THIS NOTICE DESCRIBES HOW MEDICAL 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.
General Information:
Information regarding your health care, including payment for health care, is protected by two federal laws; the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 V.S.C. & 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. & 290dd-2, 42 C.F.R. Part 2. Under these laws, Covenant Hills may not say to a person outside Covenant Hills that you attend the program, nor may Covenant Hills disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
Covenant Hills must obtain your written consent before it can disclose information about you for payment purposes. For example, Covenant Hills must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Covenant Hills can share information for treatment purposes or for health care operations. However, federal law permits Covenant Hills to disclose information without your written permission:
- Pursuant to an agreement with a business associate;
- For research, audit or evaluations
- To report a crime committed on Covenant Hills premises or against the personnel;
- To medical personnel in a medical emergency;
- To appropriate authorities to report suspected child abuse or neglect
- As allowed by a court order
For example, Covenant Hills can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a business associate agreement in place.
Before Covenant Hills can use or disclose any information about your health in a manner, which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing.
Your Rights:
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Covenant Hills is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency. You have the right to request that we communicate with you by alternative means or at an alternative location. You may ask us to send your information to you at a different address (for example, your work address) or by different means (for example, by fax instead of by mail). When we can reasonably and lawfully agree to your request we will do so and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by Covenant Hills except in the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances. Under HIPPA you also have the right, with some exceptions, to amend health care information maintained in Covenant Hills’s records, and to request and receive an accounting of disclosures of your health-related information made by Covenant Hills, during the six years prior to your request. You also have the right to receive a paper copy of this notice.
PH/CH Duties:
PH/CH is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. PH/CH is required by law to abide by the terms of this notice. PH/CH reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. In the event of any revision to this notice, participants will be required to review, sign, and date revised notice.
Complaints and Reporting Violations:
You may complain to Covenant Hills or the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. Complaints concerning potential violations of HIPAA regulations may be filed with any of Covenant Hills staff. Staff will then refer all complaints to Covenant Hills, Privacy Officer. The Privacy Officer will review any and all complaints by means of interview with complainant. Complaints may be made either orally or in writing (if an oral complaint, participant may be asked to provide written documentation of the incident in question). You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
Contact:
PH/CH:
Executive Director Privacy Officer: 949-489-8121
U.S. Dept. of Health & Human Services Region IX of Civil Rights
50 United Nations
Plaza, Room 22
San Francisco, Ca 94102 415-437-8310
County Privacy Office: 714-834-5172
County Bldg 38, Suite 676 Santa Ana, Ca
by