who the patient is. 
   We may also share your protected health information with a “business associate” that assists us with operations — for example, a billing service or an information-technology firm that maintains our electronic medical records. We have a written contract with each business associate requiring them to protect the confidentiality of your information. 
   
4. For Health-related Benefits and Alternative Services: We may use and disclose medical information to tell you about health-related services, benefits, or programs that might help you, and to tell you about or recommend possible treatment options or alternatives. 
   
5. To Individuals Involved in Your Care: We may release health information about you to a friend or family member who is involved in your medical care or who helps pay for your care, to the extent that information is directly relevant to their involvement. In a disaster, we may disclose information to an entity assisting in relief efforts; California law limits a disaster-welfare-inquiry response to basic information such as your name, city of residence, age, and general condition. 
   
   If you have given someone power of attorney, or if someone is your legal guardian or authorized personal representative, that person may be able to exercise your rights and make choices about your health information. We will verify the person’s authority before we take any action. 
   
6. As Required by Law: We will disclose medical information about you when required to do so by federal, state, or local law — for example, when the law requires reporting of abuse, violence, or neglect. 
   
7. To Avert a Serious Threat to Health or Safety: We may use or disclose medical information when necessary to prevent a serious threat to your health and safety or that of the public or another person. Any such disclosure would be only to someone able to help prevent or lessen the threat. 
   
8. For Research Purposes: Consistent with our mission to improve the quality of care for people living with HIV/AIDS, One Community Health participates in research projects, including projects conducted with the University of California, Davis Health, Division of Infectious Diseases (“UC Davis”). All such projects are reviewed and approved through a special process to protect patient safety, welfare, and confidentiality. A researcher or one of your providers may contact you about a study. Your 
   enrollment in any study is completely voluntary, and you will have the opportunity to ask questions and provide written informed consent before enrolling. Some studies may use information about your treatment without requiring informed consent, subject to the safeguards required by law. 
   
9. Specially Protected Information — Additional Safeguards: Some categories of information receive heightened protection under state and federal law. For these categories, we apply additional safeguards and, in many cases, will not disclose the information without your specific written authorization, even for treatment, payment, or operations. 
   
10. HIV/AIDS Status and Test Results: Information about HIV/AIDS testing, status, and care is protected under California Health and Safety Code section 120975 and related laws. We will not disclose your HIV-related information except as you authorize in writing or as specifically permitted by law. Unlawful disclosure can subject a person to civil and criminal penalties. 
    
11. Substance Use Disorder Records: If you receive substance use disorder (SUD) treatment from a federally assisted program, those records are protected by the federal confidentiality regulations at 42 CFR Part 2. In general, we may not disclose information that would identify you as having a substance use disorder without your written consent, except in limited circumstances allowed by law (such as a medical emergency). 
    
12. Mental Health and Psychotherapy Notes: Mental-health information receives additional protection under California law. Psychotherapy notes (notes recorded by a mental-health professional documenting or analyzing a counseling session and kept separate from the rest of your record) are not disclosed without your written authorization, except in the limited circumstances permitted by law. 
    
13. Genetic Information: Your genetic information is protected under the federal Genetic Information Nondiscrimination Act (GINA) and California law and is not used or disclosed except as permitted by law. 
    
14. Sensitive Services for Minors: Under California law, minors may consent on their own to certain sensitive services — for example, care related to the prevention or treatment of sexually transmitted infections and HIV, mental health, and substance use (California Family Code sections 6924–6929). When a minor lawfully consents to such care, the related records are generally controlled by the minor, and we follow California’s confidential-communication rules for that information. 
    
15. Confidential Communications for Sensitive Services: If you receive sensitive services, or if disclosure of your information could endanger you, you have the right under California law (Civil Code sections 56.107 and 56.108) to ask that we communicate with you in a confidential way — for example, by directing communications to a specific address or phone number. We will honor reasonable requests. 
    
    
    Special Situations
16. Public Health Activities: We may disclose information for public-health purposes, which generally include: 
    • preventing or controlling disease, injury, or disability; 
    • reporting vital events such as births and deaths; 
    • reporting child abuse or neglect; 
    • reporting adverse events or reactions related to foods, drugs, or products; 
    • notifying people of recalls, repairs, or replacements of products they may be using; 
    • notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition; and 
    • notifying the appropriate authority if we believe a patient has been the victim of abuse, neglect, or domestic violence, as required or authorized by law. 
      
