Notice of Privacy Practices

 Health Insurance Portability and Accountability Act (HIPAA)

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 of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your Protected Health Information.

“Protected health information” means health information (including identifying information about you) we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care, and payment for your health care services. We are required by law to maintain the privacy of your Protected Health Information and to provide you with this notice of our legal duties and privacy practices with respect to your Protected Health Information. We are also required to comply with the terms of our current Notice of Privacy Practices.

How We Will Use and Disclose Your Protected Health Information

The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice Privacy Officer.

For Treatment. We will use and disclosure your Protected Health Information without your authorization to provide your health care and any related services. We will also use and disclose your Protected Health Information to coordinate and manage your health care and related services. For example, we may need to disclose information to a case manager who is responsible for coordinating your care. We may also disclose your Protected Health Information among our clinicians and other staff (including clinicians other than your therapist or principal clinician), who work at Turning Point Community Programs (TPCP). For example, our staff may discuss your care at a case conference. In addition, we may disclose your Protected Health Information without your authorization to another health care provider (e.g., your primary care physician or a laboratory) working outside of TPCP for purposes of your treatment.

For Payment. We may use or disclose your Protected Health Information without your authorization so that the treatment and services you receive are billed to, and payment is collected from, your health plan or other third party payer. By way of example, we may disclose your Protected Health Information to permit your health plan to take certain actions before your health plan approves or pays for your services. These actions may include:

  • making a determination of eligibility or coverage for health insurance;
  • reviewing your services to determine if they were medically necessary;
  • reviewing your services to determine if they were appropriately authorized in advance of your care; or
  • reviewing your services for purposes of utilization review, to ensure the appropriateness of your care, or to justify the charges for your care.

For Health Care Operations. We may use and disclose health information about you without your authorization for our health care operations. These uses and disclosures are necessary to run our organization and make sure that our consumers receive quality care. These activities may include, by way of example, quality assessment and improvement, reviewing the performance or qualifications of our clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities. We may combine health information of many of our clients to decide what additional services we should offer, what services are no longer needed, and whether treatments are effective. We may also provide your Protected Health Information to other health care providers or to your health plan to assist them in their own health care operations. We will do so only if you have or have had a relationship with the other provider or health plan. For example, we may provide information about you to your health plan to assist them in their quality assurance activities.

Appointment Reminders, Health-Related Benefits and Services. We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We may also use and disclose health information to tell you about health-related benefits or services that may be of interest to you. If you do not want us to provide you with information about health-related benefits or services, you must notify the Privacy Officer in writing at 3440 Viking Drive, Suite 114, Sacramento, CA 95827. Please state clearly that you do not want to receive materials about health-related benefits or services.

Uses and Disclosures That May be Made Without Your Authorization,
But For Which You Will Have an Opportunity to Object

Facility Directory. We maintain a limited facility directory within our residential facilities for the purpose of allowing visitors and callers to locate you and to allow clergy to determine your religious affiliation. This limited information will only be provided to individuals who ask for you by name and may include your name, location in the facility (room number, but not the type of unit), your general condition, and your religious affiliation. A statement of your general condition may, for example, inform a caller of your visitation and telephone privileges, but will not disclose the diagnosis or type of treatment you are receiving. Your religious affiliation, if provided to us upon admission, and your name and room number may be provided to a member of the clergy, such as a priest, pastor or rabbi, even if the clergy member does not ask for you by name. When you are admitted to our residential facilities, you will generally have an opportunity to object to being included in our facility directory. If you choose NOT to be included in the facility directory, your directory information will not be provided to the clergy or to a person asking for you by name. Nor will you be identified as present at the facility. If you are admitted in an emergency, the clinician responsible for your admission will determine if, in his/her professional judgment, you are capable of agreeing or objecting to being identified in the facility directory. If the clinician determines that you are not able to agree or object (e.g., you are not conscious or able to communicate clearly), that clinician will decide whether it is in your best interest to be listed in our facility directory. If the clinician decides it is in your best interest, you will be listed in our facility directory. If you later become able to make your own health care decisions, we will ask whether you agree or object to being listed in our facility directory and we will honor your expressed wishes at that time. If asked, we do not confirm orally, in writing or through any other medium that you are our current or former client, with the exceptions listed below under “Person’s Involved in an Individual’s Care.”

