TO CLIENTS OF CIFC - PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE READ CAREFULLY.
Effective Date: August 1st, 2015
Purpose of this Notice of
Privacy Practices (NPP).
The Center for Individual & Family Counseling (CIFC) is required by the Health Insurance Portability and Accountability Act (HIPAA) to provide you with a list of laws and regulations affecting the confidentiality of your protected health information (PHI). This NPP addresses when CIFC must or may disclose your PHI.
CIFC will not disclose your PHI unless authorized or required under California or Federal law or regulation, or upon your written authorization.
II. PHI Defined. PHI is your individually identifiable information. PHI includes:
· Health information, including demographic information;
· Information that relates to your physical or mental health or the provision of or payment of health care; and
· Information that identifies you.
PHI in Connection with your
CIFC can use and disclose your PHI to treat you, which may include disclosing your PHI to another health care professional. For example, if you are being treated by a physician or a psychiatrist, CIFC can disclose your PHI to him or her to help coordinate your care, although my preference is for you to give CIFC written Authorization to do so.
B. PHI in Connection to Payment for your treatment
CIFC can use and disclose your PHI to bill and collect payment for the treatment and services provided by CIFC to you. For example, CIFC may send your PHI to your insurance company to get paid for the services that CIFC provides to you, although CIFC’s preference is for you to give Authorization to do so.
C. PHI in Connection to health care operations
CIFC can use and disclose your PHI for purposes of conducting health care operations pertaining to CIFC’s practice, including contacting you when necessary. For example, CIFC may need to disclose your PHI to my attorney to obtain advice about complying with applicable laws.
The Strictest Law Applies.
California and Federal law sometimes have different standards and requirements. In these cases, we will follow the strictest. For example, if Federal law allows the disclosure of information without your consent or authorization, but California law requires your consent or authorization, we will obtain your consent or authorization.
III. Your Rights – All PHI.
A. Electronic or Paper Copy of Your Medical Record.
· We will provide a copy or summary of your PHI, usually within 15 days of your written request. We may charge a reasonable, cost-based fee.
· The Patient Access to Health Records Act (PAHRA) gives you the right to see and copy your medical records (with some exceptions) that we maintain.
1. Submit a written request to the Executive Director;
· Please complete the “Consent and Authorization to Release Confidential Information” form and specify the requested delivery method
2. CIFC will review the request and determine whether it falls within an exception – thereby preventing the record’s release;
3. If the requested record falls within an exception, CIFC will notify the requestor in writing why the record cannot be released; and
4. If the requested record is releasable, the requested records will be released consistent with your written request.
B. Request Confidential Communications.
· You can ask us to contact you in a specific way (for example, home or office phone) or send mail to a different address.
· We will say “yes” to reasonable requests.
D. Limit What We Use and Share.
· You can ask us not to use or share certain health information for treatment, payment, or our operations – we are not required to agree to your request, and we may say “no” if it would affect your care.
F. Get A Copy of This Notice.
· You can ask for a paper copy of this NPP at any time, even if you agreed to receive it electronically. We will promptly provide you with a paper copy.
H. File A Complaint.
· You may file a complaint if you feel that your rights were violated.
· You can complain if you feel we have violated your rights by contacting us using the information on the back page.
· We will not retaliate against you for filing a complaint.
IV. Your Choices – all PHI.
Preferences on How We Share Information.
Talk to us if you have a clear preference for how we share your information in the situations described below. You should tell us in writing, what you want us to do, and we will follow your instructions.
B. You have the right and choice to tell us to:
· Share information with your family, close friends, or others involved in your care; and
· Share information in a disaster relief situation.
If you are unable to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
C. In these cases, we never share your information without your written consent:
· Marketing purposes;
· Sale of your information; and
· Most sharing of psychotherapy notes.
· California law requires prior written authorization for certain types of sensitive information disclosures, including psychotherapy notes and drug and alcohol treatment records.
· We may contact you for fundraising efforts, but you can tell us not to contact you again.
V. CIFC’s Responsibilities.
CIFC has the following responsibilities about the privacy and security of your PHI:
1. CIFC is required by law to maintain the privacy and security of your PHI;
2. CIFC will promptly let you know if there is a breach that may have compromised the privacy or security of your information;
3. CIFC must follow the duties and privacy practices describe in this NPP and give you a copy of it; and
4. CIFC will not use or share your information other than as described in this NPP unless you tell us we can, in writing. If you tell us we can, you may change your mind at any time.
