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Note: this portal is only for patients already accepted by Dr. Li -- and not for those who are inquiring.

Dr. Li will be away from 3/29 through 4/8 and not checking this portal during that time.

Dr. Li's clinic days are Tues, Wed, Thurs. She will check portal messages during the week and respond in order of priority. Non-urgent messages only. Please allow up to 3-4 business days for a reply. Thank you for your patience!

For urgent matters, contact your primary care doctor or nearest emergency room.

Thank you!

Register with Cynthia Li, MD, Inc.

Welcome to the Cynthia Li, MD, Inc. registration page. To register as a new patient, please enter your information in the fields below. Please do not use this form if you are already a patient (you have seen any of our practitioners in the past). To set up patient portal access or amend your information, please contact us.

If you are already a registered patient with online access, you can log in here

Per Business and Professions Code section 138, all California physicians and surgeons are required to inform their patients that they are licensed by the Medical Board of California, and must include the Board's contact information. The information must read as follows:

NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov
Cynthia Li, MD
Board Certified Internist

Basic Contact Information

First Name * Middle Name (or initial) Last Name *

Date of Birth *

Social Security Number Nickname/Preferred Name Gender * Pronouns Race Ethnicity

Your Address

Address 1 * Address 2 City * State * Zip Code * Timezone

Contact Information

Mobile Phone Number Home Phone Number Work Phone Number Preferred Contact Number Email Address (Primary) * Secondary Email Address Home Fax Number

Contact Preferences

Non-medical automated notifications (such as informational or educational emails, news about the practice, promotions, or marketing emails) Email: SMS/Text:

Emergency Contact

First Name * Middle Name Last Name * Relationship to Patient Email Address Phone Number *

Insurance Information

Our practice does not bill insurance, but this information is helpful when considering what diagnostic services (labs) or other specialty services to order.

Plan Name Group Number Member ID Insurance Type

Medical Information

Please enter your basic medical information below. You may also add or edit this information after you've signed up.

Height (in INCHES) Weight (in POUNDS) Your Primary Care Provider name and contact information (also list other specialists who are regular providers, such as Psychiatrist or OB/GYN, etc)

Relevant Family Medical History (indicate which family member if applicable)

Set Username and Password for Patient Portal

Please create a username and password that you will use to log into the Patient portal in the future.

Your username must be at least 4 characters long

Username *

Your password must be at least 8 characters long and include at least one number or special character.

Password * Confirm Password *

The patient portal gives you access to your medical records and lets you securely communicate with your doctors. When you sign up, you will receive an email with instructions for logging in.

Credit Card Information

Card Details

Card Number * Card Type * CVV Code *^{What is a CVV?} Expiration Date (mm/yy) * /

Credit Card Billing Address

First name on card * Last name on card * Billing Address * Zip/Postal Code * State/Province *

"I consent to having medical information sent to my email address (we cannot guarantee the security of messages delivered by email)." "I have read and accept the terms of the privacy policy below:" *

PRIVACY POLICY

I am committed to safeguarding your privacy. This privacy policy and agreement (this "Privacy Policy") covers how I collect and use information in my electronic medical records and practice management software system (the "EMR") that can be used to identify you and that was created, used, or disclosed in the course of providing a health care service (your "Protected Information"), which includes information that you provide or access via the patient portal at www.cynthialimd.com (the "Patient Portal").

In this policy, "you" and "your" refer to a user of the Patient Portal, patient, or other person with Protected Information on file with Cynthia Li, MD, Inc.. "I," "my," and "me" refer to Cynthia Li, MD, Inc..

By law, you have a right to access and amend your medical records. I am the custodian of any records created by me or shared with me, which I maintain in accordance with federal and state law.

Please read this policy carefully. By checking the box, clicking on "I Agree", or otherwise signifying acceptance of this privacy policy, you are acknowledging that you have read it, understand it, and are agreeing to be legally bound by the terms provided here.

The Information I Collect

I collect protected information about you in order to provide you with medical services, operate the EMR and the Patient Portal, and respond to your requests.

I collect Protected Information in the form of (1) registration information that you provide in order to enroll as a patient or use the Patient Portal; (2) information that is created, used, or disclosed in the course of providing health care services to you, which I file in your medical record electronically and/or on paper (your "Protected Health Information"); and (3) financial records, such as billing or insurance information, records of payments, and balance statements, related to my provision of health care services to you (your "Billing Information").I do not collect any more Protected Information than reasonably necessary to provide medical services, operate the EMR and the Patient Portal, and respond to your requests.

I may ask you for Protected Information concerning family members or others for whom you are authorized to act as a personal representative. I use this information to create and gather medical records for these people, and will use and disclose this information in the same manner as I use and disclose your Protected Information.

I may use cookies, collect information about your computer and browser, and log usage information.

A cookie is a small amount of data, which often includes an anonymous unique identifier, which is sent from a website and stored on your computer's hard drive. Cookies can be used to provide you with a tailored user experience and to make it easier for you to use a website upon a future visit. I may include cookies on my website or the Patient Portal and use them to recognize you. While you may set your browser so that it does not accept cookies, cookies must be enabled if you wish to access certain personalized features.

I may collect or log information about your system, including your IP address, operating system, web browser, and referrer addresses, as well as the presence of any software that my website or the Patient Portal may require to operate with your computer. I may also record page views, and other general statistical information, which will be aggregated with that of other users and may be disclosed to as anonymous, aggregate information in order to understand how my website and the Patient Portal are being used.

