Privacy Practice
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NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH 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 notice, please contact Arroyo Vista Family Health Center’s (Arroyo Vista) Privacy Officer at (323) 987-2000 ext. #2013.
A. WHO WILL FOLLOW THIS NOTICE
This notice describes Arroyo Vista’s practices and that of:
Any health care professional authorized to enter information into your health record.
All Health Center sites.
Any member of a volunteer group.
All employees, staff and other personnel.
All Arroyo Vista sites shall follow the terms of this notice and may share your information with each other for treatment, payment or health care operations purposes described in this notice.
B. ARROYO VISTA’S PLEDGE REGARDING MEDICAL INFORMATION
Arroyo Vista understands that information about you and your health is personal.
Arroyo Vista is committed to protecting information about you.
Arroyo Vista creates a record of the care and services you receive. A record is required to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Arroyo Vista.
This notice will tell you about the ways in which Arroyo Vista may use and disclose information about you. Arroyo Vista’s Notice of Privacy Practices also describes your rights and certain obligations that Arroyo Vista has regarding the use and disclosure of your information.
Arroyo Vista is required by law to:
Make sure that the information that identifies you is kept private (with certain exceptions)
Give you this notice of our legal duties and privacy practices with respect to information about you
Follow the terms of the Privacy Notice that is currently in effect.
C. HOW ARROYO VISTA MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that Arroyo Vista may use and disclose information. Not every use or disclosure in a category will be listed. However, all of the ways Arroyo Vista is permitted to use and disclose information will fall within one of the following categories:
DISCLOSURE AT YOUR REQUEST
Arroyo Vista may disclose information when requested by you. This disclosure at your request will require a written authorization by you.
FOR TREATMENT
Arroyo Vista may use information about you to provide you with healthcare treatment or services. Arroyo Vista may disclose information about you to doctors, nurses, technicians, health care students, or other personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.
FOR PAYMENT
Arroyo Vista may use and disclose information about you so that the treatment and services you receive may be billed to you and payment may be collected from you, or an insurance company or a third party. For example, Arroyo Vista may need to give information about treatment you received at Arroyo Vista to your health plan for payment to Arroyo Vista or reimburse you for the treatment you received.
FOR HEALTH CARE OPERATIONS
Arroyo Vista may use and disclose information about you for health care operations. These uses and disclosures are necessary to run our facility and make sure that all of our patients receive quality care. For example, Arroyo Vista may use information to review our treatment and services and to evaluate the performance of our staff in caring for you.
INCIDENTAL USES AND DISCLOSURES
There are certain incidental uses or disclosures of your health information that occurs while Arroyo Vista is conducting standard flow of operation. For instance, individuals waiting in the same area may hear your name called. Arroyo Vista will make reasonable efforts to limit these incidental uses and disclosures.
FUNDRAISING ACTIVITIES
Arroyo Vista may use information about you for fundraising purposes, but only with a valid signed authorization from you. All patients have the right to refuse receiving fundraising communications.
FAMILY MEMBERS OR OTHERS YOU DESIGNATE
If your spouse, parent, child, or sibling makes a request for information and you are unable to authorize the release of this information, Arroyo Vista is required to give the requesting person notification of your presence in our facility. Unless you request to withhold this information, Arroyo Vista must make reasonable attempts to notify your next of kin or any other person designated by you. Upon request of a family member, Arroyo Vista is required to provide information regarding your serious illness, injury, or death.
TO INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE
Arroyo Vista may release information about you to a friend or family member who is authorized to be involved in your health care. Arroyo Vista may also give information to someone who helps pay for your care.
In addition, Arroyo Vista may disclose information about you to an organization assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
RESEARCH
Under certain circumstances, Arroyo Vista may use and disclose information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received a different medication, for the same condition.
AS REQUIRED BY LAW
Arroyo Vista will disclose information about you when required to do so by federal, state or local law.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
Arroyo Vista may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
HEALTH INFORMATION EXCHANGE
Arroyo Vista may share your health information electronically with other groups through a Health Information Exchange network. These other groups may include hospitals, laboratories, doctors, public health departments, health plans, and other participants. Sharing data electronically is a faster way to get your health data to the providers treating you. For example, if you travel and need treatment, it allows other doctors that participate to electronically access your information to help care for you. Arroyo Vista is also involved in the Affordable Care Act and may use and share information as permitted to achieve national goals related to meaningful use of electronic health systems.
You may opt out of your information being accessible in or through the HIE(s) and disable access to your health information by completing and submitting an Opt-Out form (HIE Change of Consent) to Arroyo Vista Family Health Center by email (Healthinformation@arroyovista.org). Even if you opt-out of your information being generally accessible through the HIE(s), your health information relating to public health reporting and controlled dangerous substances information will still be available to providers through the HIE(s) as permitted by law. Your health care provider may also participate in other HIEs, including HIEs that allow your provider to share your information directly through our electronic medical record system.
