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, please contact our Privacy Officer, whose name and number is at the bottom of this notice.
Our Duty to Safeguard Your Protected Health Information.
Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered “Protected Health Information” (“PHI”). We are required to extend certain protections to your PHI, and to give you this Notice about our privacy practices that explain how, when, and why we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the purpose of the use of disclosure.
We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, we will post a new Notice in waiting rooms, with the receptionist at the unit where you receive services.
How We May Use and Disclose Your Protected Health Information.
We may use and disclose PHI for a variety of reasons. Most uses and disclosures of PHI – including psychotherapy notes – require your authorization. We have a limited right to use and/ or disclose your PHI for purposes of treatment, payment, or operations. For uses beyond that, we must have your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must have in place an agreement from the outside entity that it will extend the same degree of privacy protection to your information, as we must apply to your PHI. However, the law provides that we are permitted to make some uses/disclosures without your consent or authorization. The following offers more description and examples of our potential uses/disclosures of your PHI. Uses and disclosures of PHI that are not described in this notice will not be made without your written authorization.
✵ Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.
Generally, we may use or disclose your PHI as follows:
⮚ For treatment: We may disclose your PHI to doctors, nurses, and other health care personnel who are involved in providing your health care. For example, your PHI will be shared among members of your treatment team. Your PHI may also be shared with outside entities performing ancillary services relating to your treatment, such as lab work or for consultation purposes, or other health agencies involved in provision and/or coordination of your care.
⮚ To obtain payment: We may use/disclose your PHI in order to bill and collect payment for your health care services. For example, we may contact your employer and/or release portions of your PHI to the Medicaid program, the Medicare program, the local Vocational Rehabilitation office, and Private insurer to get paid for services we delivered to you.
⮚ For health care operations: We may use/ disclose your PHI in the course of operating our Mental Health, Substance Abuse, Mental Retardation/Developmental Disabilities, and Family or Children’s service programs. For example, we may take your photograph for medication identification purposes, use your PHI in evaluating the quality of services provided, or disclose your PHI to our accounting department or attorney for audit purposes. Since we are an integrated system, we may disclose your PHI to designated staff in our central office or our support services for similar purposes. Release of your PHI to the Regional Board and/or state agencies might also be necessary to determine your eligibility for publicly funded services.
⮚ Appointment Reminders: Unless you provide us with alternative instructions, we may send appointment reminders and other similar materials to your home.
✵ Uses and Disclosures Requiring Authorization:
For uses and disclosures beyond treatment, payment, and operations purposes, we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. Authorizations can be revoked any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.
✵ Uses and Disclosures of PHI from Mental Health Records Not Requiring Consent or Authorization:
The law provides that we may use/disclose your PHI from mental health records without consent or authorization in the following circumstances:
⮚ When required by law: We may disclose PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.
⮚ For public health activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority.
⮚ For health oversight activities: We may disclose PHI to our central office, the protection and advocacy agency, or another agency responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents.
⮚ Relating to decedents: We may disclose PHI relating to an individual’s death to coroners upon request.
⮚ For research purposes: In certain circumstances, and under supervision of a privacy board, we may disclose PHI to our central office research staff and their designees in order to assist medical/psychiatric research.
⮚ To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably present or lessen the threat of harm.
⮚ For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.
✵ Uses and Disclosures of PHI from Alcohol and Other Drug Records Not Requiring Consent or Authorization:
The law provides that we may use/disclose your PHI from alcohol and other drug records without consent or authorization in the following circumstances:
⮚ When required by law: We may disclose PHI when a law requires that we report information about suspected child abuse and neglect, or when a crime has been committed on the program premises or against program personnel, or in response to a court order.
⮚ Relating to decedents: We may disclose PHI relating to an individual’s death if state or federal law requires the information for collection of vital statistics or inquiry into cause of death.
⮚ For research, audit, or evaluation purposes: In certain circumstances, we may disclose PHI for research, audit, or evaluation purposes.
⮚ To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI to law enforcement when a threat is made to commit a crime on the program premises or against program personnel.
✵ Uses and Disclosures Requiring You to have an Opportunity to Object:
In the following situations, we may disclose a limited amount of your PHI if we inform you about the disclosure in advance and you do not object, as long as the disclosure is not otherwise prohibited by law. However, if there is an emergency situation and you cannot be given your opportunity to object, disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest. You must be informed and given an opportunity to object to further disclosure as soon as you are able to do so.
Your Rights Regarding Your Protected Health Information.
You have the following rights relating to your protected health information:
⮚ To request on uses/disclosures: You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to any restrictions on our use/disclosure of your PHI, we will put the agreement in writing and abide by it, except in emergency situations. We cannot agree to limit uses/disclosures that are required by law.
⮚ To choose how we contact you: You have the right to ask that we send you information at an alternative address or by an alternative means. We must agree to your request as long as it is reasonably easy for us to do.
⮚ To inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, you have the right to see your protected health information upon your written request. We will respond to your request within thirty days. If we deny your access, we will give you written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed, depending on your circumstances. You have the right to choose what portions of your information you want copied and to have prior information on the cost of copying.
⮚ To request amendment of your PHI: If you believe that there is a mistake or missing information in our record of your PHI, you may request, in writing, that we correct or add to the record. We will respond within 60 days of receiving your request. We may deny the request if we determine that the PHI is: (i) correct and complete, (ii) not created by us and/or not part of our records, or; (iii) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your PHI. If we approve the request for amendment, we will change the PHI and so inform you, and tell others that need to know about the changes in the PHI.
⮚ To find out what disclosures have been made: You have the right to get a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure: for treatment, payment, and operations; to you, your family; or pursuant to your written authorization. The list also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or before April, 2003. We will respond to your written request for such a list within 60 days of receiving it. Your request can relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent requests.
⮚ To receive this notice: You have a right to receive a paper copy of this Notice and/or an electronic copy by email upon request.
To receive notice of a breach: We will notify you if your PHI has been breached.
To request restriction of PHI to your health plan: if you pay cash in full for a specific service, you can request information relating to that service not be disclosed to your health plan.
How to Complain about our Privacy Practices:
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed below. You also may file a written complaint with the Secretary of the U.S. Department of Health and Human Services at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
We will take no retaliatory action against you if you make such complaint.
Contact Person for Information, or to Submit a Complaint:
If you have questions about this Notice or any complaints about our privacy practices, please contact: