Terms and Conditions

Privacy Policies, Member Rights, and Responsibilities

THIS NOTICE DESCRIBES HOW PAWC MAY USE AND DISCLOSE PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Disclosures for Treatment, Payment, and Health Care Operations

Psychiatric Alternatives and Wellness Center and its providers ("PAWC") may use or disclose your protected health information ("PHI") for certain treatment, payment, and health care operations without your written authorization, as permitted under federal and state law.

In certain circumstances PAWC may only disclose PHI when the recipient provides required assurances of confidentiality.

Definitions:

"PHI" refers to individually identifiable health information in your record.
"Treatment" includes diagnosis, therapy sessions, telehealth visits, consultation, and care coordination with other health professionals. PAWC may use secure electronic systems and telehealth technologies to provide treatment.
"Payment" includes reimbursement, eligibility verification, billing, and claims processing.
"Health Care Operations" include quality improvement activities, clinical supervision, credentialing, care coordination, and administrative activities.
"Use" means internal sharing within PAWC.
"Disclosure" means releasing information outside PAWC.
"Authorization" is your written permission for specific uses or disclosures.

PAWC may use secure electronic systems, patient portals, and telehealth technologies to transmit PHI for treatment, payment, and operations. All transmissions will comply with HIPAA and California law.

If you pay out-of-pocket and in full, you have the right to request that PAWC not disclose information about that service to your health plan, and PAWC must honor the request unless disclosure is required by law.

II. Uses and Disclosures Requiring Authorization

PAWC may use or disclose PHI for purposes outside of treatment, payment, and health care operations only with your written authorization.

Authorization is required for:

Marketing communications, except for communications permitted by law (e.g., face-to-face discussions or nominal promotional gifts).
Sale of PHI, which PAWC does not engage in.

You may revoke or modify any authorization at any time by submitting a written request. Revocation is not effective until PAWC receives it and does not affect prior disclosures made in reliance on your authorization.

III. Uses and Disclosures with Neither Consent nor Authorization

PAWC may use or disclose PHI without your authorization under the following circumstances:

Child Abuse - Providers must report suspected child abuse or neglect.
Adult and Domestic Abuse - Providers must report suspected abuse, abandonment, abduction, isolation, financial exploitation, or neglect involving elders or dependent adults unless a statutory exception applies.
Health Oversight - If a complaint is filed with the California Board of Psychology or other licensing boards, PAWC may disclose relevant PHI.
Judicial and Administrative Proceedings - PAWC may disclose PHI:
- With your written authorization
- With a valid court order
- In response to a compliant subpoena with proper notice to you
- When the patient-litigant exception applies
Serious Threat to Health or Safety - If a patient poses a serious threat of violence or danger to self or others, PAWC may disclose PHI necessary to prevent harm.
Law Enforcement - PAWC may disclose limited PHI to law enforcement as required by law.
Worker's Compensation - PAWC may disclose PHI to comply with worker's compensation laws and for employment-related medical services with appropriate consent.
Breach Notification - PAWC is required by federal and state law to notify you in the event of a breach of unsecured PHI.

IV. Patient's Rights and Provider Duties

Patient's Rights

Right to Request Restrictions - You may request restrictions on the use or disclosure of your PHI. PAWC is not required to agree except when:
- you request a restriction on disclosures to a health plan and
- you pay out-of-pocket and in full for the service.
Right to Receive Confidential Communications - You may request that communications be sent to an alternative address or phone number.
Right to Inspect and Copy - You have the right to inspect or obtain a paper or electronic copy of your PHI. PAWC may deny access in limited circumstances; you may request a review of most denials.
Right to Amend - You may request an amendment to your PHI. PAWC may deny the request but will provide information about how to submit a statement of disagreement.
Right to an Accounting - You may request an accounting of disclosures of PHI made without your authorization except for treatment, payment, and operations.
Right to a Paper Copy - You may request a paper copy of this Notice at any time.

Provider Duties

PAWC and its providers are required by law to:

Maintain the privacy and security of your PHI.
Provide this Notice describing legal duties and privacy practices.
Comply with HIPAA, CMIA, and other applicable laws.
Notify you promptly if a breach compromises the privacy or security of your PHI.
Follow the terms of this Notice currently in effect.
Not retaliate against you for exercising your privacy rights or filing a complaint.

PAWC reserves the right to change its privacy practices. Any revised Notice will apply to all PHI maintained by PAWC and will be posted in our offices and on our website.

V. Questions and Complaints

If you have questions about this Notice, want to exercise your rights, or wish to file a complaint, contact:

Psychiatric Alternatives and Wellness Center
3609 Sacramento Street
San Francisco, CA 94118
Phone: 415.237.0377
Fax: 415.484.1944
Email: admin@psychiatricalternatives.com

You may also file a complaint with:

Office for Civil Rights (OCR)
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201