17. Health Oversight Activities: We may disclose medical information to governmental, licensing, auditing, and accrediting agencies for activities authorized by federal and California law. 
    
18. Lawsuits and Other Legal Actions: In connection with lawsuits or other legal proceedings, we may disclose information about you in response to a court or administrative order, or in response to a subpoena, discovery request, warrant, summons, or other lawful process, subject to the additional protections that apply to specially protected information.
    
19. Law Enforcement: When required by law, we may disclose your health information to a law-enforcement official to comply with a court order, warrant, or grand-jury subpoena, and for other limited law-enforcement purposes permitted by law. 
    
20. Coroners, Medical Examiners, and Funeral Directors: We may, and are sometimes required to, disclose health information to coroners, medical examiners, and funeral directors to assist with their investigation of a death or to enable them to carry out their duties. 
    
21. Organ and Tissue Donation: We may disclose health information to organizations involved in procuring, banking, or transplanting organs and tissues. You may request, in writing, a restriction on how much information we share when responding to such requests.
    
22. Military, National Security, and Specialized Government Functions: As required by law, we may disclose medical information to authorized federal officials for intelligence, counterintelligence, and other national-security activities, and for protective services. If you are or were a member of the armed forces, we may release information to military command authorities as the law requires.  
    
23. Inmates: If you are an inmate of a correctional institution or in the custody of law-enforcement officials, we may release medical information to the institution or official as necessary for your health care, to protect your or others’ health and safety, or for the safety and security of the institution. 
    
24. Worker’s Compensation: We may disclose your health information as necessary to comply with workers’-compensation laws, which provide benefits for work-related injuries or illnesses. 
    
25. Marketing, Sale of Information, and Fundraising: 
    
    We never sell your information. We will not sell your protected health information, and we will not use it for marketing purposes, without first obtaining your written authorization. 
    
    Outreach and Fundraising. We will not use or disclose your personal medical information in our outreach or fundraising activities. We may use aggregate, de-identified demographic data — for example, a brochure that lists the number of patients we serve and basic demographic information in the aggregate. If you do not want to receive any fundraising communications, notify the Privacy Officer at the number listed at the top of this Notice, and we will honor your request. 

Your Rights Regarding Medical Information About You

1. Right to Inspect and Copy: With certain exceptions, you have the right to inspect and copy the health information we use to make decisions about your care. To access your protected health information, submit a written request to Health Information Management at the address below. 
   
   Health Information Management 
   One Community Health 
   1500 21st Street 
   Sacramento, CA 95811 
   
   If you request a copy, we will provide it within the timeframe required by law (generally within 15 days for records maintained in California), and we may charge a reasonable, cost-based fee. If circumstances prevent us from fulfilling your request on time, we will notify you of the delay. We may deny your request only in limited circumstances; if we do, we will explain why and tell you how to seek review, where applicable. 
   
2. Electronic access (21st Century Cures Act): If your written request clearly and specifically asks us to send an electronic copy of your record to you or to a person or entity you name, and we do not deny the request, we will send it in the form and format you request (if readily producible) and will charge no more than our cost of responding. We do not engage in “information blocking” and will provide timely electronic access to your electronic health information as required by law. 
   
3. Right to Amend or Supplement: 
   If you believe information we have about you is incorrect or incomplete, you may ask us to amend it or to add an addendum, for as long as we keep the information. Submit your request in writing to Health Information Management at the address above and include a reason that supports your request. An addendum may not exceed 250 words per item you believe is incomplete or incorrect. We may deny a request that is not in writing or that does not meet legal requirements; if we deny it, we will explain why in writing within 60 days. 
   
4. Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures” — a list of certain disclosures we made of your medical information, generally during the six years before your request, for purposes other than treatment, payment, or health-care operations and certain other purposes. Submit your request in writing to the Compliance Department at the address above and indicate the form you want (for example, paper or electronic). The first list in any 12-month period is free; we may charge for additional lists and will notify you of the cost so you can withdraw or modify your request. 
   
5. Right to Request Restrictions: You have the right to request a restriction on how we use or disclose your medical information for treatment, payment, or operations, and on what we disclose to someone involved in your care. We are generally not required to agree, but if we do, we will comply except where the information is needed for emergency treatment or disclosure is required by law. 
   
   Out-of-pocket restriction. If you ask us not to disclose information about a service to your health plan, and you pay for that service yourself, in full, at the time of service, we are required by law to honor your request. 
   
