CATHOLIC CHARITIES OF SANTA CLARA COUNTY
2625 ZANKER ROAD, SAN JOSE, CA 95134
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.
If you have any questions about this Privacy Notice, please contact our
Privacy officer at 408-325-5105 or aschultz@ccsj.org.
I. Introduction
This Notice of Privacy Practices describes how we may use and disclose
your protected health information to carry out treatment, payment or health
care operations and for other purposes that are permitted or required
by law. This Notice also describes your rights regarding health information
we maintain about you and a brief description of how you may exercise
these rights. This Notice further states the obligations we have to protect
your health information.
“Protected health information” means health information, including
identifying information about you, we have collected from you or received
from your health care providers, health plans, your employer or a health
care clearinghouse. It may include information about your past, present
or future physical or mental health or condition, the provision of your
health care, and payment for your health care services.
We are required by law to maintain the privacy of your health information
and to provide you with this notice of our legal duties and privacy practices
with respect to your health information. We are also required to comply
with the terms of our current Notice of Privacy Practices.
II. How We Will Use and Disclose Your Health Information
We will use and disclose your health information as described in each
category listed below. For each category, we will explain what we mean
in general, but not describe all specific uses or disclosures of health
information.
A. Uses and Disclosures for Treatment, Payment and Operations
1. For Treatment. We will use and disclosure your health
information without your authorization to provide your health care and
any related services. We will also use and disclose your health information
to coordinate and manage your health care and related services. For example,
we may need to disclose information to a case manager who is responsible
for coordinating your care.
We may also disclose your health information among our clinicians and
other staff, e.g. intake coordinator and program assistants who work at
Catholic Charities (CCSJ). For example, our staff may discuss your care
at a case conference. In addition, we may disclose your health information
without your authorization to another health care provider (e.g., your
primary care physician or a laboratory) working outside of Catholic Charities
for purposes of your treatment.
2. For Payment. We may use or disclose your health information
without your authorization so that the treatment and services you receive
are billed to, and payment is collected from, your health plan or other
third party payer. By way of example, we may disclose your health information
to permit your health plan or other health insurer to take certain actions
before your health plan or insurer approves or pays for your services.
These actions may include:
• making a determination of eligibility or coverage for health insurance;
• reviewing your services to determine if they were medically necessary;
• reviewing your services to determine if they were appropriately
authorized or certified in advance of your care; or
• reviewing your services for purposes of utilization review, to
ensure the appropriateness of your care, or to justify the charges for
your care.
For example, your health plan or insurer may ask us to share your health
information in order to determine if the plan will approve additional
visits to your therapist.
We may also disclose your health information to another health care provider
so that provider can bill you for services they provided to you, for example
an ambulance service that transported you to the hospital.
3. For Health Care Operations. We may use and disclose
health information about you without your authorization for our health
care operations. These uses and disclosures are necessary to run our organization
and make sure that our consumers receive quality care. These activities
may include, for example, quality assessment and improvement, reviewing
the performance or qualifications of our clinicians, training students
in clinical activities, licensing, accreditation, business planning and
development, and general administrative activities. We may combine health
information of many of our clients to decide what additional services
we should offer, what services are no longer needed, and whether certain
treatments are effective.
We may also provide your health information to other health care providers
or to your health plan to assist them in performing certain of their own
health care operations. We will do so only if you have or have had a relationship
with the other provider or health plan. For example, we may provide information
about you to your health plan to assist them in their quality assurance
activities.
We may also use and disclose your health information to contact you to
remind you of your appointment.
Finally, we may use and disclose your health information to inform you
about possible treatment options or alternatives that may be of interest
to you.
4. Health-Related Benefits and Services. We may use and
disclose health information to tell you about health-related benefits
or services that may be of interest to you. If you do not want us to provide
you with information about health-related benefits or services, you must
notify the Privacy Officer in writing at Catholic Charities, 2625 Zanker
Road, San Jose, CA 05134. Please state clearly that you do not want to
receive materials about health-related benefits or services.
B. Uses and Disclosures That May be Made Without Your Authorization,
But For Which You Will Have an Opportunity to Object.
