ELEVATE ADDICTION SERVICES
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.
October 6, 2015
SUMMARY OF YOUR PRIVACY RIGHTS
At Elevate Addiction Services (“EAS”), we are committed to preserving the privacy and confidentiality of your health information whether created by us or maintained on our premises. We are required by certain federal and state regulations to implement policies and procedures to safeguard the privacy of your health information. Copies of our privacy policies and procedures are maintained in the legal office at our main address listed hereunder. We are required by federal and state regulations to abide by the privacy practices described in this notice and any future revisions that we may make to the notice as may become necessary or as authorized by law.
Protected health information is any individually identifiable information about your past, present, or future physical or mental health or condition, the provisions of health care to you, or payment for the health care treatment or services you receive. As such, we are required to provide you with this Notice of Privacy Practices that contains information regarding our privacy practices that explains how, when and why we may use or disclose your protected health information and your rights and our obligations regarding any such uses or disclosures. Except in specified circumstances, we will use or disclose only the minimum necessary protected health information to accomplish the intended purpose of use or disclosure of such information.
We have a limited right to use and disclose your health information for purposes of treatment, payment, or for the operations of our facility. For other purposes, you must give us your written authorization to release your protected health information unless the law permits or requires us to make the use or disclosure without your authorization.
We may use a limited amount of your protected health information when raising money for our facility and its operations. The information we may use will be limited to your name, address, telephone number, and dates for which you received services at our facility. If you do not wish to be contacted for participation in fundraising activities, you must provide written notification to our Privacy Officer listed herein.
EAS is including HITECH Act provisions to this Notice of Privacy Practices as follows:
HITECH Notification Requirements
Under HITECH, EAS is required to notify you if your health information has been breached. Notification must occur by first class mail within 60 days of the event. A breach occurs when an unauthorized use or disclosure that compromises the privacy or security of your protected health information poses a significant risk for financial, reputational, or other harm to you. This notice must:
(1) Contain a brief description of what happened, including the date of the breach and the date of discovery;
(2) The steps that you should take to protect yourself from potential harm resulting from the breach;
(3) A brief description of what EAS is doing to investigate the breach, mitigate losses, and to protect against further breaches.
EAS Business Associate Agreements shall provide that all HIPAA security administrative safeguards, physical safeguards, technical safeguards and security policies, procedures, and documentation requirements apply directly to the business associate.
Client Cash Payments
HITECH states that if you pay in full for your EAS services out of pocket then you can demand that the information regarding your EAS services not be disclosed to your third party payer since no claim is being made against the third party payer.
Access and Accounting of Electronic Health Records
EAS does not create or maintain client electronic health records at this time.
I. Understanding Your Health Record & Information.
When you enroll at EAS a record of personal health information is created. As you progress through your services at our facility, this record is updated. Typically, this record contains your symptoms, examination, lab test results, diagnoses, and plan for future care. This information, often referred to as your health record, serves as a:
- Plan for your care and treatment;
- Communication source between health care professionals;
- Tool with which we can check results and continually work to improve the care we provide;
- Means by which private insurance payers can verify the services billed; and,
- Legal documentation that describes the care you receive.
Understanding what is in your health record and how the information is used helps you to:
- Ensure its accuracy;
- Better understand why others may review your health information; and,
- Make an informed decision when authorizing disclosures.
II. Your Health Information Rights
Although your health record is the physical property of EAS, the information belongs to you. You have the right to:
- Inspect and receive a copy of your health record. You have the right to inspect and copy your health information, such as your health and billing records that we use to make a decision about your care and services. In order to inspect or copy your health information, you must submit a written request to us. If you request a copy of this information, we may charge you a reasonable fee for the paper, labor, mailing, and retrieval costs involved in filling your request. We will respond within thirty (30) days of receipt of such requests. Should we deny your request to inspect and/or copy your health information, we will provide you with written notice of our reasons of the denial and your rights for requesting a review of our denial.
- Request a restriction on certain uses and disclosures of your health information. You have the right to request that we limit how we use or disclose your protected health information for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care or services. For example, you may ask that EAS not disclose your health information or course of treatment to a family member.
- Request a correction/amendment to your health record. If you believe the health information we have about you is incorrect or incomplete, you have the right to request a correction or amendment of your health information as long as we maintain/retain your health record. We will respond within sixty (60) days of receipt of your written request. We may deny your request if: a) your request is not submitted in writing; b) your written request does not contain a reason to support your request; c) the information was not requested by us, unless the person or entity that created the information is no longer available to make the amendment; d) it is not part of the health information kept by our facility; e) it is not part of the information which would be permitted to inspect and copy; or f) the information is already accurate and complete. If your request is denied, we will provide you with a written notification of the reason(s) for such denial and your rights to have the request, the denial, and any written response you may have relative to the information and denial process appended to your health record.
- Request to receive confidential communication about your health information. You may ask that we communicate with you at a location other than your home or by a different means of communication such as by telephone or mail. To request confidential communications you must: a) notify us in writing; b) indicate the information you wish to receive; c) indicate whether or not you wish to limit or restrict our use or disclosure of such information; and d) identify to whom the restrictions apply (that is, which family member(s), agency, etc.).
- Request to receive a listing of certain disclosures EAS has made of your health information. A record of disclosures of your health information is maintained by EAS for six (6) years or the life of the record, whichever is longer. You have the right to request that we provide you with a listing of when, to whom, for what purpose, and what content of your protected health information we have released over the specified period of time. This accounting will not include any information we have made for the purposes of treatment, payment, or health care operations or information released to you, your family, or disclosures made for national security purposes, or any releases pursuant to your authorization. We will respond to your request within sixty (60) days of the receipt of your written request. Should additional time be needed to reply, you will be notified of such extension. However, in no case will such extension exceed thirty (30) days.
- Revoke your written authorization to use or disclose health information. This does not apply to health information already disclosed or used in circumstances where we have taken action on your authorization or the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim under the policy or the policy itself.
- Obtain a copy of the EAS Notice of Privacy Practices upon request.
III. EAS’s Responsibilities
EAS is required by law to:
- Maintain the privacy of your health information;
- Inform you about our privacy practices regarding health information we collect and maintain about you;
- Notify you if we are unable to agree to a requested restriction;
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations; and,
- Honor the terms of this notice or any subsequent revisions of this notice.
EAS reserves the right to change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You may request a revised version by contacting the legal office at 800.556.8885 and requesting that a revised copy be sent to you in the mail.
EAS understands that health information about you is personal and is committed to protecting your health information. EAS will not use or disclose your health information without your permission, except as described in this notice and as permitted by applicable federal and state laws.
IV. How EAS will use and disclose health information about you.
The following categories describe how we may use and disclose health information about you:
We will use and disclose your health information to provide, coordinate, or manage your treatment and any related services. This includes the coordination or management of your health care with another provider.
For example: Your personal health information will be recorded in your health record and used to determine the course of treatment for you. EAS staff will record the actions they take in your health record so that other health care providers will know how you are responding to treatment.
If EAS refers you to another health care facility or provider, EAS may disclose your relevant health information to that health care provider for treatment purposes only.
We will use and disclose your health information for payment purposes.
For example: If you have health insurance, invoices for EAS services may be sent to your health insurance provider for payment. The information accompanying the invoices will include information that identifies you as well as your diagnosis, procedures, and supplies used for your treatment.
We will use and disclose your health information for healthcare operations.
For example: We may use your health information to evaluate your care and outcomes with our quality improvement team. This information will be used to continually improve the quality and effectiveness of the services we provide.
Business Associates: EAS may provide some healthcare services and related functions through the use of contracts with business associates. In such an instance EAS may disclose your health information to business associates so that they can perform their duties. We require our business associates to protect and safeguard your health information in accordance with all applicable federal laws.