6. Right to Request Confidential Communications: You have the right to request that we communicate with you about your health information in a specific way or at a specific location — for example, by sending mail to a particular address. Submit reasonable requests in writing to Health Information Management. We must comply if you tell us that not doing so could endanger you.  
   
7. Right to Be Notified of a Breach: You have the right to be notified if a breach occurs that may have compromised the privacy or security of your unsecured protected health information. 
   
8. Right to a Paper Copy of this Notice: You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. 
   
   To exercise any of these rights, or for a more detailed explanation, contact our Privacy Officer at (833) 969-2549. 

Breach Notification

Despite our efforts to keep your information confidential, if a breach of unsecured protected health information occurs, we will notify you as required by law. In some cases, a business associate may provide the notification. The law also requires us to report certain breaches to state and federal authorities. 

The OCHIN Collaborative

One Community Health is part of an organized health-care arrangement that includes participants in OCHIN. A current list of OCHIN participants is available at www.ochin.org. 

As a business associate of One Community Health, OCHIN supplies information technology and related services and engages in quality-assessment and improvement activities on behalf of participants — for example, coordinating clinical-review activities and helping participants improve referral management. Your personal health information may be shared with other OCHIN participants or through a Health Information Exchange (HIE) only when necessary for treatment or for the health-care-operations purposes of the organized health-care arrangement. 

You can opt out of HIE sharing. To learn more about Health Information Exchange or to opt out of having your information shared through an HIE, contact One Community Health’s Privacy Officer at (833) 969-2549. 

The personal health information involved may include past, present, and future medical information, and information described in the Privacy Rule. Any disclosure will be made consistent with the Privacy Rule and other applicable laws, as amended. You may be entitled to an accounting of these disclosures as required by law. 

Changes to This Notice

We reserve the right to change our privacy practices and this Notice at any time. Until an amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice will apply to all protected health information we maintain, regardless of when it was created or received. We will keep a copy of the current Notice posted in our reception area and on our website. 

Complaints

Complaints about this Notice, or about how we handle your health information, should be directed to our Privacy Officer at 833-969-2549. You will not be penalized for filing a complaint. If you are not satisfied with how we handle a complaint, you may submit a written complaint to any of the following: 

U.S. Department of Health & Human Services — Office for Civil Rights, Region IX 
90 7th Street, Suite 4-100, San Francisco, CA 94103 
Phone: (800) 368-1019 • TDD: (800) 537-7697 • Fax: (202) 619-3818 
Email: ocrmail@hhs.gov
Online: https://ocrportal.hhs.gov/ocr/cp/wizard_cp.jsf 


California Agencies 

Effective date of original Notice: 2013. This revision supersedes the version last revised 3/01/2021. Current revision date: 3/18/2026. 

Ryan White HIV/AIDS Program — Client Notice & Rights 

One Community Health receives funding through the federal Ryan White HIV/AIDS Program (RWHAP), including Parts C and D, to provide HIV primary care and support services. If you receive services supported by the Ryan White Program, the following applies to you in addition to the rights described elsewhere in this packet. 

No one is denied HIV care because they cannot pay. Your ability to pay does not affect your eligibility for, or access to, services supported by the Ryan White Program or our Sliding Fee Discount Program. 

Eligibility and Recertification 

To receive Ryan White–funded services, you must generally have a diagnosis of HIV, reside in our service area, and have income at or below the limit set for the program. We are required to verify and re-verify your eligibility periodically (recertification). To keep your services without interruption, please provide the requested documentation when asked. We keep this information confidential. 

Immigration status does not matter. Your immigration or citizenship status is not relevant to your eligibility for Ryan White services. 

Ryan White Is the “Payer of Last Resort” 

By law, the Ryan White Program pays only after other available resources. This means we will help you identify and enroll in any coverage you may qualify for — such as Medi-Cal, Medicare, Covered California, or private insurance — and the Ryan White Program covers eligible HIV-related services and costs that those sources do not. Helping you obtain and keep coverage is part of your care. 

Limits on What You Can Be Charged 

Federal law limits the total amount you can be charged in a calendar year for Ryan White–funded services, based on your income compared with the Federal Poverty Level (FPL). This annual cap includes all charges combined — enrollment fees, deductibles, copayments, coinsurance, and similar charges: 

Once you reach your annual cap, you will not be charged for additional Ryan White–covered services for the rest of that year. Please keep records of your medical out-of-pocket costs and let our staff know so we can track your cap. If you have questions, contact Patient Financial Services. 

