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HIPAA Policy (Health Insurance Portability and Accountability Act of 1996)


Dr. Gindi and the Century City Primary Care, LLC staff ensure that all patients’ medical records are maintained and protected for confidentiality consistent with legal, current, and standardized regulations. Personnel having access to patient protected health records have been instructed in HIPAA rules and regulations and must sign an attestation noting confidentiality rules. Each patient’s protected health record will be filed, stored, and restricted from public access. All patients have the ability to review, inspect, and/or obtain a copy of their protected health information in their medical record. It at any time a patient feels there has been a breach of this confidentiality, they should notify the office immediately. Below you will find our form signed by each and every patient and included in their medical record.


Click Here for Dr. Gindi's HIPAA Policy Form.

Release of Medical Records


Release of medical records is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). No records are released from Dr. Gindi’s office without specific consent by patients or their legal representatives. This includes records released to insurance companies, medical organizations, or other physicians. Below you will find a form for permission to release medical records. This must be specific, signed and dated. 


Click Here for Dr. Gindi's Release of Medical Records and Consent to Discuss Medical Care forms. 

Financial Policy


Dr. Gindi and his office personnel provide medical services as a traditional fee for service practice based upon one fee schedule. The office is not a "concierge" practice and does not charge a retainer fee. We do not provide different services for different levels of payment. Payments are made payable to Elie M. Gindi, MD, Inc.


Federal ID 95-4015444


Dr. Gindi is not a participating provider for any HMO, PPO, or EPO, and he is not contracted with any provider for Care California. Payment is due in full at the time of service unless arrangements have been made with office personnel in advance. The office will provide patients with a charge slip with the necessary billing information to submit to insurance including provided services, charges, and diagnosis codes. Most PPO and some other plans will reimburse the insured for a portion of charges. It is the patient's responsibility to contact their insurance company to determine the amount insurance will reimburse for services rendered by a "non-participating provider." Dr. Gindi's charges are not dependent upon the level of "charge allowance" or reimbursement by insurance companies. The office accepts cash, checks, Master Card, Visa, American Express, and Discover. There will be a $20.00 charge on all returned checks.


Click Here for Dr. Gindi's complete financial policy information.

Medicare Policy


As of June 30, 2014, Dr Gindi is no longer a participating Medicare Provider. This status is called "opt out." Per Medicare regulations, Medicare participants in Part B must sign an affidavit stating that they understand that Medicare cannot be billed for services rendered. Most Medigap or secondary insurances will not pay for any services. Individuals can check with their providers to see if that is the case with their policy. Payment is due if full at the time of service. The office accepts cash, checks, Master Card, Visa, American Express, and Discover. There will be a $20.00 charge on all returned checks.


Dr. Gindi is not a provider for State Medical services.


Click Here to review the affadavit for Medicare Opt-out Patients.

Advanced Directive and POLST

The following is adapted from the California Medical Association (CMA) site on Advance Directives.


California law provides individuals the ability to insure that their health care wishes are known and considered if they become unable to make these decisions themselves. The California Medical Association (CMA) encourages Californians to think and talk with loved ones about their wishes for end-of-life medical care, before a serious illness or injury occurs.


In California, an Advance Health Care Directive is the legally recognized format for a “living will” and it has replaced the Durable Power of Attorney for Health Care (or “DPAHC”). It does not require and attorney or notary. It requires the signature of an adult witness.


An Advance Health Care Directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. Patients may write down their health care wishes in the Advance Health Care Directive form. For example, a desire not to receive treatment that only prolongs the dying process if seriously ill. Doctors and other providers must follow patient's lawful instructions within the limits of generally accepted health care standards.


An advance directive allows a patient to appoint a health care "agent" who will have legal authority to make health care decisions in the event that patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority. This person is also known as an “Attorney-in-fact.”


An Advance Health Care Directive also allows patients to express their wishes about organ and tissue donation.


Due to copyright laws, the CMA Advanced Directive form cannot be viewed here or downloaded. Individuals can access useful information and purchase forms from the CMA website below. Dr. Gindi has the forms available to patients at no charge.


POLST (Physician Orders for Life-Sustaining Treatment) is intended to complement an Advance Health Care Directive, particularly for those who are seriously ill or have been diagnosed with a terminal illness. Having a completed and fully executed POLST form means that patient end-of-life health care wishes have been translated into actionable physician orders. POLST can help ensure that a patient’s health care wishes are implemented and followed without any delay. POLST can help emergency medical personnel or others in the event of an emergency, and specifically what life sustaining measures are to be undertaken or withheld according to a patient’s wishes.


POLST does not require and attorney or notary, but does require physician and adult witness signatures. Dr. Gindi’s staff has copies or you can download or copy the form.


Information and a dowloadable POLST form can be found at


Click Here to view POLST form.



Individuals can find useful end of life and directive information from the CMA website:


For more information about end-of-life medical decisions, also visit the Coalition for Compassionate Care of California website at


The booklet “Finding Your Way” is a useful guide to thinking about and discussing these issues. Center for Healthcare Decisions, 3400 Data Drive, Rancho Cordova, CA 95670 or order it through their website at

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