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Notice Of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL 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 the Privacy Specialist, Arifa Majeed at (626) 814-2419 or in writing to 1115 S. Sunset Ave., West Covina, CA 91790.

WHO WILL FOLLOW THIS NOTICE

This Notice describes the privacy practices of:

  • Citrus Valley Health Partners (CVHP), Queen of the Valley Campus, Inter-Community Campus, Foothill Presbyterian Hospital, Citrus Valley Hospice & Home Health, and Citrus Valley Health Foundation.
  • Any health care professional authorized to enter information into your hospital chart.
  • All departments and units of the hospital.
  • All employees, staff, and other hospital personnel.
  • Any member of a volunteer group we allow to help you while you are in the hospital.

All these entities, sites, and locations of CVHP follow the terms of this Notice. In addition, these entities, sites, and locations may share medical/mental health information with each other for treatment, payment, or health care operations purposes described in this Notice. This Notice does not cover the physicians that provide medical services at these facilities, because they are self-employed independent contractors and not agents, servants, or employees of the hospital.

OUR PLEDGE REGARDING MEDICAL/MENTAL HEALTH INFORMATION

We understand that medical/mental health information about you and your health is personal and are committed to protecting medical/mental information about you. We create a record of the care and services you receive at the hospital in order 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 the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic.

This Notice will tell you about the ways in which we may use and disclose medical/mental health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical/mental health information.

We are required by law to:

  • Make sure that medical/mental health information that identifies you is kept private;
  • Give you this Notice of our legal duties and privacy practices with respect to medical/mental health information about you; and
  • Follow the terms of the Notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL/MENTAL HEALTH INFORMATION

The following categories describe different ways that we use and disclose medical/mental health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Disclosure at Your Request

Medical/Mental Health Information

We may disclose information when requested by you. This may require a written authorization by you. A form entitled "Authorization for Use and Disclosure of Protected Health Information" may be obtained from the Medical Records/Health Information Management Department.

For Treatment

Medical/Mental Health Information

We may use medical/mental health information about you to provide you with medical/mental health treatment or services. We may disclose medical/mental health information about you to doctors, nurses, technicians, clinical students, or other hospital personnel who are involved in taking care of you at the hospital. 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. In addition, the doctor may need to tell the dietician if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical/mental health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose medical/mental health information to people outside the hospital who may be involved in your medical/mental health treatment after you leave the hospital, such as health care providers or long term health care agencies that will provide services that are part of your care.

For Payment

Medical/Mental Health Information

We may use and disclose medical/mental health information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may also provide basic information about you and your health plan, insurance company, or other source of payment to practitioners outside the hospital who are involved in your care, to assist them in obtaining payment for services they provide to you.

For Health Care Operations

Medical/Mental Health Information

We may use and disclose medical/mental health information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical/mental health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical/mental health information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, clinical students, and other hospital personnel for review and learning purposes. We may also combine the medical/mental health information we have with medical/mental health information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical/mental health information so that others may use it to study health care and health care delivery without learning who the specific patients are.

Citrus Health Information Exchange (CHIE)
To help improve your medical/mental health care, we participate in an electronic health information exchange or "HIE" with other physicians, hospitals, and health care providers ("User") in our community. The HIE is a way for Users to share patient health information with each other for the purposes of treating patients, obtaining payment for such treatment from insurance companies and other third party payors, and for certain other administrative uses permitted by law.

The HIE we participate in allows us to send and receive your health information to and from other Users who have treated you and who also participate in the CHIE. The CHIE may only be used by us or other Users to provide you with treatment, obtain payment for your medical treatment, or to perform other administrative tasks permitted by the HIE's rules and law. We and other Users will not send or receive your health information through the CHIE for any other purposes.

Business Associates
Medical/Mental Health Information

Some of our functions are accomplished through contracted services provided by business associates. Some examples include the copy services we use when making copies of your health record, transcription services, and auditors. When these services are contracted, we may disclose your medical/mental health information to our business associates so that they can perform the job we have asked them to do. To protect your medical/mental health information, however, we require the business associate to appropriately safeguard your medical/mental health information.

Marketing and Sale
Medical/Mental Health Information

Uses and disclosures of medical/mental health information for marketing purposes, and disclosures that constitute a sale of medical/mental health information, may require your authorization.