AIDS Drug Assistance Program (ADAP) and Medication Access 

We can help you apply for the AIDS Drug Assistance Program (ADAP) and other medication-assistance programs that help cover the cost of HIV medications and related drugs. Ask your provider, case manager, or pharmacy staff for help with enrollment and recertification. 

Confidentiality of Your HIV Information 

Your HIV status and HIV-related information receive special protection under California law (Health and Safety Code section 120975 and related laws). We will not disclose this information except as you authorize in writing or as specifically permitted by law. 

Your Right to File a Ryan White Grievance 

If you disagree with a decision about your Ryan White eligibility or services, or you are unhappy with the care or services you receive, you have the right to file a grievance without fear of retaliation and without any effect on your care. You may: 

• speak with your case manager, provider, or their supervisor; 
• call the One Community Health Compliance & Privacy Line at (833) 969-2549; or 
• submit a written grievance using the process described in the Patient Grievance & Complaint Policy in this packet. 

You may also contact the Ryan White Program’s funding agency or grievance contact. We can provide that contact information and interpreter assistance on request. 

Patient Rights and Responsibilities (State of California) 

In accordance with California law, patients of One Community Health have the following Rights and Responsibilities. 

Patient Rights

One Community Health patients have the right to: 

1. Receive care and exercise these rights without discrimination based on race, color, national origin, ancestry, immigration status, age, religion, pregnancy, marital status, genetic information, disability or medical condition (including HIV/AIDS, mental health, or substance use), or the source of payment for your care. 
   
2. Considerate and respectful care, and a safe environment free from abuse, neglect, harassment, and retaliation. 
   
3. Free language-interpreter services and, for patients with disabilities, free auxiliary aids and services to communicate effectively with us. 
4. Reasonable accommodations for a disability, and information provided in a format you can access and understand. 
   
5. Know the name of the provider who has primary responsibility for coordinating your care, and the names and professional relationships of other providers who will see you. 
   
6. Receive information from your provider about your condition and your prospects for recovery in terms you can understand. 
   
7. Receive enough information about any proposed treatment or procedure to give informed consent or to refuse care. Except in emergencies, this includes a description of the procedure or treatment, the medically significant risks involved, alternatives (including non-treatment) and their risks, and the name of the person who will carry out the procedure. 
   
8. Appropriate assessment and management of your pain, information about pain and pain-relief options, and the right to participate in pain-management decisions. You may request or refuse any modality to relieve pain. If your provider declines to prescribe an opioid for severe chronic intractable pain, the provider must inform you that other physicians specialize in such treatment.  
   
9. Formulate advance directives and designate a decision-maker if you become unable to understand a proposed treatment or to communicate your wishes. Practitioners who care for you will comply with these directives. All patient rights apply to the person legally responsible for making decisions on your behalf. 
   
10. Participate actively in decisions about your medical care, including, to the extent permitted by law, the right to refuse treatment and to leave against medical advice. 
    
11. Full consideration of privacy concerning your care. Case discussion, consultation, examination, and treatment are confidential and will be conducted discreetly. You have the right to know the reason for the presence of any individual. 
    
12. Confidential treatment of all communications and records pertaining to your care. You will receive a separate Notice of Privacy Practices (included in this packet) that explains your privacy rights in detail. 
    
13. Request confidential communications and additional protections for sensitive services (including mental-health and substance-use care) as provided by law. 
    
14. Reasonable continuity of care, and to know in advance the time and location of appointments and the provider who will deliver your care. 
    
15. Be advised if your provider proposes to engage in or perform research or human experimentation affecting your care, and to refuse to participate in any research without affecting your care. 
    
16. Be informed by your provider, or a delegate, of your continuing health-care needs and how to obtain follow-up care. 
    
17. Examine and receive an explanation of your bill, regardless of the source of payment, and to receive information about financial assistance, the Sliding Fee Discount Program, and (for self-pay patients) a Good Faith Estimate of expected charges. 
    
18. Know which clinic rules and policies apply to your conduct as a patient.
    
19. Access your medical record and request copies, including electronic copies, as described in the Notice of Privacy Practices. 
    
20. Voice concerns and file a grievance or complaint — including a Ryan White grievance — without fear of retaliation or any effect on your care. 
    
