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.
We understand that medical information about you福彩app是正规的吗 and you福彩app是正规的吗r health is personal. We are committed to protecting you福彩app是正规的吗r health information. We refer to this information as "Protected Health Information" or "PHI". We create a record of the care and services you福彩app是正规的吗 receive from Hillsides. We need this record to provide you福彩app是正规的吗 with quality care and to comply with certain legal and payment requirements. This notice will tell you福彩app是正规的吗 about the ways in which we may use and disclose you福彩app是正规的吗r PHI. We also describe you福彩app是正规的吗r rights and certain obligations we have regarding the use and disclosure of you福彩app是正规的吗r PHI.
We are required by law to:
- Keep you福彩app是正规的吗r PHI private;
- Notify you福彩app是正规的吗 of our legal duties and privacy practices concerning you福彩app是正规的吗r PHI;
- Notify you福彩app是正规的吗 if you福彩app是正规的吗r PHI is affected by a breach; and
- Follow the terms of the notice that is currently in effect.
1. Uses and Disclosures We May Make Without Written Authorization
We may use or disclose you福彩app是正规的吗r PHI for certain purposes without you福彩app是正规的吗r authorization, including:
Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of treatment. For example, you福彩app是正规的吗r health information may be used by our staff to send you福彩app是正规的吗 appointment reminders, and we may disclose PHI to other health care professionals so that they may treat you福彩app是正规的吗 and so that we can coordinate the services we provide to you福彩app是正规的吗. We may use you福彩app是正规的吗r health information to send you福彩app是正规的吗 information on you福彩app是正规的吗r treatment and treatment alternatives.
Payment. Your health information may be used or disclosed to seek payment for our services from you福彩app是正规的吗r health plan or from other sources of coverage. For example, we may need to give information about you福彩app是正规的吗 to you福彩app是正规的吗r health plan to obtain preauthorization for treatment or reimbursement for our services.
Health care operations. Your health information may be used or disclosed to support the day-to-day activities that are necessary for the operations and management of Hillsides and ensure that our patients receive quality care. For example, we may use information to train our staff or review their performance.
Other Uses and Disclosures. We may also use or disclose you福彩app是正规的吗r PHI for certain other purposes permitted by application federal or state law and regulations, including:
- Process & Proceedings. We may disclose information in response to a court or administrative order, subpoena, discovery request, or other lawful process.
- Specialized governmental functions, including to correctional institutions. We may disclose information about an inmate or other person in lawful custody to an official or correctional institution, or in other law enforcement custodial situations.
- Required by law. We may disclose information when required by law to do so.
- Public health reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department. We are also required to report child abuse and neglect.
- Abuse, neglect, and domestic violence. We may disclose information concerning victims of abuse, neglect, or domestic violence to the appropriate government agency.
- Health oversight activities. We may disclose information to health oversight agencies for health oversight activities including audits, investigations, licensure or disciplinary actions.
- Serious threats to health or safety. We may disclose information to necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
- Social services agencies and agencies providing public benefits. We may disclose information to social service agencies. For example, under our contract with the Department of Mental Health, if you福彩app是正规的吗r case becomes open with Department of Children and Family 福彩app是正规的吗 (DCFS), there is automatic sharing of information including date of intake agency and primary therapist providing treatment to the DCFS County Social Worker (CSW). Likewise, DCFS will share information back to the mental health provider pertaining to the open case, CSW and Supervisor information.
- Research. We may use or disclose information for research purposes, if certain conditions are satisfied.
- Law enforcement. Your health information may be disclosed to law enforcement agencies to facilitate law-enforcement investigations, and to comply with government mandated reporting. We may disclose to a law enforcement official concerning the PHI of a suspect, fugitive, material witness, crime victim or missing person, or a crime committed on our premises.
2. Disclosures We May Make Unless You Object
Unless you福彩app是正规的吗 tell us otherwise, we may disclose you福彩app是正规的吗r information for the following purposes:
Individuals Involved in Your Care or Payment for Your Care. We may disclose PHI about you福彩app是正规的吗 to a family member, friend, or other person you福彩app是正规的吗 designate if you福彩app是正规的吗 give us permission to do so, which you福彩app是正规的吗 can do orally. We will limit the disclosure to information relevant to that person’s involvement in you福彩app是正规的吗r care or payment for you福彩app是正规的吗r care.
Fundraising. Unless you福彩app是正规的吗 request us not to, we will use you福彩app是正规的吗r name and address to support our fund-raising efforts. If you福彩app是正规的吗 do not want to participate in fund-raising efforts, please check the appropriate box on the Acknowledgement of Notice of Privacy Practices.
Facility Directory. We may use and disclose information to maintain our residential treatment facility directory. If a person asks for you福彩app是正规的吗 by name, we will only disclose you福彩app是正规的吗r name, general condition, and location in our facility, but only if the law permits us to do so. We may also disclose you福彩app是正规的吗r religious affiliation to clergy.