Interpreters: In order to provide proper EAS services, EAS may use the services of an interpreter. This may require the use or disclosure of your personal health information to the interpreter. We require any interpreter to protect and safeguard your health information in accordance with all applicable federal laws.
Uses and Disclosures about Decedents: EAS may use or disclose health information about decedents to a coroner or medical examiner for the purpose of identifying a deceased person, determining the cause of death, or other duties are authorized by law. EAS may disclose health information to funeral directors consistent with applicable laws as necessary to carry out their duties.
Workers Compensation: EAS may use or disclose your health information for workers compensation purposes as authorized or required by law.
Public Health: EAS may use or disclose your health information to public health or other appropriate government authorities as follows: (1) EAS may use or disclose your health information to government authorities that are authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or conducting public health surveillance, investigations, and interventions; (2) EAS may disclose your health information to government authorities that are authorized by law to receive reports of child abuse or neglect; (3) EAS may disclose your health information to government authorities that are authorized by law to receive reports of other abuse, neglect, or domestic violence as required by law, or as authorized by law if EAS believes it is necessary to prevent serious harm; and (4) when authorized by law, EAS may disclose your health information to an individual who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
Health Oversight Authorities: EAS may use or disclose your health information to health oversight agencies (for example, the California Department of Health Care Services) for activities authorized by law. These oversight activities include: investigations, audits, inspections and other actions. EAS is required by law to disclose protected health information to the Secretary of Health and Human Services to investigate or determine compliance with the HIPAA privacy standards.
Compelling Circumstances: EAS may use or disclose your health information in certain other situations involving compelling circumstances affecting the health or safety of an individual. For example, in certain circumstances: (1) EAS may disclose limited protected health information where requested by a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness or missing person; (2) EAS may use or disclose protected health information if we believe it is necessary to prevent or lessen a serious or imminent threat to the health and safety of a person; (3) EAS may use or disclose protected health information to report a crime committed on the EAS premises; and (4) EAS may make any other disclosures that are required by law.
Non-Violation of this Notice: EAS is not in violation of this notice or the HIPAA Privacy Rule if any of its employees or its contractors (business associates) discloses protected health information under the following circumstances:
- Disclosure by Whistleblowers: If an EAS employee or contractor (business associate) in good faith believes that EAS has engaged in conduct that is unlawful or otherwise violates clinical and professional standards or that the care or services provided by EAS had the potential of endangering one or more clients or members of the workplace or the public and discloses such information to:
- A public health oversight authority (for example, the California Department of Health Care Services) authorized by law to investigate or otherwise oversee the relevant conduct or the suspected violation, or an appropriate health care accreditation organization for the purpose of reporting the allegation of failure to meet professional standards or misconduct by EAS; or
- An attorney on behalf of an employee or contractor (business associate) for the purpose of determining their legal options regarding the suspected violation.
- Disclosures by Employee Crime Victims: Under certain circumstances, an EAS employee (or contractor) who is a victim of a crime on or off the premises may disclose information about the suspect to law enforcement officials provided that:
- The information disclosed is about the suspect who committed the criminal act.
- The information disclosed is limited to identifying and locating the suspect.
Any other uses and disclosures will be made only with your written authorization, which you may later revoke in writing at any time. (Such revocation would not apply where the health information already has been disclosed or used or in circumstances where EAS has taken action in reliance on your authorization or the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim under the policy or the policy itself.)
To exercise your rights under this Notice, to ask for more information, or to report a problem contact:
Ms. Ashly M. Guernaccini
Elevate Addiction Services
262 Gaffey Road
Watsonville, California 95076
If you believe your privacy rights have been violated, you may file a written complaint with:
Secretary of Health and Human Services
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
Toll Free: 1-877-696-6775
There will be no retaliation for filing a complaint.