21. Have all One Community Health personnel observe these rights.  

How to File a Grievance or Complaint 

You may file a grievance by calling the One Community Health Compliance & Privacy Line at (833) 969-2549, or in writing to: 

One Community Health 
Attn: Chief Compliance Officer 
1500 21st Street 
Sacramento, California 95811 

You may also file a complaint with the California Department of Public Health, regardless of whether you use our grievance process, by calling (800) 554-0354 or writing to: 

California Department of Public Health 
2000 Evergreen Street, Suite 210 Sacramento, CA 95815 

Patient Responsibilities

As a patient of One Community Health, you are responsible for:

1. providing complete and accurate information about your past and present illnesses, complaints, medications, and medical history to the best of your ability; 
2. reporting unexpected changes in your condition to your provider; 
3. following the treatment plan recommended by your providers, keeping your appointments, and notifying us if you cannot keep an appointment; 
4. providing the documentation needed to determine eligibility and benefits, including for the Ryan White Program and financial assistance, when requested; 
5. meeting the financial obligations of your care promptly, or asking for help if you cannot; and 
6. following clinic rules and being respectful of other patients, visitors, and staff. 

Appointment & Cancellation Policy 

Keeping your scheduled appointments helps protect your health and the continuity of your care. By acknowledging this policy, you agree to make every effort to keep your appointments and to call us at least twenty-four (24) hours in advance to reschedule or cancel. 

If you need help making, rescheduling, or canceling an appointment, please call (916) 443-3299. 

As a courtesy, our staff aims to call patients one day before a scheduled appointment as a reminder. If you are unavailable, we may leave a brief message stating that you have an appointment at the 21st Street clinic, with the date and time. If you do not have a phone or voicemail, you may not receive these reminders; you are always welcome to call us to confirm your appointments. You may also ask us to limit the content of reminder messages or to use a confidential method of contact. 

Missing an appointment will not cause you to be denied care or treated differently, and it will not affect your eligibility for the Ryan White Program or financial assistance. Telehealth visits are subject to the same courtesy and cancellation guidelines. 

Patient Grievance & Complaint Policy 

One Community Health provides services to all eligible individuals without discrimination on the basis of race, creed, color, age, religion, ancestry, national origin, immigration status, physical or mental disability (including substance use), HIV/AIDS status, political affiliation, or belief. 

As a patient, you have the right to file a grievance if you believe you have been treated unfairly. You will not suffer any negative effect on your care for filing a grievance, and all grievances are handled confidentially. Interpreter assistance is available free of charge. 

If you have a complaint or concern, you may take any of these steps: 

1. Talk with your clinician, case manager, or their supervisor about your concern, in person or by completing a Record of Communication form available at the Front Desk in the clinic and social-services areas. 
   
2. Report your concern through the One Community Health Compliance & Privacy Line at (833) 969-2549. 
   
3. File a formal written complaint on a One Community Health Complaint Tracking Form, available at the Front Desk. A staff member responsible for investigating and resolving complaints will review and follow up on your complaint. 
   
4. If you remain unsatisfied after these steps, you may write to the Chief Executive Officer, One Community Health, 1500 21st Street, Sacramento, CA 95811. 

You may also file a complaint with an outside agency at any time — including the U.S. Department of Health & Human Services Office for Civil Rights, the California Department of Public Health, or the Ryan White Program funding agency — whether or not you use our internal process. Contact information appears in the Notice of Privacy Practices and Patient Rights sections of this packet. 

Code of Conduct 

One Community Health is committed to a safe environment for patients, visitors, and staff. We ask all patients, visitors, and staff to treat one another with respect and to follow our policies. This Code is applied fairly and consistently, without discrimination. When behavior may be related to a disability, a behavioral-health condition, or a crisis, we will consider reasonable accommodations and supportive, trauma-informed approaches consistent with safety. 

The following behaviors are unacceptable and may result in immediate action, up to and including disenrollment from services: 

1. Physical assault — direct physical contact with staff or patients with intent to harm. 
   
2. Possession of weapons — including but not limited to guns, rifles, knives, and explosive devices. 
   
3. Forgery — of medical documents, including but not limited to prescriptions. 
   
4. Drug-related misconduct — selling or gifting prescribed medications or street drugs on the premises, other drug-seeking behavior, or bringing illegal drugs, un-prescribed drugs, or alcohol onto the premises. 
   