Persons Involved in Your Care. We may provide health information about you to someone who helps pay for your care. We may use or disclose your Protected Health Information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. We may also use or disclose your Protected Health Information to an entity assisting in disaster relief efforts and to coordinate uses and disclosures for this purpose to family or other individuals involved in your health care. In limited circumstances, we may disclose health information about you to a friend or family member who is involved in your care. If you are physically present and have the capacity to make health care decisions, your Protected Health Information may only be disclosed with your agreement to persons you designate to be involved in your care. But, if you are in an emergency situation, we may disclose your Protected Health Information to a spouse, a family member, or a friend so that such person may assist in your care. In this case we will determine whether the disclosure is in your best interest and, if so, only disclose information that is directly relevant to participation in your care. And, if you are not in an emergency situation but are unable to make health care decisions, we will disclose your Protected Health Information to: a person designated to participate in your care in accordance with an advance directive validly executed under state law, your guardian or other fiduciary if one has been appointed by a court, or if applicable, the state agency responsible for consenting to your care.

Uses and Disclosures That May be Made
Without Your Authorization or Opportunity to Object

Emergencies. We may use and disclose your Protected Health Information in an emergency treatment situation. By way of example, we may provide your Protected Health Information to a paramedic who is transporting you in an ambulance. If a clinician is required by law to treat you and your treating clinician has attempted to obtain your authorization but is unable to do so, the treating clinician may nevertheless use or disclose your Protected Health Information to treat you.

Research. We may disclose your Protected Health Information to researchers when their research has been approved by an Institutional Review Board or a similar privacy board that has reviewed the research proposal and established protocols to protect the privacy of your Protected Health Information. As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person. Under these circumstances, we will only disclose health information to someone who is able to help prevent or lessen the threat.

Organ and Tissue Donation. If you are an organ donor, we may release your Protected Health Information to an organ procurement organization or to an entity that conducts organ, eye or tissue transplantation, or serves as an organ donation bank, as necessary to facilitate organ, eye or tissue donation and transplantation.

Public Health Activities. We may disclose health information about you as necessary for public health activities including, by way of example, disclosures to:

  • report to public health authorities for the purpose of preventing or controlling disease, injury or disability;
  • report vital events such as birth or death
  • conduct public health surveillance or investigations;
  • report child abuse or neglect;
  • report events to the Food and Drug Administration (FDA) or to a person subject to the jurisdiction of the FDA including information about defective products or problems with medications;
  • notify consumers about FDA-initiated product recalls;
  • notify a person who may have been exposed to a communicable disease or who is at risk of contracting or spreading a disease or condition;
  • notify the appropriate government agency if we believe you have been a victim of abuse, neglect or domestic violence. We will only notify an agency if we obtain your agreement or if we are required or authorized by law to report such abuse, neglect or domestic violence.

Health Oversight Activities. We may disclose health information about you to a health oversight agency for activities authorized by law. Oversight agencies include government agencies that oversee the health care system, government benefit programs such as Medicare or Medicaid, other government programs regulating health care, and civil rights laws.

Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your Protected Health Information.

Disclosures in Legal Proceedings. We may disclose health information about you to a court or administrative agency when a judge or administrative agency orders us to do so. We also may disclose health information about you in legal proceedings without your permission or without a judge or administrative agency’s order when:

  • we receive a subpoena for your Protected Health Information. We will not provide this information in response to a subpoena without your authorization if the request is for records of a federally-assisted substance abuse program.

Law Enforcement Activities. We may disclose health information to a law enforcement official for law enforcement purposes when:

  • a court order, subpoena, warrant, summons or similar process requires us to do so; or
  • the information is needed to identify or locate a suspect, fugitive, material witness or missing person; or
  • we report a death that we believe may be the result of criminal conduct; or
  • we report criminal conduct occurring on the premises of our facility; or
  • we determine that the law enforcement purpose is to respond to a threat of an imminently dangerous activity by you against yourself or another person; or
  • the disclosure is otherwise required by law.

We may also disclose health information about a client who is a victim of a crime, without a court order or without being required to do so by law. However, we will do so only if the disclosure has been requested by a law enforcement official and the victim agrees to the disclosure or, in the case of the victim’s incapacity, the following occurs:

  • the law enforcement official represents to us that (i) the victim is not the subject of the investigation and (ii) an immediate law enforcement activity to meet a serious danger to the victim or others depends upon the disclosure; and
  • we determine that the disclosure is in the victim’s best interest.

