This notice describes how medical and mental health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
What is this Notice and why is it Important?
By law, Casa, which includes all staff, contracted service providers, and board members, is required to protect the privacy of your identifiable medical and other health information (protected health information).
Casa is also required by law to give you this Notice to tell you how Casa may use and give out (“disclose”) your protected health information held by Casa. Casa must follow the terms of this Notice when using or disclosing your protected health information. Casa is required to obtain your permission before using or disclosing your protected health information except as described below.
How Casa May Use Your Protected Health Information
Casa generally is required to obtain your written authorization (“permission”) before using your protected health information. This section explains those situations where, under federal law, Casa may use or disclose your protected health information without your permission.
Casa does not need to obtain your written permission to use your protected health information for the following purposes:
- Treatment: We use and disclose your protected health information to provide health care services to you. This includes uses and disclosures to:
- Treat your psychoactive substance dependence disorder, or
- Contact you to provide appointment reminders, or
- Give you information about treatment alternatives or other recovery related benefits and services that may interest you.
- Payment: We may use and disclose your protected health information to obtain payment for treatment services that we provide to you. This includes uses and disclosures to:
- Submit and obtain payment from your health insurer, HMO, or other company that pays for the cost of some of your treatment, or
- Verify that your payer will pay for your treatment.
- