NOTICE OF PRIVACY PRACTICES
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.
Central Coast Psychological Services Corporation (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
TO INSPECT AND COPY PHI
You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.
The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed. Another licensed health care professional will review your request and the denial and I will comply with the outcome of the review. If your request to see your mental health information is denied, you may arrange to have a third party professional review the record on your behalf.
TO AMEND PHI
You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement. Your request may be denied if you ask 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 information kept by the Practice; is not part of the information which you would be permitted to inspect or copy; or is accurate and complete.
TO REQUEST CONFIDENTIAL COMMUNICATIONS
You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.
TO LIMIT WHAT IS USED OR SHARED
You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
TO OBTAIN A LIST OF THOSE WITH WHOM YOUR PHI HAS BEEN SHARED
You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
TO RECEIVE A COPY OF THIS NOTICE
You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
TO CHOOSE SOMEONE TO ACT FOR YOU
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
TO FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE VIOLATED
You can file a complaint by contacting the Practice using the following information:
Kristyn Collins
(805) 235-0251
Central Coast Psychological Services Corporation
1172 E. Grand Ave., Arroyo Grande CA 93420
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue, S.W.,
Washington, D.C. 20201
calling 1-877-696-6775
or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
The Practice will not retaliate against you for filing a complaint.
TO OPT OUT OF RECEIVING FUNDRAISING COMMUNICATIONS
The Practice may contact you for fundraising efforts, but you can ask not to be contacted again.
OUR USES AND DISCLOSURES
1. ROUTINE USES AND DISCLOSURES OF PHI
The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
TO TREAT YOU
The Practice can use and share PHI with other professionals who are treating you. Example: Your primary care doctor asks about your mental health treatment.
TO RUN THE HEALTH CARE OPERATIONS
The Practice can use and share PHI to run the business, improve your care, and contact you. Example: The Practice uses PHI to send you appointment reminders if you choose.
TO BILL FOR YOUR SERVICES
The Practice can use and share PHI to bill and get payment from health plans or other entities. Example: The Practice gives PHI to your health insurance plan so it will pay for your services.
2. USES AND DISCLOSURES OF PHI THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT
The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:
TO HELP WITH PUBLIC HEALTH AND SAFETY ISSUES.
Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Serious threat to health or safety: To prevent a serious and imminent threat.
Abuse or Neglect: To report abuse, neglect, or domestic violence.
CHILD REPORTING ACT: TO DISCLOSE TO AUTHORITIES THE ACCESS, STREAMING OR DOWNLOAD OF MATERIAL WHERE A CHILD IS ENGAGED IN AN OBSCENE SEXUAL ACT.
To comply with law, law enforcement, or other government requests
Required by law: If required by federal, state or local law.
Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for the purpose of determining your own security clearance and other national security activities authorized by law.
Workers' Compensation: To comply with workers' compensation laws or support claims
TO COMPLY WITH OTHER REQUESTS
Coroners and Funeral Directors: To perform their legally authorized duties.
Organ Donation: For organ donation or transplantation.
Research: For research that has been approved by an institutional review board.
Inmates: The Practice created or received your PHI in the course of providing care.
Business Associates: To organizations that perform functions, activities or services on our behalf.
3. USES AND DISCLOSURES OF PHI THAT MAY BE MADE WITH YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT
UNLESS YOU OBJECT, THE PRACTICE MAY DISCLOSE PHI:
To your family, friends, or others if PHI directly relates to that person's involvement in your care.
If it is in your best interest because you are unable to state your preference.
4. USES AND DISCLOSURES OF PHI BASED UPON YOUR WRITTEN AUTHORIZATION
The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:
MARKETING, SALE OF PHI, AND PSYCHOTHERAPY NOTES.
You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in Notice unless you give your permission in writing.
OUR RESPONSIBILITIES
The Practice is required by law to maintain the privacy and security of PHI.
The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.
The Practice reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website.
The Practice will inform you if PHI is compromised in a breach.
PRIVACY RULES FOR PARENTS AND MINORS
The Privacy Rule generally allows a parent to have access to the medical records about their child, as the minor child’s personal representative when such access is not inconsistent with State or other law.
There are three situations when the parent would not be the minor’s personal representative under the Privacy Rule. These exceptions are:
When the minor is the one who consents to care and the consent of the parent is not required under State or other applicable law;
When the minor obtains care at the direction of a court or a person appointed by the court; and
When, and to the extent that, the parent agrees that the minor and the health care provider may have a confidential relationship.
However, even in these exceptional situations, the parent may have access to the medical records of the minor related to this treatment when State or other applicable law requires or permits such parental access. Parental access would be denied when State or other law prohibits such access. If State or other applicable law is silent on a parent’s right of access in these cases, the licensed health care provider may exercise his or her professional judgment to the extent allowed by law to grant or deny parental access to the minor’s medical information.
Finally, as is the case with respect to all personal representatives under the Privacy Rule, a provider may choose not to treat a parent as a personal representative when the provider reasonably believes, in his or her professional judgment, that the child has been or may be subjected to domestic violence, abuse or neglect, or that treating the parent as the child’s personal representative could endanger the child.