VI. Uses and Disclosures Requiring Your Consent – all PHI.
CIFC may use and disclose your PHI consistent with a signed and valid consent and authorization to release your confidential information. There are specific Federal and California requirements for this consent and authorization. Additionally, there are certain circumstances where CIFC may use or disclose your PHI without your consent, as outlined in this NPP.
VII. Uses and Disclosures Not Requiring Your Consent – all PHI.
1. Employees. We will share your PHI among CIFC employees to the extent necessary to provide you services.
2. Child Abuse or Neglect. We will disclose information about suspected child abuse or neglect to appropriate State or local authorities.
3. Medical Emergency. We will share your PHI to medical personnel to the extent necessary to meet a bona fide medical emergency.
4. Valid Court Order. We will disclose your PHI when there is a valid court order. The standard for obtaining a valid court order for the release of records associated with drug or alcohol treatment is higher than that for other medical records.
5. Qualified Personnel. We may disclose your PHI to qualified personnel to conduct scientific research, management and financial audits, program evaluation, but such personnel may not identify you, directly or indirectly, in any report of such research, audit, or evaluation, or otherwise disclose your identity in any manner, provided appropriate safeguards are used.
6. Elder Abuse or Neglect. CIFC as an entity is not a mandated reporter. However, most of our staff are mandated reporters in their professional capacities.
VIII. Uses and Disclosures Not Requiring Your Consent.
In addition to the exceptions to nondisclosure above, your PHI, treatment may be disclosed, without your consent, in the following cases:
1. Treatment. We may use your
PHI and share it with other professionals who are treating you. Treatment means
the provision, coordination, or management of health care and related services.
Treatment includes the coordination or management of health care by a health
care provider with a third party; consultation between health care providers
relating to a patient; or the referral of a patient for health care from one
health care provider to another.
o Example. A doctor treating you for an injury asks another doctor about your
overall health condition.
2. Health Care Operations. We
may use and share your PHI to run our program, improve your care, and contact
you when necessary.
o Example. We use your PHI to manage your treatment and services.
3. Payment. We may use and share
your PHI to bill and get payment from health plans or other entities or
persons. This means that if a family member or friend is paying for your counseling
services, we may disclose necessary PHI to them to get paid.
o Example. We give information about you to your health insurance plan or parent
paying for your treatment to pay for your receipt of services.
4. Business Associates. We may disclose your PHI to CIFC Business Associates. These are persons or entities that may have access your PHI, such as off-site cloud sorage. Business Associates are bound by the same confidentiality rules & regulations as CIFC.
5. Help with public health and safety issues. We may share your PHI for certain situations such as:
· Reporting suspected abuse, neglect.
· Preventing or reducing a serious threat to anyone’s health or safety; and
· County coroner for reasons not already discussed.
6. Comply with the law. We may share your PHI if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
7. Address workers’ compensation, law enforcement, and other government requests. We may use or share health information about you:
· For workers’ compensation claims;
· For law enforcement purposes or with a law enforcement official;
· With health oversight agencies for activities authorized by law; and
· For special government functions such as military, national security, and presidential services.
8. Respond to lawsuits and legal actions. We may share your PHI in response to a court or administrative order or subpoena.
9. Cause of Death. We will to disclose when cause of death is being reported.
10. Crimes against CIFC Personnel or On Premises. We may report any information about a crime committed by you either on CIFC premises or against any person who works for CIFC or about any threat to commit such a crime.
11. Appointment Reminders. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
IX. Notice of Privacy Practices Amendments.
CIFC can change the terms of this NPP. If we change the terms, those changes will apply to all information we have about you. The new NPP will be available upon request, in our office, and on our website.
You have the right to complain to the Health and Human Services Agency and CIFC if you think that your privacy rights have been violated and your PHI has been disclosed without authorization.
U.S. Department of Health and Human Services Office
for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Center for Individual & Family Counseling
Attention: Sherry Winston, LMFT, Executive Director
5445 Laurel Canyon Blvd.
2nd Floor North Hollywood, CA 91607