1. Persons Involved in Your Care. We may provide health
information about you to someone who helps pay for your care. We may use
or disclose your health information to notify or assist in notifying a
family member, personal representative, public guardian or conservator
or any other person that is responsible for your care of your location,
general condition or death. We may also use or disclose your health information
to an entity assisting in disaster relief efforts and to coordinate uses
and disclosures for this purpose to family or other individuals involved
in your health care.
In limited circumstances, we may disclose health information about you
to a friend or family member who is involved in your care. If you are
physically present and have the capacity to make health care decisions,
your health information may only be disclosed with your agreement to persons
you designate to be involved in your care.
But, if you are in an emergency situation, we may disclose your health
information to a spouse, a family member, or a friend so that such person
may assist in your care. In this case we will determine whether the disclosure
is in your best interest and, if so, only disclose information that is
directly relevant to participation in your care.
And, if you are not in an emergency situation but are unable to make health
care decisions, we will disclose your health information to:
>> a person designated to participate in your care in accordance
with an advance directive validly executed under state law,
>> your guardian or other fiduciary if one has been appointed by a court,
or if applicable, the state agency responsible for consenting to your
care.
C. Uses and Disclosures That May be Made Without Your Authorization
or Opportunity to Object.
1. Emergencies. We may use and disclose your health information
in an emergency treatment situation. By way of example, we may provide
your health information to a paramedic who is transporting you in an ambulance.
If a clinician is required by law to treat you and your treating clinician
has attempted to obtain your authorization but is unable to do so, the
treating clinician may nevertheless use or disclose your health information
to treat you.
2. Research. We may disclose your health information
to researchers when their research has been approved by an Institutional
Review Board or a similar Privacy Board that has reviewed the research
proposal and established protocols to protect the privacy of your health
information.
3. As Required By Law. We will disclose health information
about you when required to do so by federal, state or local law.
4. To Avert a Serious Threat to Health or Safety. We
may use and disclose health information about you when necessary to prevent
a serious and imminent threat to your health or safety or to the health
or safety of the public or another person. Under these circumstances,
we will only disclose health information to someone who is able to help
prevent or lessen the threat.
5. Organ and Tissue Donation. If you are an organ donor,
we may release your health information to an organ procurement organization
or to an entity that conducts organ, eye or tissue transplantation, or
serves as an organ donation bank, as necessary to facilitate organ, eye
or tissue donation and transplantation.
6. Public Health Activities. We may disclose health information
about you as necessary for public health activities including, by way
of example, disclosures to:
>> report to public health authorities for the purpose of preventing or
controlling disease, injury or disability;
>> report vital events such as birth or death;
>> conduct public health surveillance or investigations;
>> report child abuse or neglect;
>> report certain events to the Food and Drug Administration (FDA) or to
a person subject to the jurisdiction of the FDA including information
about defective products or problems with medications;
>> notify consumers about FDA-initiated product recalls;
>> notify a person who may have been exposed to a communicable disease
or who is at risk of contracting or spreading a disease or condition;
>> notify the appropriate government agency if we believe you have been
a victim of elder abuse and/or neglect or domestic violence. We will only
notify an agency if we obtain your agreement or if we are required or
authorized by law to report such abuse, neglect or domestic violence.
7. Health Oversight Activities. We may disclose health
information about you to a health oversight agency for activities authorized
by law. Oversight agencies include government agencies that oversee the
health care system, government benefit programs such as Medicare or Medicaid,
other government programs regulating health care, and civil rights laws.
8. Disclosures in Legal Proceedings. We may disclose
health information about you to a court or administrative agency when
a judge or administrative agency orders us to do so. We also may disclose
health information about you in legal proceedings without your permission
or without a judge or administrative agency’s order when:
>> we receive a subpoena for your health information. We will not provide
this information in response to a subpoena without your authorization
if the request is for records of a federally-assisted substance abuse
program;
9. Law Enforcement Activities. We may disclose health
information to a law enforcement official for law enforcement purposes
when:
>> a court order, subpoena, warrant, summons or similar process requires
us to do so; or
>> the information is needed to identify or locate a suspect, fugitive,
material witness or missing person; or
>> we report a death that we believe may be the result of criminal conduct;
or
>> we report criminal conduct occurring on the premises of our facility;
or
>> we determine that the law enforcement purpose is to respond to a threat
of an imminently dangerous activity by you against yourself or another
person; or
>> the disclosure is otherwise required by law.
