 |
Notice of Privacy Practices
Effective July 1, 2004
THIS NOTICE DESCRIBES HOW MEDICAL / BEHAVIORAL HEALTH
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact the Privacy
Official, Director of Health Information Management at (949) 499-7207.
WHO WILL FOLLOW THIS NOTICE
This notice describes Pacific Crest Medical Group Inc’s practices
and that of:
- Any health care professional authorized to enter information into
your medical record.
- All departments and units of the health care system.
- Any volunteer in our organizations.
- All employees, staff and other designated personnel (e.g., students,
contracted agency staff).
- Physicians and other health care providers on our staff, while they
are practicing in our facilities.
- All Pacific Crest Medical Group, Inc. All these entities, sites and
locations follow the terms of this notice. In addition, these entities,
sites and locations may share medical / behavioral health information
with each other for treatment, payment or health care operations purposes
described in this notice.
OUR PLEDGE REGARDING MEDICAL / BEHAVIORAL HEALTH INFORMATION
We understand that medical / behavioral health information about you
and your health is personal. We are committed to protecting medical /
behavioral health information about you. We create a record of the care
and services you receive in our facilities. We need this record to provide
you with quality care and to comply with certain legal requirements. Physicians
(personal, consultants, specialists) involved in your care may have different
policies or notices regarding the doctor’s use and disclosure of
your medical / behavioral health information created and/or maintained
in the doctor’s office or clinic.
This notice will tell you about the ways in which we may use and disclose
medical / behavioral health information about you, via any medium (written,
oral, or electronic). We also describe your rights and certain obligations
we have regarding the use and disclosure of medical / behavioral health
information.
We are required by law to:
- Make sure that medical / behavioral health information that identifies
you is kept private and confidential (with certain exceptions);
- Give you this notice of our legal duties and privacy practices with
respect to medical / behavioral health information about you; and
- Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL / BEHAVIORAL HEALTH
INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose
medical / behavioral health information. For each category of uses or
disclosures we will explain what we mean and try to give some examples.
Not every use or disclosure in a category will be listed. However, all
the ways we are permitted to use and disclose information will fall within
one of the categories.
- Treatment. We may use medical / behavioral health
information about you to provide you with medical treatment or services.
We may disclose medical / behavioral health information about you to
doctors, nurses, technicians, health care students (nursing, medical,
psychology, etc.), or other personnel who are involved in taking care
of you. For example, a doctor treating you for a broken leg may need
to know if you have diabetes because diabetes may slow the healing process.
In addition, the doctor may need to tell a dietitian if you have diabetes
so that we can arrange for appropriate meals. Different departments
of the hospital also may share medical / behavioral health information
about you in order to coordinate the different things you need, such
as prescriptions, lab work and x-rays. We also may disclose medical
/ behavioral health information about you to others who may be involved
in your medical care, such as caregivers, clergy or others we use to
provide services that are part of your care. We also may disclose medical
/ behavioral health information about you to individuals outside the
facility who may be involved in your medical care after you leave our
facility.
- Payment. We may use and disclose medical / behavioral
health information about you so that the treatment and services you
receive may be billed and collected from you, the party responsible
for your bill, an insurance company or a third party. For example, we
may need to give your health plan information about surgery you received
at the hospital so your health plan will pay us or reimburse you for
the surgery. 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.
- Health Care Operations. We may use and disclose
medical / behavioral health information about you for health care operations.
These uses and disclosures are necessary to make sure that all of our
patients receive quality care. For example, we may use medical / behavioral
health information to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also combine
medical / behavioral health information about our patients to decide
what additional services we should offer, what services are not needed,
and whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, health care students (nursing,
medical, psychology, etc.), and other personnel for review and learning
purposes. We may also disclose information to accreditation agencies,
such as the Joint Commission on the Accreditation of Healthcare Organizations
(JCAHO) for purposes of evaluating this facility for accreditation.
We may also combine the medical / behavioral health information we have
with medical / behavioral health information from other health care
agencies to compare how we are doing and see where we can make improvements
in the care and services we offer. We may remove information that identifies
you from this set of medical / behavioral health information so others
may use it to study health care and health care delivery without learning
who the specific patients are.
- Appointment Reminders. We may use and disclose medical
/ behavioral health information to contact you as a reminder that you
have an appointment for treatment or medical care.
- Treatment Alternatives. We may use and disclose
medical / behavioral health information to tell you about or recommend
possible treatment options or alternatives that may be important to
you.
- Health-Related Benefits and Services. We may use
and disclose medical / behavioral health information to tell you about
health-related benefits or services that may be of interest to you.
- Individuals Involved in Your Care. We may release
medical / behavioral health information about you to a friend or family
member who is involved in your medical care. Unless there is a specific
written request from you to the contrary, we may also tell your family
or friends your condition and that you are in the hospital. Certain
state laws may require us to get your written authorization before we
release behavioral health information to a friend or family member who
is involved in your care.
- Disaster Relief. We may disclose medical / behavioral
health information about you to an entity assisting in a disaster relief
effort (for example, the Red Cross) so that your family can be notified
about your condition, status and location.
- Research. Under certain circumstances, we may use
and disclose medical / behavioral health information about you for research
purposes, when approved by the Institutional Review Board or Privacy
Board.
- As Required by Law. We will disclose medical / behavioral
health information about you when required to do so by federal, state,
or local law. [For example, disclosure of protected health information
is required to the Department of Health Services for the purpose of
birth defect monitoring. Access to this information is limited to authorized
individuals. Also, California maintains a system for collecting information
regarding cancer hazards and potential remedies.]
- To Avert a Serious Threat to Health or Safety. We
may use and disclose medical / behavioral health information about you
when necessary to prevent a serious threat to your health and safety
or the health and safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the threat. For
example, if you were involved in a violent crime, disclosure may be
made to law enforcement.
SPECIAL SITUATIONS
- Organ and Tissue Donation. If you are an organ or
tissue donor, we may release medical / behavioral health information
to organizations that handle procurement or transplantation, or to a
donation bank.
- Military and Veterans. If you are a member of the
armed forces or a veteran, we may release medical / behavioral health
information about you as required by military command authorities. We
may also release medical / behavioral health information about foreign
military personnel to the appropriate foreign military authority.
- Workers’ Compensation. We may release medical
/ behavioral health information about you to your workers’ compensation
program, for work-related injuries or illness.
- Public Health Risks. We may disclose medical / behavioral
health information about you for public health activities. These activities
generally include the following:
- To prevent or control disease, injury or disability;
- To report births and deaths;
- To report the abuse or neglect of children, elders and dependent
adults;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or
may be at risk for contracting or spreading a disease or condition;
- To notify the appropriate government authority if we believe
a patient has been the victim of abuse, neglect or domestic violence.
We will only make this disclosure if you agree or when required
or authorized by law.
- Health Oversight Activities. We may disclose medical
/ behavioral health information to a health oversight agency for activities
authorized by law. These oversight activities include, for example,
audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
- Lawsuits and Disputes. If you are involved in a
lawsuit or a dispute, we may disclose medical / behavioral health information
about you in response to a court or administrative order. We may also
disclose medical / behavioral health information about you in response
to a subpoena, discovery request, or other lawful process by someone
else involved in the dispute.
- Law Enforcement. We may release medical / behavioral
health information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar
process;
- To identify or locate a suspect, fugitive, material witness,
or missing person;
- About the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the facility; and
- In emergency circumstances to report a crime, the location of
the crime or victims; or the identity, description or location of
the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors.
We may release medical / behavioral health information to a coroner
or medical examiner. This may be necessary, for example, to identify
a deceased person or determine the cause of death. We may also release
medical / behavioral health information about patients of the hospital
to funeral directors as necessary to carry out their duties
- National Security and Intelligence Activities. We
may release medical / behavioral health information about you to authorized
federal officials for intelligence, counterintelligence, and other national
security activities authorized by law.
- Protective Services for the President and Others.
We may disclose medical / behavioral 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 conduct special
investigations.
- Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may
release medical / behavioral health information about you to the correctional
institution or law enforcement official. This release would be necessary
(1) for the institution to provide you with health care; (2) to protect
your health and safety or the health and safety of others; or (3) for
the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL / BEHAVIORAL HEALTH INFORMATION
ABOUT YOU.
You have the following rights regarding medical / behavioral health information
we maintain about you:
- Right to Inspect and Copy. You have the right to
inspect and receive a copy of the medical / behavioral health information
that may be used to make decisions about your care. Usually, this includes
medical and billing records, but may not include psychotherapy notes.
To inspect and copy medical / behavioral health information that may
be used to make decisions about you, please contact the medical records
custodian in the physician office. If you request a copy of the information,
we may charge a fee for the costs of copying, mailing or other supplies
associated with your request. We may deny your request to inspect and
receive a copy in certain very limited circumstances. If you are denied
access to medical / behavioral health information, you may request that
the denial be reviewed. We will comply with state law when choosing
a reviewer. The person conducting the review will not be the person
who denied your request. We will comply with the outcome of the review.
- Right to Amend. If you feel that the medical / behavioral
health information we have about you is incorrect or incomplete, you
may ask us to amend the information. You have the right to request an
amendment for as long as the information is kept by the facility. To
request an amendment, your request must be made in writing and submitted
to Health Information Management Department. In addition, you must provide
a reason that supports your request. We 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, we may deny your request if you ask us to
amend information that:
- Was not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
- Is not part of the medical / behavioral health information kept
by the facility;
- Is not part of the information which you would be permitted to
inspect and copy; or
- Is accurate and complete.
- Right to an Accounting of Disclosures. You have the
right to request an “accounting of disclosures.” This is
a list of the disclosures we made of medical / behavioral health information
about you other than our own uses for treatment, payment and health
care operations, as those functions are described above. To request
this list or accounting of disclosures, you must submit your request
in writing to the Health Information Management Department. Your request
must state a time period which may not be longer than six years and
may not include dates before April 14, 2003. Your request should indicate
in what form you want the list (for example, on paper, electronically).
The first list you request within a 12-month period will be free. For
additional lists, we may charge you for the costs of providing the list.
We will notify you of the cost involved and you may choose to withdraw
or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You have the right
to request a restriction or limitation on the medical / behavioral health
information we use or disclose about you for treatment, payment or health
care operations. You also have the right to request a limit on the medical
/ behavioral health information we disclose about you to someone who
is involved in your care or the payment for your care, like a family
member or friend. For example, you could ask that we not use or disclose
information about a surgery you had. We are 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,
or if the disclosure is required by law. To request restrictions, you
must make your request in writing to an admitting representative in
the Admitting Department. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use,
disclosure or both; and (3) 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 we communicate with you about medical
matters in a certain way or at a certain location. For example, you
can ask that we only contact you at work or by mail. To request confidential
communications, you must make your request in writing to an admitting
representative in the Admitting Department. We will not ask you the
reason for your request. While we are not required to agree to your
request, we will accommodate all reasonable requests. 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 a paper copy of this notice. 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, contact the office
receptionist.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to
make the revised or changed notice effective for medical / behavioral
health information we already have about you as well as any information
we receive in the future. We will post a copy of the current notice in
the facility. The notice will contain on the first page, in the top right-hand
corner, the effective date. If the notice is changed, we will offer you
a copy of the notice upon your request.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a
complaint with the facility or with the Secretary of the Department of
Health and Human Services. To file a complaint with the facility, contact
the Privacy Official at 32392 Coast Highway, Laguna Beach, CA 92651. All
complaints must be in writing; therefore you will be asked to submit your
complaint in writing or we will assist you in documenting your complaint.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL / BEHAVIORAL HEALTH INFORMATION
Other uses and disclosures of medical / behavioral health information
not covered by this notice or the laws that apply to us will be made only
with your written permission. If you provide us permission to use or disclose
medical / behavioral health information about you, you may revoke that
permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical / behavioral health information
about you for the reasons covered by your written authorization.
You understand that we are unable to take back any disclosures we have
already made with your permission, and that we are required to retain
our records of the care that we provided to you.
|
|
|
