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HIPAA NOTICE OF PRIVACY PRACTICES Effective Date: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU/YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT. If you have any questions about this notice, please contact the Privacy Officer at Community Family Guidance Center (the Center), 10929 South Street, Suite 208B, Cerritos, CA 90703. WHO WILL FOLLOW THIS NOTICE. This notice describes Community Family Guidance Center=s practices and that of: < All students, interns, employees, consultants. < All departments, sites and locations of the Center, < All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share health information with each other for treatment, payment or operations purposes described in this notice. OUR PLEDGE REGARDING MEDICAL INFORMATION: We understand that information about you and/or your child=s health is personal. We are committed to protecting information about you/your child. Each time you meet with a clinician, a record is made of your visit. Typically, this record contains your concerns, symptoms, diagnosis, treatment, and plans for future care. This information, often referred to as your health or medical record, is needed to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your/your child=s care generated by the Center. This notice will tell you about the ways in which we may use and disclose medical information (AProtected Health Information@or APHI@) about you/your child without written authorization. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. We are required by law to: < Make sure that health information that identifies you/your child is kept private; < Give you this notice of our legal duties and privacy practices with respect to health information about you/your child; and < Follow the terms of the notice that are currently in effect. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATON ABOUT YOU/YOUR CHILD. The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. < For Treatment. We may use your/your child=s PHI to provide treatment or services. We may disclose PHI to members of your treatment team, including specialists and consulting staff at the Center. For example, a therapist providing mental health services targeting symptoms of depression may need to consult with the psychiatrist about your/your child=s response to psychotropic medication. In addition, the therapist may need to consult with our Case Manager to investigate supportive services, such as respite care. Different departments of the Center may also share health information about you/your child in order to coordinate the different things you need, such as appointments, prescriptions, lab work, resources, or other treatment modalities, such as group treatment. < For Payment. We may use and disclose your/your child=s PHI to obtain payment for services that we provide to you/your child. For example, we may need to give your health plan information about your/your child=s treatment so your health plan will pay us or reimburse you. Many services are funded through contracts with Los Angeles County Department of Mental Health that mandate we report demographic, outcome, and other health information, including your/your child=s diagnoses. We may also disclose information about you/your child to personnel of cities that provide us with funding to provide services to its residents < For Health Care Operations. We may use and disclose PHI about you/your child for Center operations. These uses and disclosures are necessary to run the Center and make sure that all of our consumers receive quality care. For example, we may call you/your child by name in the waiting room for your appointment. We may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you/your child. We may combine health information about many consumers to decide what additional services the Center should offer and the most effective way of doing so. We may disclose information to interns and other Center personnel for review and learning purposes. < Business Associates. There are some services provided in our organization through contacts with business associates. One example is a medical records storage facility that stores closed charts. To protect your health information, we require business associates to appropriately safeguard your information. < Appointment Reminders. We may use and disclose health information to contact you as a reminder that you/your child has an appointment for care at the Center. < Individuals Involved in Your/Your Child=s Care. We may release medical information about you/your child to a friend or family member who is involved in your medical care. For example, if you designate another individual to bring your child in for services, and during the course of treatment important information needs to be shared in order to care for immediate needs of the child, we may share this information. < Disaster Relief. We may disclose health information about you/your child to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. < To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you/your child when necessary to prevent a serious threat to your/your child=s health and safety or the health and safety of the public or another person. For example, if a therapist believes a client poses a serious threat of harm to him/herself or is engaging in serious self-destructive activity, the therapist may be required to contact family members or others who can help provide protection or hospitalization. If a client communicates a threat of serious bodily harm to another, the therapist will be required to take protective actions, which may include notifying the potential victim and the police and/or seeking appropriate hospitalization. < Public Health Risks. We may disclose health information about you/your child for public health activities. For example, if a therapist suspects that a child, an elderly person, or a disabled person is being abused, she/he will be required to file a report with the appropriate agency. < Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health system, government programs, and compliance with civil rights laws. < As Required By Law. We will disclose health information about you/your child when required to do so by federal, state or local law. SPECIAL SITUATIONS < Lawsuits and Disputes. Certain legal circumstances may require us to disclose health information about you/your child. For example, if records were subpoenaed or if a judge ordered release of records. < Law Enforcement. We may release health information if asked to do so by a law enforcement official: In response to a court order, subpoena, warrant, summons or similar process; About criminal conduct at the Center; and In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. < Specialized Government Functions. We may use or disclose your PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances. < Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU. You have the following rights regarding medical information we maintain about you/your child. < Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your/your child=s care. Usually, this includes medical and billing records, but may not include some mental health information.. To inspect and copy information that may be used to make decisions about you, you must submit your request in writing to the Center=s Clinical Director. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. You should take note that, if you are a parent or legal guardian of a minor, certain portions of the minor=s medical record will not be accessible to you, for example, records pertaining to health care services for which the minor can lawfully give consent and therefore for which the minor has the right to inspect or obtain copies of the record; or the health care provider determines, in good faith, that access to the patient records requested by the representative would have a detrimental effect on the provider=s professional relationship with the minor patient or on the minor=s physical safety or psychological well-being. If you are denied access to health information, you may request that the denial be reviewed. Another licensed mental health professional chosen by the Center will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. < Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Center. To request an amendment, your request must be made in writing and submitted to the Center=s Clinical Director. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: C Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; C Is not part of the health information kept by or for the Center; C Is not part of the information which you would be permitted to inspect and copy; or C Is accurate and complete. Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your medical records, we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect. < Right to an Accounting of Disclosures. You have the right to request an Aaccounting of disclosures.@ This is a list of the disclosures we made of health information about you/your child other than our own uses for treatment, payment, and health care operations, or for which you signed an authorization. The accounting will include those other functions described above. To request this list or accounting of disclosures, you must submit your request in writing to the Center=s Clinical Director. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you $0.25 per page. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. < Right to Request Restrictions You have the right to request a restriction or limitation on the health information we use or disclose about you/your child for treatment, payment or health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you/your child with emergency treatment. To request restrictions, you must make your request in writing to the Center=s Clinical Director. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. < Right to Request Confidential Communications. You have the right to request that we communicate with you/your child about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Center=s Clinical Director. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. < Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at our website, www.cfgconline.com You may request a paper copy of this notice from the Center staff providing your treatment. CHANGES TO THIS NOTICE We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the Center. Should our information practices change, we will provide you with a revised notice at the time of your appointment. The effective date will be on the first page. In addition, each time you apply to the Center for services, we will offer a copy of the current notice in effect. You may request this notice at any time from the Reception Staff. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with the Center by contacting the Clinical Director, Community Family Guidance Center, 10929 South Street, Suite 208B, Cerritos, CA, 90703, or with the Secretary of the Department of Health and Human Services (listed below). All complaints must be submitted in writing. You will not be penalized for filing a complaint. U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Ave., S.W., Room 509F Washington, DC 90201 |