We may also disclose health information about a client who is a victim
of a crime, without a court order or without being required to do so by
law. However, we will do so only if the disclosure has been requested
by a law enforcement official and the victim agrees to the disclosure
or, in the case of the victim’s incapacity, the following occurs:
>> the law enforcement official represents to us that (i) the victim is
not the subject of the investigation and (ii) an immediate law enforcement
activity to meet a serious danger to the victim or others depends upon
the disclosure; and
>> we determine that the disclosure is in the victim’s best interest.
10. Medical Examiners or Funeral Directors. We may provide
health information about our consumers to a medical examiner. Medical
examiners are appointed by law to assist in identifying deceased persons
and to determine the cause of death in certain circumstances. We may also
disclose health information about our consumers to funeral directors as
necessary to carry out their duties.
11. Military and Veterans. If you a member of the armed
forces, we may disclose your health information as required by military
command authorities. We may also disclose your health information for
the purpose of determining your eligibility for benefits provided by the
Department of Veterans Affairs. Finally, if you are a member of a foreign
military service, we may disclose your health information to that foreign
military authority.
12. National Security and Protective Services for the President
and Others. We may disclose medical information about you to
authorized federal officials for intelligence, counter-intelligence, and
other national security activities authorized by law. We may also disclose
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 so they may conduct special investigations.
13. Inmates. If you are an inmate of a correctional institution
or under the custody of a law enforcement official, we may disclose health
information about you to the correctional institution or law enforcement
official.
14. Workers’ Compensation. We may disclose health
information about you to comply with the state’s Workers’
Compensation Law.
III. Uses and Disclosures of Your Health Information with Your
Permission.
Uses and disclosures not described in Section II of this Notice of Privacy
Practices will generally only be made with your written permission, called
an “authorization.” You have the right to revoke an authorization
at any time. If you revoke your authorization we will not make any further
uses or disclosures of your health information under that authorization,
unless we have already taken an action relying upon the uses or disclosures
you have previously authorized.
IV. Your Rights Regarding Your Health Information.
A. Right to Inspect and Copy.
You have the right to request an opportunity to inspect or copy health
information used to make decisions about your care – whether they
are decisions about your treatment or payment of your care. Usually, this
would include clinical and billing records, but not psychotherapy notes.
You must submit your request in writing to our Privacy Officer at Catholic
Charities, 2625 Zanker Road, San Jose, CA 95134. If you request a copy
of the information, we may charge a fee for the cost of copying, mailing
and supplies associated with your request. We may deny your request to
inspect or copy your health information in certain limited circumstances.
In some cases, you will have the right to have the denial reviewed by
a licensed health care professional not directly involved in the original
decision to deny access. We will inform you in writing if the denial of
your request may be reviewed. Once the review is completed, we will honor
the decision made by the licensed health care professional reviewer.
B. Right to Amend.
For as long as we keep records about you, you have the right to request
us to amend any health information used to make decisions about your care
– whether they are decisions about your treatment or payment of
your care. Usually, this would include clinical and billing records, but
not psychotherapy notes. To request an amendment, you must submit a written
document to our Privacy Officer at Catholic Charities, 2625 Zanker Road,
San Jose CA 95134 and tell us why you believe the information is incorrect
or inaccurate. We may deny your request for an amendment if it is not
in writing or does not include a reason to support the request. We may
also deny your request if you ask us to amend health information that:
>> was not created by us, unless the person or entity that created the
health information is no longer available to make the amendment;
>> is not part of the health information we maintain to make decisions
about your care;
>> is not part of the health information that you would be permitted to
inspect or copy; or
>> is accurate and complete.
If we deny your request to amend, we will send you a written notice of
the denial stating the basis for the denial and offering you the opportunity
to provide a written statement disagreeing with the denial. If you do
not wish to prepare a written statement of disagreement, you may ask that
the requested amendment and our denial be attached to all future disclosures
of the health information that is the subject of your request.
If you choose to submit a written statement of disagreement, we have the
right to prepare a written rebuttal to your statement of disagreement.
In this case, we will attach the written request and the rebuttal (as
well as the original request and denial) to all future disclosures of
the health information that is the subject of your request.
C. Right to an Accounting of Disclosures.
You have the right to request that we provide you with an accounting of
disclosures we have made of your health information. An accounting is
a list of disclosures. But this list will not include certain disclosures
of your health information, for example, those we have made for purposes
of treatment, payment, and health care operations.