3. Other Uses and Disclosures Require Your Authorization
Disclosure of you福彩app是正规的吗r health information or its use for any purposes other than those listed above requires you福彩app是正规的吗r specific written authorization. If you福彩app是正规的吗 change you福彩app是正规的吗r mind after authorizing a use or disclosure of you福彩app是正规的吗r information, you福彩app是正规的吗 may submit a written revocation of the authorization. However, you福彩app是正规的吗r decision to revoke the
authorization will not affect or undo any use or disclosure of you福彩app是正规的吗r information that occurred before you福彩app是正规的吗 notified us of you福彩app是正规的吗r decision to revoke you福彩app是正规的吗r authorization.
Without you福彩app是正规的吗r authorization, we are expressly prohibited to use or disclose you福彩app是正规的吗r protected health information for marketing purposes and we are specifically required to disclose in such authorization if financial remuneration is involved in such marketing. We may not sell you福彩app是正规的吗r protected health information without you福彩app是正规的吗r authorization. We may not use or disclose most psychotherapy notes contained in you福彩app是正规的吗r protected health information without you福彩app是正规的吗r authorization.
4. Your Individual Rights Concerning Your PHI
You have certain rights under the federal privacy laws. These include:
a. The right to request restrictions on the use and disclosure of you福彩app是正规的吗r protected health information
b. The right to receive confidential communications concerning you福彩app是正规的吗r treatment
c. The right to inspect and copy you福彩app是正规的吗r protected health information
d. The right to amend or submit corrections to you福彩app是正规的吗r protected health information
e. The right to receive an accounting of how and to whom you福彩app是正规的吗r protected health information has been
f. The right to receive a printed copy of this notice.
This section explains you福彩app是正规的吗r rights and some of our responsibilities to help you福彩app是正规的吗
Get an electronic or paper copy of you福彩app是正规的吗r medical record
- You can ask to see or get an electronic or paper copy of you福彩app是正规的吗r medical record and other health information we have about you福彩app是正规的吗. Ask us how to do this.
- We will provide a copy or a summary of you福彩app是正规的吗r health information, usually within 30 days of you福彩app是正规的吗r request.
Ask us to correct you福彩app是正规的吗r medical record
- You can ask us to correct health information about you福彩app是正规的吗 that you福彩app是正规的吗 think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to you福彩app是正规的吗r request, but we’ll tell you福彩app是正规的吗 why in writing within 30 days.
Request confidential communications
- We normally contact you福彩app是正规的吗 by telephone at you福彩app是正规的吗r 福彩app是正规的吗, cell or at you福彩app是正规的吗r 福彩app是正规的吗 address
- You can ask us to contact you福彩app是正规的吗 in a specific way (for example, 福彩app是正规的吗, cell or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to you福彩app是正规的吗r request, and we may say “no” if it would affect you福彩app是正规的吗r care.
- If you福彩app是正规的吗 pay for a service or health care item out-of-pocket in full, you福彩app是正规的吗 can ask us not to share that information for the purpose of payment or operations with you福彩app是正规的吗r health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared you福彩app是正规的吗r health information for six years prior to the date you福彩app是正规的吗 ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you福彩app是正规的吗 asked us to make).
Choose someone to act for you福彩app是正规的吗
- If you福彩app是正规的吗 have given someone medical power of attorney or if someone is you福彩app是正规的吗r legal guardian, that person can exercise you福彩app是正规的吗r rights and make choices about you福彩app是正规的吗r health information.
- We will make sure the person has this authority and can act for you福彩app是正规的吗 before we take any action.
Get a copy of this notice
- You may obtain a paper copy of this Notice upon request.
- You may receive a paper copy, even if you福彩app是正规的吗 agreed to receive electronic notices from us.
5. Right to Revise Privacy Practices and Changes to This Notice
As permitted by law, we reserve the right to amend or modify our privacy policies and practices at any time. These changes in our policies and practices may be required by changes in federal and state laws and regulations. If we materially change our privacy policies and practices, we will revise this Notice and post a copy of the current Notice in our reception areas and on our website. Upon request, we will provide you福彩app是正规的吗 with the most recently revised notice. The revised policies and practices will be applied to all protected health information we maintain, regardless of when we received it.
If you福彩app是正规的吗 would like to submit a comment or complaint about our privacy practices, or believe that you福彩app是正规的吗r privacy rights have been violated, you福彩app是正规的吗 should call the matter to our attention by sending a letter outlining you福彩app是正规的吗r concerns to: Toni Aikins, Ph.D., Privacy Officer, Hillsides Support 福彩app是正规的吗:
815 Colorado Blvd., Suite 300, Los Angeles, CA 90041. T (323) 543.2800, ext.218
You can also file a complaint with the U.S. Department of Health and Human 福彩app是正规的吗 Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling , or visiting .
You will not be penalized or otherwise retaliated against by us, for filing a complaint.
7. Contact Person
If you福彩app是正规的吗 have any questions about this Notice, or if you福彩app是正规的吗 want to exercise any right explained above, or complain about any use or disclosure of you福彩app是正规的吗r information, the name and address of the person you福彩app是正规的吗 may contact is: Toni Aikins, Ph.D., Privacy Officer, Hillsides Support 福彩app是正规的吗: 815 Colorado Blvd., Suite 300, Los Angeles, CA 90041 T (323) 543.2800, ext.218 C (661) 803-1063
8. Effective Date This notice is effective on or after 5/23/2016, TA
940 Avenue 64
Pasadena, CA 91105