Medical Examiners or Funeral Directors. We may provide health information about our consumers to a medical examiner. We may also disclose health information about our consumers to funeral directors as necessary to carry out their duties.

Military and Veterans. If you a member of the armed forces, we may disclose your Protected Health Information as required by military command authorities. We may also disclose your Protected Health Information for the purpose of determining your eligibility for benefits provided by the Department of Veterans Affairs. Finally, if you are a member of a foreign military service, we may disclose your Protected Health Information to that foreign military authority.

National Security and Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law. We may also disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or so they may conduct special investigations.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose health information about you to the correctional institution or law enforcement official.

Workers’ Compensation. We may disclose health information about you to comply with the state’s Workers’ Compensation Law.

Uses and Disclosures of Your Protected Health Information with Your Permission

The following uses and disclosures of your Protected Health Information will be made only with your written authorization:

  • Uses and disclosures of Protected Health Information for marketing purpose’s;
  • Disclosures that constitute a sale of your Protected Health Information;
  • Most uses and disclosures of psychotherapy notes; and
  • If we intend to engage in fundraising, you have the right to opt out of receiving such communications

Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

Your Rights Regarding Your Protected Health Information

Right to Inspect and Copy. You have the right to request an opportunity to inspect or copy health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes. You must submit your request in writing to our Privacy Officer, 3440 Viking Drive, Suite 114, Sacramento, CA 95827, send an email to ToiGray@tpcp.org or call (916) 364-8395 x 2025. If you request a copy of the information, we may charge a fee for the cost of copying, mailing and supplies associated with your request. We may deny your request to inspect or copy your Protected Health Information in certain limited circumstances. In some cases, you will have the right to have the denial reviewed by a licensed health care professional not directly involved in the original decision to deny access. We will inform you in writing if the denial of your request may be reviewed. Once the review is completed, we will honor the decision made by the licensed health care professional reviewer.

Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information.

Right to Amend. For as long as we keep records about you, you have the right to request us to amend any health information created by us, used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes. To request an amendment, you must submit a written document to our Privacy Officer, 3440 Viking Drive, Suite 114, Sacramento, CA 95827 and tell us why you believe the information is incorrect or inaccurate. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer, 3440 Viking Drive, Suite 114, Sacramento, CA 95827. For your convenience, you may submit your request on a form called a “Request For Accounting,” which you may obtain from our Privacy Officer. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years and does not include dates before April 14, 2003. The first accounting you request within a twelve month period will be free. For additional requests during the same 12 month period, we may charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.

Right to Request Restrictions. You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations. To request a restriction, you must request the restriction in writing addressed to the Privacy Officer, 3440 Viking Drive, Suite 114, Sacramento, CA 95827.The Privacy Officer will ask you to sign a request for restriction form, which you should complete and return to the Privacy Officer. We are not required to agree to a restriction that you may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.

Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.

Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care only in a location or through a certain method. For example, you may request that we contact you only at work or by e-mail.

To request such a confidential communication, you must make your request in writing to the Privacy Officer, 3440 Viking Drive, Suite 114, Sacramento, CA 95827. We will accommodate all reasonable requests. You do not need to give us a reason for the request; but your request must specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice. You have the right to obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy, contact our Privacy Officer, 3440 Viking Drive, Suite 114, Sacramento, CA 95827.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our office responsible for receiving complaints at 3440 Viking Drive, Suite 114, Sacramento, CA 95827, send an email to ToiGray@tpcp.org or call (916) 364-8395 ext. 2025. All complaints must be submitted in writing. Our Privacy Officer will assist you with writing your complaint, if you request such assistance. We will not retaliate against you for filing a complaint.

Changes to this Notice

We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. We will post a copy of the current Notice of Privacy Practices at our main office and at each site where we provide care. You may also obtain a copy of the current Notice of Privacy Practices by calling us at (916) 364-8395 and requesting that a copy be sent to you in the mail or by asking for one any time you are at our offices.

In addition, each site has their assigned HIPAA Site Officer. If you have questions or complaints, please contact your HIPAA Site Officer. If the HIPAA Site Officer is not available, please contact Toi Gray, Privacy Officer, at (916) 364-8395 x 2025 or email ToiGray@tpcp.org.