Jewish Family and Children’s Service of Long Beach & West Orange County

Notice and Acknowledgement 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.

Effective Date of this Notice:

This notice is effective January 1, 2016.

JFCS is required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”). JFCS must abide by the terms of this Notice, and must notify you if a breach of your unsecured PHI occurs. JFCS can change the terms of this Notice, and such changes will apply to all information JFCS has about you. The new Notice will be available upon request.

Except for the specific purposes set forth below, JFCS will use and disclose your PHI only with your written authorization (“Authorization”). It is your right to revoke such Authorization at any time by giving JFCS a written notice of your revocation.

Uses (Inside Practice) and disclosure (Outside Practice) relating to treatment, payment, or heath care operations do not require your written consent.

JFCS can use and disclose your PHI without your Authorization for the following reasons:

  1. For your treatment. JFCS can use and disclose your PHI to treat you, which may include disclosing your PHI to another health care professional. For example, if you are being treated by a physician or a psychiatrist, JFCS can disclose your PHI to him or her to help coordinate your care, although JFCS preference is for you to give JFCS Authorization to do so.
  1. To obtain payment for your treatment. JFCS can use and disclose your PHI to bill and collect payment for the treatment and services provided by JFCS to you. For example, JFCS might send your PHI to a third party to get paid for the health care services that JFCS has provided to you, although JFCS preference is for you to give JFCS authorization to do so.
  1. For health care operations. JFCS can use and disclose your PHI for purposes of conducting health care operations pertaining to JFCS practice including contacting you when necessary. For example, JFCS may need to disclose your PHI to a JFCS attorney to obtain advice about complying with applicable laws.

Certain uses and disclosures require your Authorization:

  1. Psychotherapy notes. JFCS does keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any uses or disclosure of such notes requires your authorization unless the use or disclosure is:
  2. For JFCS use in treating you.
  3. For JFCS use in training or supervising other mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
  4. For JFCS use in defending JFCS in legal proceedings instigated by you.
  5. For use by The Secretary Of Health And Human Services to investigate JFCS compliance with HIPAA.
  6. Required by law, and the use of disclosure is limited to the requirements of such law.
  7. Required by law, for certain health oversight activities pertaining to the originator of the psychotherapy notes.
  8. Required by a coroner who is performing duties authorized by law.
  9. Required to help avert a serious threat to the health and safety of others.
  1. Marketing purposes. As a mental health agency, JFCS will not use or disclose your PHI for marketing purposes.
  1. Sale of PHI. As a mental health agency, JFCS will not sell your PHI in the regular course of JFCS business.

Certain uses and disclosures do not require your Authorization. Subject to certain limitations in the law, JFCS can use and disclose your PHI without your authorization for the following reasons:

  1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
  1. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or deducing a serious threat to anyone’s health or safety.
  1. For health oversight activities, including audits and investigations.
  1. For the purposes of clinical training and oversight, JFCS Director of Clinical Services may “view” (video and/or audio) a therapy session without gaining explicit consent of the client. In this event no permanent record would be made.
  1. For judicial and administrative proceedings, including responding to a court or administrative order, although JFCS preference is to obtain and authorization from you before doing so.
  1. For law enforcement purposes, including reporting crimes occurring on JFCS premises.
  1. To coroners or medical examiners, when such individuals are performing duties authorized by law.
  1. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
  1. For workers’ compensation purposes. Although JFCS preference is to obtain an authorization from you, JFCS may provide your PHI in order to comply with workers’ compensation laws.
  1. Appointment reminders and health related benefits or services. JFCS may use and disclose your PHI to contact you to remind you that you have an appointment with JFCS. JFCS may also use and disclose your PHI to tell you about treatment alternatives or other health care services or benefits that JFCS offers.

Certain uses and disclosures require you to have the opportunity to object:

  1. Disclosures to family, friends, or others. JFCS may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

 Your rights regarding your PHI

You have the following rights with respect to your PHI:

  1. The Right To Request Limits On Uses And Disclosures Of Your PHI. You have the right to ask JFCS not to use or disclose certain PHI for treatment, payment, or health care purposes. JFCS is not required to agree to your request, and may say “no” if JFCS believes it would affect your health care.
  1. The Right To Request Restrictions For Out-Of-Pocket Expenses Paid For In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or heath care purposes if the PHI pertains solely to a health care item or a heath care service that you have paid for out-of-pocket in full.
  1. The Right To Choose How JFCS Sends PHI To You. You have the right to ask JFCS to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and JFCS will agree to all reasonable requests.
  1. The Right To See And Get Copies Of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that JFCS has about you.

JFCS will provide you with a copy of your records, or summary at your request.

Complaints

If you think JFCS may have violated your privacy rights, you may file a complaint by contacting JFCS at the information on the first page.

You can also 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
  • Visiting www.hhs.gov/ocr/privacy/hipaa/complaints

JFCS will not retaliate against you if you file a complaint about JFCS privacy practices.

The JFCS Notice of Privacy Practices is subject to change. In the event of a change you will be given an updated version to review and sign.

If you have any questions about the JFCS Notice of Privacy Practices, please contact JFCS at:

JFCS

3801 East Willow Street

Long Beach, CA 90815

562-427-7916