Fundraising Activities
Medical/Mental Health Information

We may use information about you, or disclose such information to a foundation related to the hospital, to contact you in an effort to raise money for the hospital and its operations. You have the right to opt out of receiving fundraising communications. If you receive a fundraising communication, it will tell you how to opt out.

Hospital Directory
Medical Information

We may include certain, limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition, and your religious affiliation. Unless there is a request from you to the contrary, this directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they don't ask for you by name.

Mental Health Information

We do not release information about mental health patients through our hospital directory.

Individuals Involved in Your Care or Payment for Your Care.

Medical Information

We may release medical information about you to a family member or friend who is involved in your medical care. We may also give information to someone who helps pay for your care. Unless there is a specific, written request from you to the contrary, we may also tell your family or friends your condition and that you are in the hospital.

Mental Health Information

Upon request of a family member and with your consent, we may give the family member notification of your diagnosis, prognosis, medications prescribed and their side effects and progress. If a request for information is made by your spouse, adult child, parent, or adult sibling and you are unable to authorize the release of this information, we are required to give the requesting person notification of your presence in the hospital, except to the extent prohibited by federal law.

Upon your admission, we must make reasonable attempts to notify your next of kin or any other person designated by you, of your admission, unless you request that this information not be provided. We must also make reasonable attempts to notify your next of kin or any other person designated by you, of your release, transfer, serious illness, injury, or death only if requested by a family member, unless you request that this information not be provided.

Disaster Relief

Medical/Mental Health Information

We may disclose medical/mental health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you arrive at the emergency department either unconscious or otherwise unable to communicate, we are required to attempt to contact someone we believe can make health care decisions for you (e.g. a family member or agent under a health care power of attorney.)

Research

Medical/Mental Health Information

Under certain circumstances, we may use and disclose medical/mental health 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 another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical/mental health information, trying to balance the research needs with patients' need for privacy of their medical/mental health information.

Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital.

As Required By Law

Medical/Mental Health Information

We will disclose medical/mental health information about you when required to do so by federal, state, or local law.

To Avert a Serious and Imminent Threat to Health or Safety

Medical/Mental Health Information

We may use and disclose medical/mental health information about you when necessary to prevent a serious and imminent threat to your health and safety or the health and safety of another person or the public. Any disclosure, however, would only be to someone able to help prevent the threat.

Organ and Tissue Donation

Medical/Mental Health Information

We may release medical/mental health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans

Medical Information

If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign, military personnel to the appropriate foreign, military authority.

Workers' Compensation

Medical Information

We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Notification/Reporting of Abuse

Medical/Mental Health Information

We may disclose medical/mental health information about you for public health activities. These activities generally include the following:

  • To prevent or control disease, injury, or disability;
  • To report births and deaths;
  • 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 emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws;
  • To report the abuse or neglect of children, elders, and dependent adults; and
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities

Medical/Mental Health Information

We may disclose medical/mental health information to a health oversight agency for activities authorized by law. Examples of oversight activities include audits, investigations, inspections, and licensure. These oversight activities are necessary to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes

Medical/Mental Health Information

If you are involved in a lawsuit, we may disclose medical/mental health information about you in response to a court or administrative order. We may also disclose medical/mental health information about you in response to 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.

Mental Health Information

We may disclose mental health information to a court, attorneys, and court employees in the course of conservatorship and other judicial or administrative proceedings.

Law Enforcement

Medical/Mental Health Information

We may release medical/mental health 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, certain escapees, or missing persons;
  • About a death we believe may be the result of criminal conduct; or
  • About criminal conduct at the hospital.

Medical Information

We may release medical information if asked to do so by a law enforcement official:

  • About the victim of a crime if, under certain limited circumstance, we are unable to obtain the person's agreement; or
  • 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.

Mental Health Information

We may release mental health information if asked to do so by a law enforcement official:

  • When requested by an officer who lodges a warrant with the facility; and
  • When requested at the time of a patient's involuntary hospitalization.

Coroners, Medical Examiners, and Funeral Directors

Medical/Mental Health Information

We may release medical/mental health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities

Medical Information

We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others

Medical Information

We may disclose medical information about you to authorized, federal officials, so they may provide protection to the President, other authorized persons, or foreign heads of state or to conduct special investigations.

Mental Health Information

We may disclose mental health information about you to government law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.

Inmates

Medical Information

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. We may release medical information when necessary

  • For the institution to provide you with health care;
  • To protect your health and safety or the health and safety of others; or
  • For the safety and security of the correctional institution.