My Use of Your Protected Information

I will not share your Protected Information with any third party, other than as expressly disclosed in this policy. In general, I will use your Protected Information as necessary to provide you with medical care, respond to your requests, and maintain the EMR and the Patient Portal. I will use your Billing Information to obtain payment for medical services that I provide to you.

I will use and disclose your Protected Information in accordance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and its regulations, including the Standards for Privacy of Individually Identifiable Health Information (the "Privacy Rule"), the Security Standards for the Protection of Electronic Protected Health Information (the "Security Rule"), as well as the Health Information Technology for Economic and Clinical Health Act (the "HITECH Act"), and other applicable federal and state laws.

I may send you condition-specific content on an opt-out basis.

Periodically, I may send you news, bulletins, educational materials, marketing materials, or other information based on your Protected Health Information, e.g., targeted to your specific health condition(s). You will have the ability to opt-out of receiving unsolicited communications, but not formal notices concerning (i) operation of the EMR or the Patient Portal or (ii) legal and other related notices concerning your relationship to me.

I may disclose your protected information to staff, or in upon acquisition of my business, provided that safeguards are in place.

In the course of providing products or services to us, my staff and third-party service providers ("Vendors") may have access to your Protected Information. Access to your Protected Information by a Vendor is limited to the information reasonably necessary for the Vendor to perform his or her limited functions for me, and is granted only after the Vendor has contractually promised to protect the privacy of your information consistent with this Privacy Policy.

I may transfer to a third party information I collect, including any Protected Information, in connection with a sale or transfer (or potential sale or transfer) of the business entity responsible for the information under this Privacy Policy, provided the acquiring third party agrees to privacy safeguards that are equivalent to or stronger than those outlined in this Privacy Policy.

I may disclose your protected information as required by law or to prevent imminent harm.

I will reveal your Protected Information to the extent I reasonably believe I am required to do so by law. If I receive legal process calling for the disclosure of your Protected Information, I will attempt to notify you via the email address you supplied during registration before I respond to the request, unless such notification is prohibited or is not feasible.

As permitted by law, I may disclose your Protected Information if I reasonably believe that disclosure is necessary to eliminate or reduce significant risk of serious bodily harm or death.

I may disclose anonymous, aggregate information.

"Aggregate Information" is anonymous, aggregated information relating to a group of people, from which individuals’ identities or individually-identifiable characteristics have been removed. For example, Aggregate Information may include statistical information and analyses concerning: the use of my services, Patient Portal usage, website page views, or health statistics, treatments, or conditions.

I may disclose Aggregate Information to third parties, and may use or disclose Aggregate Information in order to undertake or commission statistical and other summary analyses. Aggregate Information provided to third parties will not allow anyone to identify you, or determine anything personal about you.

I will notify you if I become aware of any unauthorized access to your Protected Information.

If I detect or become aware of any unauthorized access to your Protected Information, I will notify you and/or the Secretary of Health and Human Services in accordance with HIPAA, the Privacy Rule, the Security Rule, the HITECH Act, and other applicable federal and state laws.

Access to Protected Information via the Patient Portal

I may provide you with access to your Protected Information via the Patient Portal at my discretion as a convenience to you. I reserve the right to suspend your Patient Portal account at any time.

My security systems are structured to prevent the loss or misuse of your Protected Information. However, regardless of my security measures, anyone with your password and account information can access your Patient Portal account. You are solely responsible for maintaining the secrecy of your password and account information.

You may disable Patient Portal access to all or some of your Protected Information by sending me a written request to that effect. Doing so does not affect my records, but only determines whether those records are accessible via the Patient Portal.

Changes to this Privacy Policy

I reserve the right to change this Privacy Policy at any time. If I make any changes to this Privacy Policy, you will be prompted to accept the revised Privacy Policy in order to continue using the Patient Portal. If I make any changes regarding disclosure of your Protected Information to third parties, I will attempt to contact you prior to the date that the modified policy is scheduled to take effect via your current email address on file.

Effective Date

The effective date of this Privacy Policy is November 21st, 2024.

I have read and agreed to the terms of this Client Registration and Agreement. By checking this box, I consent to the following in the use of telemedicine (the use of electronic communications in lieu of an in-person visit):

1. I understand the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine which identifies me will be disclosed to researchers or other entities without my consent.

2. I understand I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.

3. I understand I have the right to inspect all information obtained in the course of a telemedicine interaction, and may receive copies of this information for a reasonable fee. Note: Dr. Li's tele-consults are not recorded. I agree to refrain from recording (by video, audio or any other means) any session without my provider's knowledge and consent.

4. I understand a variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time, as they are available.

5. I understand telemedicine may involve electronic communication of my electronic medical records to other medical practitioners who may be located in other areas, including out of state.

6. I understand I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.

7. I understand there are risks and consequences from telehealth, including, but not limited to, the possibility, despite reasonable efforts on the part of my provider, that: the transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons. I understand that my provider or I can discontinue the telehealth consult if it is felt that the videoconferencing connections are not adequate for the situation.

For patients with Medicare, please note that I have opted out of Medicare. This means no Medicare payment can be made to me. Additionally, no Medicare payment can be made to a beneficiary for items or services provided directly by me and you may not apply for reimbursement. (This exclusion does NOT apply to labs and certain diagnostic tests.).

This is the only way I can provide in-depth services to all my patients, including those older than 65 years of age.

The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.

Please check to acknowledge this.

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