SPIRITT Family Services - Privacy Notice

NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003:This notice is required by §164.520 of the Privacy Regulations –Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HIPAA Privacy Notices: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law that protects the privacy of a client’s individual identifiable health information. The Privacy Notice tells the client about their privacy rights, the duties of SPIRITT to protect health information, and how SPIRITT may use or disclose health information.

Privacy is important to all of us. You have privacy rights under a federal law that protects your health information. These rights are important for you to know. You can exercise these rights, ask questions about them, and file a complaint if you think your rights are being denied or your health information isn't being protected.

THIS INFORMATION DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

WHO WILL FOLLOW THIS NOTICE -This Notice describes SPIRITT Family Services practices and that of:

All employees, staff and other SPIRITT personnel.
Any member of a volunteer group we allow to help you while you are in the Program.

OUR PLEDGE REGARDING YOUR MEDICAL INFORMATION

SPIRITT understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Program. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the Program. As required and when appropriate, we will ensure that the minimum necessary information is released in the course of our duties.

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

SPIRITT is required by law to:

Keep your medical information, also known as “protected health information” or “PHI,” private.
Give you this Notice of our legal duties and privacy practices with respect to your PHI.

Follow the terms of the Notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI).
The following categories describe different ways that we use and disclose protected health information. 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 PHI to provide you with medical treatment or services. We may disclose your PHI to a licensed supervisor, psychiatrist, therapist, substance abuse counselor, case manager, or other Program personnel/volunteers who are involved in taking care of you at the Program.

FOR PAYMENT SPIRITT may use and disclose your PHI in order to get paid for the treatment and services we have provided you. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

FOR HEALTH CARE OPERATIONS SPIRITT may use and disclose your PHI to carry out activities that are necessary to run our Centers and to make sure that all of our clients receive quality care. We may also disclose information to doctors, nurses, technicians, medical students, and other program personnel for review and learning purposes.

APPOINTMENT REMINDERS SPIRITT may use and disclose your PHI to contact you as a reminder that you have an appointment for treatment or medical care at the Program.

TREATMENT ALTERNATIVES AND HEALTH-RELATED PRODUCTS AND SERVICES SPIRITT may use and disclose your PHI to recommend possible treatment options or alternatives that may be of interest to you.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE SPIRITT may disclose your PHI to a friend or family member who is involved in your medical care or payment related to your health care, provided that you agree to this disclosure, or we give you an opportunity to object to this disclosure.

DISASTER RELIEF PURPOSES SPIRITT may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

USE AND DISCLOSURE MEDICAL INFORMATION ABOUT YOU THAT DO NOT REQUIRE YOUR AUTHORIZATION

MEDICAL RESEARCHERS Your approval is not required when a study does not let other people know who was included in the study. The research must be set up to protect your privacy.

WORKER’S COMPENSATION or similar programs to process a claim regarding a work-related injury or illness.

FOR PUBLIC HEALTH SAFETY in order to prevent or control disease, prevent injury or disability, and report the abuse or neglect of children, elders and dependent adults.

PROGRAM OVERSIGHT ACTIVITIES we may share health information with an agency that reviews local health programs such as the Los Angeles County Department of Health Services.

COURTS OR LAWSUITS as required by a subpoena, court order or to defend a lawsuit.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS so they can perform their duties.

NATIONAL SECURITY SPIRITT may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

JAILS OR PRISONS If you are an inmate or under the custody of a law enforcement official, SPIRITT may release your PHI to the correctional institution or law enforcement official.

to provide you with health care
to protect your health and safety or the health and safety of others, or
for the safety and security of the correctional institution

OTHER USES OF YOUR MEDICAL INFORMATION Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by the authorization, except that, we are unable to take back any disclosures we have already made when the authorization was in effect, and we are required to retain our records of the care that we provided to you.

RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI) You have the following rights regarding your PHI in our records:

RIGHT TO INSPECT AND COPY

With certain exceptions, you have the right to inspect and copy your PHI from our records. Usually, this includes treatment and billing records.

To inspect and copy PHI that may be used to make decisions about you, you must submit your request in writing to your case manager or the person in charge of your treatment. Download form Link #2. or a form will be provided to you for this request by a SPIRITT professional. If you request a copy of your PHI, SPIRITT may charge a fee for the costs of copying, m ailing or other supplies associated with your request.