Mental Health Information

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release mental health information to the correctional institution or law enforcement official when required, as necessary to the administration of justice.

Multi-Disciplinary Personnel Teams

Medical/Mental Health Information

We may disclose medical/mental health information to a multi-disciplinary personnel team relevant to the prevention, identification, management, or treatment of an abused child and the child's parents, or an abused elder or dependent adult.

Advocacy Groups

Mental Health Information

We may release mental health information to the statewide protection and advocacy organization if it has a patient or patient representative's authorization, or for the purposes of certain investigations. We may release mental health information to the County Patients' Rights Office if it has a patient or patient representative's authorization, or for investigations resulting from reports required by law to be submitted to the Director of Mental Health.

Department of Justice

Mental Health Information

We may disclose limited, mental health information to the California Department of Justice for movement and identification purposes about certain criminal patients, or regarding persons who may not purchase, possess, or control a firearm or deadly weapon.

Senate and Assembly Rules Committees

Mental Health Information

We may disclose mental health information to the Senate or Assembly Rules Committee for purpose of legislative investigation.

Psychotherapy Notes

Mental Health Information

CVHP facilities do not use psychotherapy notes.

Special Categories of Information

Medical/Mental Health Information

In some circumstances, your health 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 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.

For all other purposes, an authorization will be required for us to use or disclose protected health information.

YOUR RIGHTS REGARDING MEDICAL/MENTAL HEALTH INFORMATION

You have the following rights regarding medical/mental health information that we maintain about you:

Right to Inspect and Copy

You have the right to inspect and copy medical/mental health information that may be used to make decisions about your care. Usually, this includes medical/mental health and billing records, but may not include some mental health information.

To inspect and copy medical/mental health information that may be used to make decisions about you, you must complete, sign, and submit an "Authorization for Use and Disclosure of Protected Health Information" to the Medical Records/Health Information Management Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and copy in very limited circumstances. If you are denied access to medical/mental health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend

If you feel that the medical/mental health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital.

A request for an amendment must be made in writing and submitted to the Medical Records/Health Information Management Department. In addition, you must provide a reason that supports your request. 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 deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for the hospital;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Even if we deny your request for amendment, you have the right to submit a written addendum 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 medical/mental health record, we 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 is a list of the disclosures we made of medical/mental health information about you other than our own uses for treatment, payment and health care operations, and with other exceptions pursuant to law.

To request an accounting of disclosures, you must submit your request in writing to the Medical Records/Health Information Management Department. Your request must state a time period 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 twelve month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Notification of a Breach of Unsecured Protected Health Information

You will be notified by us if there is a breach of your unsecured protected health information pursuant to state and federal law.

Right to Request Restrictions

You have the right to request a restriction or limitation on the medical/mental health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical/mental health information we disclose 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 we not use or disclose information about a surgery you had.

We are not required to agree to your request, except to the extent that you request us 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 out of pocket in full. Even if you request this special restriction, we can disclose the information to a health plan or insurer for purposes of treating you.

If we agree to another special restriction, we will comply with your request unless the information is needed to provide you with emergency treatment.

To request restrictions, you must make your request in writing to the Medical Records/Health Information Management Department. In your request, you must tell us the following:

  • What information you want to limit;
  • Whether you want to limit our use, disclosure, or both; and
  • 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 we communicate with you about medical/mental health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communication, you must make your request in writing to the Admissions/Registration Department. We will not ask you the reason for your request. We 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 us 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

To obtain a paper copy of this Notice, please call the Privacy Specialist at (626) 814-2419.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical/mental health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the hospital. The Notice will contain the effective date on the first page, in the lower left-hand corner. We will give you a copy of the Notice the first time you register or are admitted. We will give you an additional Notice upon your request, or because it has been revised subsequent to your prior admission or visit.

COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Privacy Specialist, Arifa Majeed at (626) 814-2419 or in writing at 1115 S. Sunset Ave., West Covina, CA, 91790. The Secretary of the Department of Health and Human Services may be contacted at Region IX, Office for Civil Rights, DHHS, 90 7th St., Suite 4-100, San Francisco, CA 94103 or at www.hhs.gov/ocr/privacy/hipaa/complaints/.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL/MENTAL HEALTH INFORMATION

Other uses and disclosures of medical/mental health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical/mental health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will stop the uses and disclosures allowed by that permission, except to the extent that we have already acted in reliance on your permission. You understand that we are unable to take back any disclosure we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

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