SPECIAL SITUATIONS
ORGAN, EYE AND TISSUE DONATION
Arroyo Vista may release information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank for the purposes of facilitating donation and transplantation.
MILITARY AND VETERANS
If you are a member of the armed forces, Arroyo Vista may release information about you as required by military command authorities.
WORKERS’ COMPENSATION
Arroyo Vista may release information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
PUBLIC HEALTH REQUIREMENTS
Arroyo Vista may disclose information about you for public health activities. These activities may include, without limitation, the following:
To prevent or control disease, injury or disability;
To report births and deaths;
To report regarding the abuse or neglect of children, elders and dependent adults;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
To notify the appropriate government authority if Arroyo Vista believes a patient has been the victim of abuse, neglect or domestic violence. Arroyo Vista will only make this disclosure if you agree or when required or authorized by law;
To notify emergency response employees regarding exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws.
HEALTH OVERSIGHT ACTIVITIES
Arroyo Vista may disclose information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
LAWSUITS AND DISPUTES
If you are involved in a lawsuit or a dispute, Arroyo Vista may disclose information about you in response to a court or administrative order. Arroyo Vista may also disclose information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.
LAW ENFORCEMENT
Arroyo Vista may release information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness, escapees and certain missing persons;
About the victim of a crime if, under certain limited circumstances, Arroyo Vista is unable to obtain the person’s agreement;
To report abuse, neglect, or assaults as required or permitted by law;
To report certain threats to third parties;
If the police bring you to our facility and asks Arroyo Vista to test your blood for alcohol or substance abuse;
About a death we believe may be the result of criminal conduct;
About criminal conduct at our facility;
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime;
When requested by an officer who lodges a warrant with the facility;
When requested at the time of a patient’s involuntary hospitalization (information may be released to the county mental health director/ designee)
If you are in police custody or are an inmate of a correctional institution and the information is necessary to provide you with health care, to protect your health and safety, the health and safety of others or for the safety and security of the correctional institution.
CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS
Arroyo Vista may release information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. Arroyo Vista may also release information about patients to funeral directors as necessary.
NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES
Arroyo Vista may release information about you to authorize federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS
Arroyo Vista may disclose information about you to authorized federal officials so they may provide protection to the President, elective constitutional officers and their families, or foreign heads of state or conduct special investigations.
ADVOCACY GROUPS
Arroyo Vista may disclose mental/behavioral health information to Disability Rights California for the purposes of certain investigations as permitted by law.
DEPARTMENT OF JUSTICE
Arroyo Vista may disclose limited information to the California Department of Justice for identification purposes about certain criminal patients, or regarding persons nor approved to purchase, possess or control a firearm or deadly weapon.
MULTIDISCIPLINARY PERSONNEL TEAMS
Arroyo Vista may disclose information to a multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child’s parents, or elder abuse or dependent adult and neglect.
SPECIAL CATEGORIES OF INFORMATION
In some circumstances, your information may be subject to restrictions that may limit or preclude some uses or disclosures described in this notice. For example, there are special restrictions on the use or disclosure of certain categories of information—e.g., tests for HIV or treatment for mental health conditions, genetic information, or alcohol and drug abuse. Government health benefit programs, such as Medi-Cal, may also limit the disclosure of beneficiary information for purposes unrelated to the program.
SENATE AND ASSEMBLY RULES COMMITTEES
Arroyo Vista may disclose your information to the Senate or Assembly Rules Committee for purpose of legislative investigation.
PSYCHOTHERAPY NOTES
Psychotherapy notes mean notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record.
Arroyo Vista may use or disclose your psychotherapy notes, as required by law, or:
For use by the originator of the notes
In supervised mental health training programs for students, trainees, or practitioners
By the covered entity to defend a legal action or other proceeding brought by the individual
To prevent or lessen a serious and imminent threat to the health or safety of a person or the public
For the health oversight of the originator of the psychotherapy notes
For use or disclosure to coroner or medical examiner to report a patient’s death
For use or disclosure to the Secretary of DHHS in the course of an investigation
D. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding information Arroyo Vista maintains about you:
RIGHT TO INSPECT AND COPY
You have the right to inspect and obtain a copy of information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information.
To inspect and obtain a copy of information that may be used to make decisions about you, you must submit your request in writing to Arroyo Vista Family Health Center, Health Information Management Department located at 2411 North Broadway, Los Angeles, CA 90031. If you request a copy of the information, Arroyo Vista may charge a fee for the costs of copying, mailing or other supplies associated with your request.
Arroyo Vista may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to mental health/behavioral information, you may request that the denial be reviewed. Another licensed health care professional chosen by Arroyo Vista will review your request and the denial. The person conducting the review will not be the person who denied your request. Arroyo Vista will comply with the outcome of the review.
