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NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL, MENTAL HEALTH, SOCIAL SERVICES AND DRUG AND ALCOHOL-RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Contents: I. Who We Are This Notice describes the privacy practices of Santa Anita Family its Psychologists, Marriage Family Therapists, students, care coordinators and other personnel. It applies to services furnished to you at all Santa Anita Family Service sites. II. Our Privacy Obligations We are required by law to maintain the privacy of your health information ("Protected Health Information" or "PHI") and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. This Notice describes your rights and our obligations for using or disclosing your PHI and informs you about laws that provide special protections for your PHI. Some examples of PHI are: - Information about your health condition.
- Geographic information (such as where you live or work)
- Demographic information (such as your gender, ethnicity or age)
- Unique numbers that may identify you (such as you Social Security Number, your driver's license or state certificate number or your phone number).
When we use or disclose your PHI, we are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure). Any revision or update to this notice will be available to you at each of our facilities, at the request of your service provider. III. General Information Information regarding your health care is protected by federal and state laws, including The Health Insurance Portability and Accountability Act of 1996 (HIPAA), and The Drug and Alcohol Confidentiality Regulations where applicable. Without your written permission, Santa Anita Family Service may not disclose to a person outside the agency that you attend any of our programs, nor may we disclose any information identifying you as having a behavioral issue or a problem with drug or alcohol use, participate in any of our programs including Senior Services or disclose any other PHI except as permitted by law. IV. Disclosures of PHI Allowed Without Your Authorization Federal and State laws permit Santa Anita Family Service to disclose information without your written authorization in the following situations: For Treatment. We may use and disclose protected health information about you to provide you with treatment or services. We may disclose this information, with your prior written consent, to doctors, psychologists or other licensed health care providers outside of Santa Anita Family Service who provide you with health care services or who are involved in your care. For example, if you are being treated by a medical doctor, we can disclose your protected health information to your psychologist in order to coordinate your care. For Payment. We may use and disclose your protected health information to obtain payment for services provided to you. We may also use this information to obtain prior authorization for proposed treatment or to determine your benefit eligibility. For example, protected health information may be included in a billing sent to your insurance company or to a governmental payor. For Healthcare Operations. We may use and disclose protected health information to support the healthcare services we provide. These support functions may include quality assessment and improvement activities, utilization reviews, contract compliance, accreditation, case management and other management and administrative activities. For example, we may use your protected health information in evaluating the quality of the healthcare services you received. In addition, we may use or disclose protected health information in the following specific circumstances: Appointment Reminders - We may contact you to remind you that you have an appointment or need a referral for an appointment. Treatment Alternatives - We may wish to tell you about or recommend possible treatment options or alternatives. To Individuals Involved in Your Care or Payment of Your Care - With your prior written consent, we may disclose your protected health information to your family or friends, or to any other individual you identify, when they are involved in your care or in the payment for your care. We will only disclose the protected health information directly relevant to their involvement in your care. Emergencies - In an emergency, we may use or disclose your protected health information to emergency health providers. We must first try to obtain your consent. Contracted Services -There may be some services provided to you through contracted service providers. For example, answering services, translation services, in-home aides, or other contracted healthcare providers. We may use or disclose protected health information with these contracted service providers, in order to help them do their job. To protect your health information, however, we require each contracted service provider to appropriately safeguard your information. Research - Under certain circumstances, we may use or disclose your medical information for research purposes. Information used or disclosed will be de-identified, so that your privacy is protected. Public Health Risks - We may use or disclose your protected health information for certain public health reasons, in order to prevent or control disease, injury or disability, or to report births, deaths, suspected abuse or neglect, reactions to medications or problems with products. Where Required by Law - We may make a disclosure to applicable officials when a law requires us to report information to government agencies and law enforcement personnel, or when ordered to do so in a judicial or administrative proceeding. Workers' Compensation Purposes - We may disclose information in order to comply with Workers' Compensation laws. Abuse or Neglect - We may disclose protected health information if necessary in order to report suspected child or elder abuse or neglect. Military Activity and National Security - We may disclose protected health information of armed forces personnel to the applicable military authorities if so requested by the military. We may also disclose your protected health information to authorized federal officials as necessary for national security, intelligence activities or for the protection of the President and other government officials and dignitaries. Health Oversight Activities - We may disclose protected health information to federal, state or local agencies that oversee our activities. Law Enforcement - We may disclose protected information to authorized officials in response to a search warrant, to report a crime on our premises or to help identify or locate someone. Lawsuits and Other Legal Disputes - We may use and disclose protected health information in responding to a court or administrative order, subpoena, or a discovery request. We may also use and disclose information, to the extent permitted by law, in defense of a lawsuit or arbitration. Serious Threat to Health or Safety - We may use or disclose your protected health information if we believe it is necessary to avoid a serious threat to your health or safety or to someone else's. V. Your Health Information Rights Under HIPAA and under the Drug and Alcohol Confidentiality Regulations, you have the following rights regarding your PHI: Right to personal representation The right to name a personal representative who may act on your behalf to control the privacy of your PHI. Parents and guardians will generally have the right to control the privacy of PHI about minors unless minors are permitted by law to act on their own behalf. Right to revoke authorization The right to revoke Your Authorization. You may revoke any written authorization obtained in connection with your protected information, except if as ordered by the criminal justice system, you are enrolled in a Drug or Alcohol Abuse Program and the authorization was court-ordered. In cases where we have already taken action on the authorization and the revocation is allowable, the revocation will go into effect when Santa Anita Family Service has received and processed a written revocation statement from you. Right to Request Limits on the Use and Disclosure of Your Protected Health Information You have the right to request restrictions or limits on protected health information we use or disclose about you for our treatment, payment or healthcare operations. We will consider your request, but we are not legally obligated to agree to it. To request restrictions, you must make your request in writing to our Privacy Officer at the address listed below. If we agree to your request, we will put the limits in writing and will abide by them, except in emergency situations. You may not limit the uses and disclosures which we are legally required to make. Right to See and Get Copies of Your Protected Health Information You may inspect and receive a copy of your health and billing records. Your request must be made in writing to our Privacy Officer at the address listed below. A reasonable copying charge may apply. Under certain circumstances, certain information may not be made available to you. In that case, we will tell you in writing our reasons for the denial and explain your right to have our denial reviewed. Privacy Officer, Santa Anita Family Service
Santa Anita Family Service
605 S. Myrtle Avenue
Monrovia, CA 91016
Telephone Number: (626) 359-9358 You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, the Privacy Office will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint with the Director or us. VII. Effective Date and Duration of This Notice A. Effective Date. This Notice is effective on April 14, 2003. B. Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in waiting areas around Santa Anita Family Service and on our Internet site. You also may obtain any new notice by contacting your service provider. ----------------------------------------------------------------- Santa Anita Family Service
Headquarters: 605 S. Myrtle Avenue
Monrovia, CA 91016
(626) 359-9358
Fax: (626) 358-7647
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