Psychiatric Alternatives and Wellness Center's 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 GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Disclosures for Treatment, Payment, and Health Care Operations
Psychiatric Alternatives and Wellness Center and its providers (hereby referred to as PAWC) may use or disclose your protected health information (PHI) for certain treatment, payment, and health care operations purposes without your authorization. In certain circumstances PAWC and its providers can only do so when the person or business requesting your PHI provides a written request that includes certain promises regarding protecting the confidentiality of your PHI. To help clarify these terms, here are some definitions:
- "PHI" refers to information in your health record that could identify you. It contains data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such health care.
- "Treatment, Payment and Health Care Operations"
- Treatment is when a health care provider diagnoses or treats you. Examples of treatment would include an actual therapy session or when a psychologist consults with another health care provider, such as your family physician or a psychiatrist, regarding your treatment.
- Payment is when when reimbursement is obtained for your health care. Examples of payment are when PAWC discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
- Health Care Operations is when PAWC discloses your PHI to your health care service plan (for example your health insurer), or to other health care providers contracting with your plan, or administering the plan, such as case management and care coordination.
- "Use" applies only to activities within PAWC [office, clinic, practice group, etc.] such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
- "Disclosure" applies to activities outside of PAWC [office, clinic, practice group, etc.], such as releasing, transferring, or providing access to information about you to other parties.
- "Authorization" means your written permission for specific uses or disclosures.
II. Uses and Disclosures Requiring Authorization
PAWC may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. In those instances when your doctor is asked for information for purposes outside of treatment and payment operations, we will obtain an authorization from you before releasing this information. You may revoke or modify all such authorizations (of PHI) at any time; however, the revocation or modification is not effective until PAWC receives it in writing.
III. Uses and Disclosures with Neither Consent nor Authorization
PAWC may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse: Whenever a provider at PAWC, in his/her professional capacity, has knowledge of or observes a child known or reasonably suspected to have been the victim of child abuse or neglect, that provider must immediately report such to child protective services. Also, if the provider has knowledge of or reasonably suspect that mental suffering has been inflicted upon a child or that his or her emotional well-being is endangered in any other way, that provider may report such to the above agencies.
- Adult and Domestic Abuse: If a provider at PAWC, in his/her professional capacity, has observed or has knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if the provider is told by an elder or dependent adult that he or she has experienced these or if the provider reasonably suspect such, the provider must report the known or suspected abuse immediately to the adult protective services agency or the local law enforcement agency. The provider does not have to report such an incident if:
Health Oversight: If a complaint is filed against PAWC with the California Board of Psychology, the Board has the authority to subpoena confidential mental health information from PAWC relevant to that complaint.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made about the professional services that PAWC has provided you, PAWC must not release your information without: 1) your written authorization or the authorization of your attorney or personal representative; 2) a court order; or 3) a subpoena duces tecum (a subpoena to produce records) where the party seeking your records provides PAWC with a showing that you or your attorney have been served with a copy of the subpoena, affidavit and the appropriate notice, and you have not notified PAWC that you are bringing a motion in the court to quash (block) or modify the subpoena. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. Your provider will inform you in advance if this is the case.
Serious Threat to Health or Safety: If you or your family member communicates to a provider that you pose a serious threat of physical violence against an identifiable victim, the provider must make reasonable efforts to communicate that information to the potential victim and the police. If the provider has reasonable cause to believe that you are in such a condition, as to be dangerous to yourself or others, the provider may release relevant information as necessary to prevent the threatened danger.
Worker's Compensation: If you file a worker's compensation claim, your provider may disclose to your employer your medical information created as a result of employment-related health care services provided to you at the specific prior written consent and expense of your employer so long as the requested information is relevant to your claim provided that is only used or disclosed in connection with your claim and describes your functional limitations provided that no statement of medical cause is included.
- The provider has been told by an elder or dependent adult that he or she has experienced behavior constituting physical abuse, abandonment, abduction, isolation, financial abuse or neglect;
- The provider is not aware of any independent evidence that corroborates the statement that the abuse has occurred;
- The elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia;
- in the exercise of clinical judgment, the provider reasonably believes that the abuse did not occur.
IV. Patient's Rights and Provider Duties
- Right to Request Restrictions - You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, PAWC is not required to agree to a restriction you request.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are coming to PAWC. Upon your request, your bills will be sent to another address.)
- Right to Inspect and Copy - You have the right to inspect or obtain a copy (or both) of PHI in PAWC's mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. PAWC may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, your provider will discuss with you the details of the request and denial process.
- Right to Amend - You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. PAWC may deny your request. On your request, your provider will discuss with you the details of the amendment process.
- Right to an Accounting - You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, your provider will discuss with you the details of the accounting process.
- Right to a Paper Copy - You have the right to obtain a paper copy of this notice from PAWC upon request.
- PAWC and all its providers are required by law to maintain the privacy of PHI and to provide you with a notice of its legal duties and privacy practices with respect to PHI.
- PAWC reserves the right to change the privacy policies and practices described in this notice at any time. Any changes will apply to the PHI already on file with me. Before PAWC makes any important changes to its policies, it will immediately change this notice and post a new copy of it in on the PAWC website (psychiatricalternatives.com). You may also request a copy of this notice from your provider, or you can view a copy of it in the PAWC office or on our website, which is located at psychiatricalternatives.com.
V. Questions and Complaints
If you have questions about this notice, disagree with a decision PAWC or one of its providers makes about access to your records, or have other concerns about your privacy rights, you may contact PAWC at:
Psychiatric Alternatives and Wellness Center
3676 Sacramento Street
San Francisco, CA 94118
If you believe that your privacy rights have been violated and wish to file a complaint against PAWC, you may send your written complaint to the above address.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Washington, D.C. 20201. If you file a complaint about PAWC's privacy practices, PAWC and its providers will not take retaliatory action against you.
VI. Effective Date
This notice will go into effect on October 1, 2011.