5. Threats — direct or indirect threats to cause physical harm to patients, staff, visitors, or family members. 
   
6. Theft of property — possession of property stolen from patients, staff, visitors, or family members. 
   
7. Damage to property — intentional and substantial damage to property of patients, staff, visitors, or family members. 
   
8. Verbal assault — abusive language directed at patients, staff, visitors, or family members. 
   
9. Intimidating behavior — a threatening stance, tone, approach, or other aggressive gesture toward staff, patients, or visitors on the premises. 
   
10. Sexual harassment — unwelcome verbal, physical, or visual conduct of a sexual nature, including derogatory or sexually oriented comments, unwanted touching, displayed materials, or unwanted sexual advances. 
    
11. Unauthorized recording — photography, audio recording, or video recording of any kind on the premises is prohibited. 

Repeated incidents of abusive or threatening behavior may result in termination of services. Where appropriate and consistent with safety, we will seek to resolve concerns and provide notice before ending services. 

Financial Agreement & Sliding Fee Discount Program 

This section explains One Community Health’s financial policy for services. Please read it carefully. If you have questions, contact the Practice Manager at (916) 914-6213. If you experience payment problems while you are a patient, please contact us promptly so we can help you manage your account. 

No one is denied services because of an inability to pay. As a Federally Qualified Health Center, One Community Health offers a Sliding Fee Discount Program, and we will help you find the assistance you qualify for. 

Sliding Fee Discount Program 

If you are uninsured or have limited income, you may qualify for discounted charges under our Sliding Fee Discount Program. Discounts are based on your household income and size compared with the Federal Poverty Level. Patients at the lowest income level pay only a nominal charge. Ask our staff or Patient Financial Services for an application; you will be asked to provide income documentation to determine your discount. 

Ryan White Program Charges 

If your care is supported by the Ryan White Program, federal limits cap the total you can be charged each year based on your income, as described in the Ryan White Client Notice in this packet. Patients at or below 100% of the Federal Poverty Level are not charged for Ryan White–covered services. 

Payment for Services 

As a recipient of services at One Community Health, you are responsible for the charges incurred, subject to any discount or program limit that applies to you. Co-payments, prior balances, and deductible amounts are typically due at the time of service. By acknowledging this agreement, you agree to pay for the services you receive and understand that decisions about which services you receive are made by you and your provider. For uninsured and self-pay patients, an established fee schedule and the Sliding Fee Discount Program may apply. 

For insured patients, One Community Health will submit claims to your insurance electronically or by mail. If your insurer informs us that you are responsible for a copayment, deductible, share of cost, or a non-covered service, we will bill you directly. 

If you receive a statement, please send payment within 30 days. If no payment is received within 30 days, a second notice will be sent. To set up a payment arrangement on an outstanding balance, call the Billing Unit at (916) 914-6210 or (916) 914-6339. We can discuss interest-free payment plans and financial-assistance options.

Good Faith Estimate (No Surprises Act) 

If you are uninsured or choose not to use insurance (self-pay), you have the right under federal law to receive a Good Faith Estimate of the expected charges for your care. Ask any staff member or Patient Financial Services for a Good Faith Estimate before your service. 

Insurance 

If you have insurance, we are glad to help you receive your maximum allowable benefit, and we will submit claims for covered services. It is your responsibility to understand your coverage and benefits, including any referral, pre-determination, and pre-authorization requirements; we will assist you in meeting plan requirements. Your insurance is a contract between you and your insurance company. We are required by law to collect applicable co-payments and deductibles and to send certain information to your plan. 

Assignment of Insurance Benefits 

By acknowledging this agreement, you authorize your insurance company to pay One Community Health directly and assign those benefits to us. Payment by the insurer to One Community Health under this authorization discharges the insurer of its obligations to the extent of that payment. You understand that you are financially responsible for charges not covered by this assignment, subject to any discount or program limit that applies to you, and that full payment is due at the time of service unless otherwise arranged or required by law. 

Release of Information to Obtain Payment 

By acknowledging this agreement, you authorize One Community Health to release information necessary to obtain insurance benefits for claims we submit on your behalf, and you agree that this authorization permits us to submit such claims without your signature on each individual claim. The additional protections that apply to specially protected information (such as HIV, substance-use and mental-health information) continue to apply.  

Important Phone Numbers 

Free interpreter services are available for any of these calls. Tell our staff the language you prefer.