State Hospitals - 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.

A. WHO WILL FOLLOW THIS NOTICE

This notice describes our Department of State Hospitals practices and that of:

• Any health care professional authorized to enter information into your health record.
• All departments, units, clinics, facilities, and offices.
• Any member of a volunteer group we allow to help you while you are in our care.
• All employees, staff, and other personnel.
• Any business associates we contract to conduct services on our behalf including, but not limited to, the Conditional Release Program (CONREP), the Jail Based Competency Treatment programs (JBCT), and the Admission, Evaluation, and Stabilization Center (AES).

All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites, and locations may share your information with each other for treatment, payment or health care operations purposes described in this notice.

B. OUR PLEDGE REGARDING MEDICAL AND/OR MENTAL/BEHAVIORAL HEALTH INFORMATION

• We understand that information about you and your health is personal.
• We are committed to protecting information about you.
• We create a record of care and services you receive. We need this record to provide you with the quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by us, whether made by your personnel or your provider. Your provider may have different policies or notices regarding the use and disclosure of your information created in the provider's office or clinic.

This notice will tell you about the ways in which we may use and disclose information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your information.

We are required by law to:

• Make sure that information that identifies you is kept private (with certain exceptions including when required by law);
• Give you this notice of our legal duties and privacy practices with respect to information about you; and
• Follow the terms of the notice that is currently in effect.

C. HOW WE MAY USE AND DISCLOSE YOUR MEDICAL AND/OR MENTAL/BEHAVIORAL HEALTH INFORMATION

The categories listed below describe the ways we use and disclose information. For each category of uses or disclosures, we will explain what we mean and 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.

1) Disclosure at Your Request

We may disclosure your information when requested by you, but may require a written authorization by you.

2) For Treatment

We may use information about you to provide you with medical treatment or services. We may disclose information about you to doctors, nurses, technicians, health care students, or other personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. For example, a doctor treating you for a mental health condition may need to know what medications you are currently taking, because the medications may affect what other medications may be prescribed for you.

3) For Payment

We may use and disclose information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give information about treatment you received to the Centers for Medicaid and Medicare Services so it will pay us or reimburse you for the treatment.

4) For Health Care Operations

We may use and disclose information about you for health care operations. These uses and disclosures are necessary to run our facility and make sure that all of our patients receive quality care. For example, we may use information to review our treatment and services and to evaluate the performance of our staff in caring for you.

5) Incidental Uses and Disclosures

There are certain incidental uses or disclosures of your health information that occur while we are providing services to you or conducting our business. For example, other individuals waiting in the same area may hear your name called. We will make reasonable efforts to limit these incidental uses and disclosures.

6) Family Members or Others You Designate

If a request for information is made by your spouse, parent, child, or sibling and you are unable to authorize the release of this information, we are required to give the requesting person notification of your presence in our facility. Unless you request that this information not be provided, we must make reasonable attempts to notify your next of kin or any other person designated by you, for your release, transfer, serious illness, injury, or death only upon request of the family member.

7) To Individuals Involved in Your Care or Payment for Your Care

We may release information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose information about you to an organization assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

8) Research

Under certain circumstances, we may use and disclose information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition.

9) As Required by Law

We will disclose about you when required to do so by federal, state or local law.

10) To Avert a Serious Threat to Health or Safety

We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

11) Health Information Exchange

We may share your health information electronically with other groups through a Health Information Exchange network. These other groups may include hospitals, laboratories, doctors, public health departments, health plans, and other participants. Sharing data electronically is a faster way to get your health data to the providers treating you. For example, if you travel and need treatment, it allows other doctors that participate to electronically access your information to help care for you. We are also involved in the Affordable Care Act and may use and share information as permitted to achieve national goals related to meaningful use of electronic health systems.

12) Special Situations

D. YOUR RIGHTS REGARDING MEDICAL AND/OR MENTAL/BEHAVIORAL HEALTH INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

1) Right to Inspect and Copy

We may disclose information when requested by you and may require a written authorization by you.

To inspect and/or request a copy of this medical information, you must submit your request in writing to the Privacy Officer at your hospital as listed below. If you request a copy of the information, we may charge a fee for the costs of copying associated with your request. There will be no charge for copies of records needed to support an appeal regarding eligibility for a public benefit program.

We may deny your request to inspect and/or copy your records under very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed health care professional, chosen by us, 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.

2) Right to Amend

If you feel that information we have about you is incorrect or incomplete, you may request to amend the information. You have the right to request an amendment for as long as the information is kept by us. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at your hospital whose contact information is the chart below. In addition, you may provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing, or if we believe a reason is necessary for an amendment and your request for amendment does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the information kept by or for us;
• Is not part of the information which you would be permitted to inspect and copy; or
• 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 health record 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.

3) Right to an Accounting of Disclosures

You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of information about you other than our own uses for treatment, payment and health care operations (as those functions are described above), and with other exceptions by law.

To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer at your hospital whose contact information is in the chart below. 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 or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. 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. In addition, we will notify you as required by law following a breach of your unsecured protected health information.

4) Right to Request Restrictions

You have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request, unless you request us to restrict disclosure to a health plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the health plan or insurer), has paid for the item or service out of pocket in full. Note however, that if a health plan or insurer requires this information for purposes of treating you, we may still disclose the information, even if you request the restriction for purposes of payment or health care operations.

If we agree to another special restriction, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to the Privacy Officer at your hospital whose contact information is in the chart below. 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.

5) Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you in writing or by mail.

To request confidential communications, you must make your request in writing to the Privacy Officer at your hospital whose contact information is in the chart below. 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.

6) 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. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice at our website: www.dsh.ca.gov

To obtain a paper copy of this notice submit a request to the Privacy Officer at your hospital.

E. CHANGES TO NOTICE OF PRIVACY PRACTICES

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for 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 facility. The notice will contain the effective date on the first page.

F. COMPLAINTS

You may also file a complaint with the Secretary of the federal Department of Health and Human Services. The complaint should be submitted to:

Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
Phone (800) 368-1019; Fax (202) 619-3818;
TDD (800) 537-7697
E-mail: ocrmail@hhs.gov
https://www.hhs.gov/ocr

G. OTHER USES OF MEDICAL AND/OR MENTAL/BEHAVIORAL HEALTH INFORMATION

Other uses and disclosures of information not covered by this notice of the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose information about you, you may revoke the permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your information for the purposes covered by your written authorization, except if we have already acted in reliance on your permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.