SPIRITT may deny your request to inspect and copy in certain circumstances. If you are denied the right to inspect and copy your PHI in our records, you may request that the denial be reviewed. With the exception of a few circumstances that are not subject to review, another licensed health care professional within SPIRITT, who was not involved in the denial, will review the decision. We will comply with the outcomes of the review.

RIGHT TO REQUEST AMENDMENT

If you feel that your PHI In our records is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as SPIRITT keeps the PHI. To request an amendment, Download form Link #3. or ask for a “Request to Amend Protected Health Information” form, and complete and submit this form to your case manager or the person in charge of your treatment. In addition, you must provide a reason that supports your request. SPIRITT 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, SPIRITT may deny your request if you ask us to amend PHI that:

Was not created by us, unless you can provide us with a reasonable basis to believe that the person or entity that created the PHI is no longer available to make the amendment;
Is not part of the PHI kept by or for the program?
Is not part of the PHI which you would be permitted to inspect and copy; or
Is accurate and complete.

Even if deny your request for amendment, you have the right to submit a Statement of Disagreement form, with a description 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 this form to be made part of your medical 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.

RIGHT TO AN ACCOUNTING DISCLOSURES

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

To request this list or accounting of disclosures, Download form Link #4. or ask for a “Request for an Accounting of Disclosures” form, and complete and submit this form to your case manager or the person in charge of your treatment. Your request must state a time-period that may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, SPIRITT may charge you for the costs of providing the list. SPIRITT will notify you of the cost involved before any costs are incurred and you may choose to withdraw or modify your request at the time.

RIGHT TO REQUEST RESTRICTIONS

You have the right to request that SPIRITT follow additional, special restrictions when using of disclosing your PHI for treatment, payment or health care operations. You also have the right to request that SPIRITT follow additional, special restrictions when using or disclosing your PHI to someone who is involved in your case or the payment for your health care, like a family member or friend. For example, you could ask that SPIRITT not use or disclose that you are receiving services at this program.

SPIRITT is 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 emergency treatment.

To request restrictions, ask for a “Request for Additional Restrictions of Use or Disclosure of Protected Health Information,” or download form Link #5.now. Complete and submit this form to your case manager or the person in charge of your treatment. In your request, you must tell us

what information you want to limit
whether you want to limit our use, disclosure or both; and
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 SPIRITT communicate with you about your appointments of other matters related to your treatment in a specific way or at a specific location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, download form Link #6. or a form will be provided to you for this request by a SPIRITT professional. Ask for a “Request to Receive Confidential Communications by Alternative Means or at Alternative Locations” form, and complete and submit this form to your case manager or to the person in charge for your treatment. Your request must specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.

RIGHT TO A PAPER COPY OF THIS NOTICE

You have the right to a paper copy of this Notice. Download form Link #1. or a form will be provided to you by a SPIRITT professional. 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. To obtain a paper copy of this Notice, please contact your Treatment Team.

TO ASK FOR HELP OR TURN IN A COMPLAINT

Please contact our Compliance Coordinator if you have questions, need more information, or want to report a problem with your health information. If you believe your privacy has not been protected, you may talk with any staff member right away. You may also send a written complaint to our Compliance Coordinator. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with us, or if you have comments or questions regarding our privacy practices, contact:

SPIRITT Family Services
Elvia Torres
HIPAA Compliance Coordinator
13135 Barton Road
Santa Fe Springs, CA 90605
(562) 903-7000
(562) 777-1410

To file a complaint with Los Angeles County, contact:
Los Angles County Chief Information Office (LACCIO)
Chief Information Privacy Officer
500 West Temple Street, Suite 493
Los Angeles, CA 90012
(213) 974-2164
Email: CIPO@cio.co.la.ca.us

To file a complaint with the Federal Government, contact:
Region IX, Office for Civil Rights,
U.S. Department of Health and Human Services
50 United Nations Plaza-Room 322
San Francisco, CA 94102
Voice Phone (415) 437-8310
FAX (415) 437-8329
TDD (415) 437-8311