RIGHT TO AMEND
If you feel that information Arroyo Vista has about you is incorrect or incomplete, you may ask Arroyo Vista to amend the information. You have the right to request an amendment for as long as Arroyo Vista keeps the information. To request an amendment, your request must be made in writing and submitted to Arroyo Vista Family Health Center, Health Information Management Department located at 2411 North Broadway, Los Angeles, CA 90031. In addition, you may provide a reason that supports your request.
Arroyo Vista may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, Arroyo Vista may deny your request if you ask Arroyo Vista to amend information that:
Was not created by Arroyo Vista, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the information kept by Arroyo Vista or for Arroyo Vista;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.
Even if Arroyo Vista denies your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that, you want the addendum to be made part of your health record Arroyo Vista will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.
RIGHT TO AN ACCOUNTING OF DISCLOSURES
You have the right to request an “accounting of disclosures.” This will be a list of the disclosures Arroyo Vista has made of information about you other than our own uses for treatment, payment and health care operations (as those functions are described above), and with other exceptions by law.
To request this list or accounting of disclosures, you must submit your request in writing to Arroyo Vista Family Health Center, Health Information Management Department located at 2411 North Broadway, Los Angeles, CA 90031. Your request must state a time, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, Arroyo Vista may charge you for the costs of providing the list. Arroyo Vista will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs have incurred. In addition, Arroyo Vista will notify you as required by law following a breach of your unsecured protected health information.
RIGHT TO REQUEST RESTRICTIONS
You have the right to request a restriction or limitation on the information Arroyo Vista uses or discloses about you for treatment, payment or health care operations. You also have the right to request a limit on the information Arroyo Vista discloses about you to someone who is involved in your care or the payment for your care, like a family member or friend.
For example, you could ask that Arroyo Vista not use or disclose information about a surgery you had.
Arroyo Vista is not required to agree to your request, except to the extent that you request Arroyo Vista to restrict disclosure to a health plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the health plan or insurer), has paid for the item or service in full. Even if you request this special restriction, Arroyo Vista can disclose the information to a health plan or insurer for purposes of treating you.
If Arroyo Vista agrees to another special restriction, Arroyo Vista will comply with your request unless the information is required to provide you emergency treatment.
To request restrictions, you must make your request in writing to Arroyo Vista Family Health Center, Health Information Management Department located at 2411 North Broadway, Los Angeles, CA 90031. In your request, you must tell Arroyo Vista: 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply, for example, disclosures to your spouse.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS
You have the right to request that Arroyo Vista communicate with you about health matters in a certain way or at a certain location. For example, you can ask that Arroyo Vista only contact you at work or by mail.
To request confidential communications, you must make your request in writing Arroyo Vista Family Health Center, Health Information Management Department located at 2411 North Broadway, Los Angeles, CA 90031. Arroyo Vista will not ask you the reason for your request. Arroyo Vista will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
RIGHT TO A PAPER COPY OF THIS NOTICE
You have the right to a paper copy of this notice. You may ask Arroyo Vista to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website: www.arroyovista.org
To obtain a paper copy of this notice: Copies of the Notice are available at all Arroyo Vista Family Health Center locations or you may contact the Health Information Management Department to request a copy to be mailed.
E. CHANGES TO THIS NOTICE
Arroyo Vista reserves the right to change this notice. Arroyo Vista reserves the right to make the revised or changed notice effective for information the organization already has about you as well as any information Arroyo Vista receives in the future. Arroyo Vista will post a copy of the current notice in the facility and website. The notice will contain the effective date on the first page.
F. BREACH NOTIFICATION
Arroyo Vista Family Health Center shall notify affected individual(s) if a breach occurs that compromised the patients of their information.
G. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Arroyo Vista or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with Arroyo Vista, contact Arroyo Vista Family Health Center’s Privacy Officer at (323) 987-2000 ext. 2013. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
H. OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of information not covered by this notice of the laws that apply to Arroyo Vista will be made only with your written permission. If you provide Arroyo Vista with permission to use or disclose information about you, you may revoke the permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your information for the purposes covered by your written authorization, except if Arroyo Vista has already acted in reliance on your permission. You understand that Arroyo Vista is unable to take back any disclosures Arroyo Vista has already made with your permission, and that Arroyo Vista is required to retain our records of the care that Arroyo Vista provided to you.
Mail: Office of Quality and Patient Safety The Joint Commission
One Renaissance Blvd. Oakbrook Terrace, Illinois 60181
General Questions – Customer Service 630-792-5800
Monday-Friday 8:30am to 5:00pm CST
E-mail to submit a complaint https://www.jointcommission.org/report_a_complaint.aspx
Fax to 630-792-5636