Effective Date: April 14, 2003
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.
This notice will tell you about how we may use or disclose your protected health information to carry out treatment, payment, or health care operations, and for other purposes permitted or required by law. It also describes your right to access and control your protected health information. “Protected Health Information” is information about you, including demographic information that may identify you, and relates to your past, present, or future physical and mental health condition, and related health care services.
Except as described below, no one may access to your protected health information and we will make no use or disclosure of your protected health information other than as explained in this notice unless you give written authorization. Your authorization must be properly completed, dated and signed by you or your legal guardian. You have the right to revoke your authorization, in writing, at any time. If you revoke your authorization, it will stop future uses and disclosures except to the extent that we have already undertaken an action in reliance on your authorization.
We may use and disclose the following health information, as allowed by state and federal law:
· For treatment. We may use or disclose health information about you in order to provide you with treatment or services. For example, information may be shared with our doctors, nurse practitioners, nurses, psychotherapists, case managers, and other health care personnel to create and carry out a plan for your treatment or services. We may also share information with providers outside of our system that may be involved in your treatment.
· For payment. We may use and disclose, as needed, your protected health information, to obtain payment for your health care services. For example, we may need to contact your health care plan to determine eligibility, the coverage of recommended treatment, and for reimbursement requirements.
· For health care operations. We may use and disclose your protected health information for health care operations. For example, we may use your information to review our treatment and services and to evaluate the performance of our programs in meeting your health care needs.
· Health Related Benefits and Services. We may contact you with appointment reminders or information about treatment alternatives and other health related benefits and services that may be of interest to you.
The County may use and disclose some health information only with your permission, except as required by state and federal law:
· From psychotherapy notes and certain mental health records.
· From substance abuse treatment records.
· From HIV/AIDS testing results.
In certain cases, the County may use and disclose health information only if it informs you in advance and provides an opportunity to agree or object, as required by state and federal law:
· To family members, other relatives, or other persons that you identify as assisting with your care of payment for care. If you are not present or are unable to consent, we may release necessary information if we determine it is in your best interest to do so.
· To assist with disaster relief to notify your family about you.
In specific cases, the County may use and disclose protected health information without your permission and without providing you the opportunity to agree or object:
· As required by law.
· For public health activities, which may include the following:
1. Preventing or controlling disease, injury or disability;
2. Reporting births and deaths;
3. Reporting abuse or neglect of children, elders and dependent adults;
4. Reporting reactions to medications or problems with products;
5. Notifying people of recalls of products they may use; or,
6. Notifying a person exposed to or at risk to contract or spread a disease or condition.
· For mandated reporting of abuse, neglect or domestic violence.
· For health oversight activities necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
· To the minimum extent necessary to comply with judicial and administrative proceedings when compelled by court order, or in response to a subpoena, discovery request or other lawful process as allowed by law.
· To law enforcement:
1. To identify or locate a suspect, fugitive, material witness, or missing person;
2. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
3. About a death we believe may be the result of criminal conduct;
4. About criminal conduct at the hospital; or,
5. In emergency circumstances to report a crime, the location of a crime or crime victims, or the identity, description or location of a person who may have committed a crime.
· To coroners, medical examiners and funeral directors as necessary for them to carry out their duties.
· For organ donation once you are deceased.
· For public health research in compliance with strict conditions approved and monitored by an Institutional Review Board.
· To avert serious threats to the health and safety of you or others.
· Regarding military personnel for activities deemed necessary by appropriate military command authorities to assure proper execution of a military mission.
· To determine your eligibility for or entitlement to veterans benefits.
· To authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities.
· To correctional institutions and other law enforcement official having custody of you.
· To determine your eligibility for or to enroll you in government health programs.
· For Workers Compensation or similar programs, to the minimum extent necessary.
YOUR PROTECTED HEALTH INFORMATION PRIVACY RIGHTS
· Right to Inspect and Copy: In most cases, you have the right to look at or get copies of your records. You must make the request in writing. You may be charged a fee for copying your records. If you are denied access to your records, you have the right to have the decision reviewed by a licensed healthcare professional chosen by us who was not involved in the denial decision. You may request a records access form from any of our offices or you may contact our Privacy Officer to obtain a request form.
· Right to Request Amendment: You have the right to request that we amend protected health information maintained in your medical or billing record. Your request must be in writing. We may deny your request in writing if the information: Was not created by the County; is not health information kept by or for the County; is not information you are permitted to inspect and copy; or, is accurate and complete. If we deny your request for an amendment you have the right to file a statement of disagreement with us, and the right to a review of the denial by a designated official. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Your statement and our rebuttal, or a summary of them, will be provided to persons to whom we disclose your protected health information. Contact our Privacy Officer to receive a request for an amendment form.
· Right to a List of Disclosures: You have the right to a list of the last six years of disclosures of your protected health information that was disclosed after April 14, 2003 for purposes other than treatment, payment or healthcare operations. We are not required to account for disclosures made to you, to family members or friends involved in your care, or for notification purposes. We also do not need to account for disclosures made for national security reasons, certain law enforcement purposes, disclosures made as part of a limited data set, or incidental disclosures. Please contact our Privacy Officer to request a form to request an accounting.
· Right to Request Restrictions: You have the right to request restrictions on how your information is used or disclosed. We will consider your request but are not legally required to honor it. Your request must be in writing and specify the information you want to limit; whether to limit use, disclosure, or both; and to whom limits apply. If we agree to the requested restriction, we may not use or disclose your protected health information, unless it is needed to provide emergency treatment. You may not limit the uses and disclosures that we are legally required or allowed to make.
· Right to Request Confidential Communications: You have the right to receive communications from us in an alternative way or at a certain location, and we must accommodate reasonable requests. We may ask how payment will be handled and for you to specify an alternative address or other method of contact. It is not necessary to provide an explanation of the basis for the request. Please make this request in writing to our Privacy Officer.
· Right to Paper Copy of this Notice: You have the right to receive a paper copy of this notice upon request.
· Right to file a Complaint: You have the right to file a complaint by notifying the Inyo County Privacy Officer if you do not agree with how we have used or disclosed information about you or if you think we violated your privacy rights. You may also file written complaints with the Secretary of the Department of Health and Human Services in Washington, D.C. We will not retaliate against you if you file a compliant with the Secretary or us.
This notice is effective on April 14, 2003. We reserve the right to change the terms of this notice. Any changes will apply to information that we already have about you. We will post a current copy of this notice in all our facilities and on our web site.
FOR MORE INFORMATION
If you have any questions about this notice or need more information, please contact:
Inyo County Privacy Officer
Mailing address:
Attention: Privacy Officer
Confidential
785 N. Main Street
Bishop, California 93514
Or Call:
(760) 872-4245
Disclaimer: The County of Inyo reserves the right to make changes and improvements to its Web site at any time and without
notice, and assumes no liability for damages incurred directly or indirectly as a result of errors, omissions or discrepancies.
Copyright © 2001 County of Inyo
Last Updated:
June 26, 2006