To request an accounting of disclosures, you must submit your request
in writing to the Privacy Officer at Catholic Charities, 2625 Zanker Road,
San Jose, CA 95134. For your convenience, you may submit your request
on a form called a “Request For Accounting,” which you may
obtain from our Privacy Officer. The request should state the time period
for which you wish to receive an accounting. This time period should not
be longer than six years and not include dates before April 14, 2003.
The first accounting you request within a twelve month period will be
free. For additional requests during the same 12 month period, we will
charge you for the costs of providing the accounting. We will notify you
of the amount we will charge and you may choose to withdraw or modify
your request before we incur any costs.
D. Right to Request Restrictions.
You have the right to request a restriction on the health information
we use or disclose about you for treatment, payment or health care operations.
To request a restriction, you must request the restriction at Catholic
Charities, 2625 Zanker Road, San Jose, CA 95134.The Privacy Officer will
ask you to sign a request for restriction form, which you should complete
and return to the Privacy Officer. We are not required to agree to a restriction
that you may request. If we do agree, we will honor your request unless
the restricted health information is needed to provide you with emergency
treatment.
E. Right to Request Confidential Communications.
You have the right to request that we communicate with you about your
health care only in a certain location or through a certain method. For
example, you may request that we contact you only at work or by e-mail.
To request such a confidential communication, you must make your request
in writing to the Privacy Officer at Catholic Charities, 2625 Zanker Road,
San Jose, CA 95134.. We will accommodate all reasonable requests. You
do not need to give us a reason for the request; but your request must
specify how or where you wish to be contacted.
F. Right to a Paper Copy of this Notice.
You have the right to obtain a paper copy of this Notice of Privacy Practices
at any time. Even if you have agreed to receive this Notice of Privacy
Practices electronically, you may still obtain a paper copy. To obtain
a paper copy, contact our Privacy Officer at Catholic Charities, 2625
Zanker Road, San Jose, CA 95134.
V. Confidentiality of Substance Abuse Records
For individuals who have received treatment, diagnosis or referral for
treatment from our drug or alcohol abuse programs, the confidentiality
of drug or alcohol abuse records is protected by federal law and regulations.
As a general rule, we may not tell a person outside the programs that
you attend any of these programs, or disclose any information identifying
you as an alcohol or drug abuser, unless:
>> you authorize the disclosure in writing; or
>> the disclosure is permitted by a court order; or
>> the disclosure is made to medical personnel in a medical emergency or
to qualified personnel for research, audit or program evaluation purposes;
or
>> you threaten to commit a crime either at the drug abuse or alcohol program
or against any person who works for our drug abuse or alcohol programs.
A violation by us of the federal law and regulations governing drug or
alcohol abuse is a crime. Suspected violations may be reported to the
Unites States Attorney in the district where the violation occurs. Federal
law and regulations governing confidentiality of drug or alcohol abuse
permit us to report suspected child abuse or neglect under state law to
appropriate state or local authorities.
Please see 42 U.S.C. § 290dd-2 for federal law and 42 C.F.R., Part
2 for federal regulations governing confidentiality of alcohol and drug
abuse patient records.
VI. Complaints
If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the U.S. Department of Health
and Human Services. To file a complaint with us, contact our office responsible
for receiving complaints at Catholic Charities, 2625 Zanker Road, San
Jose, CA 95134, 408-468-0100]. All complaints must be submitted in writing.
Our Privacy Officer, who can be contacted at 2625 Zanker Road, San Jose,
CA 95134, will assist you with writing your complaint, if you request
such assistance.
We will not retaliate against you for filing a complaint.
VII. Changes to this Notice
We reserve the right to change the terms of our Notice of Privacy Practices.
We also reserve the right to make the revised or changed Notice of Privacy
Practices effective for all health information we already have about you
as well as any health information we receive in the future. We will post
a copy of the current Notice of Privacy Practices at our main office and
at each site where we provide care. You may also obtain a copy of the
current Notice of Privacy Practices by accessing our website at www.ccsj.org
or by calling us at 408-468-0100 requesting that a copy be sent to you
in the mail or by asking for one any time you are at our offices.
Adopted 2-6-03
Catholic Charities of Santa Clara County
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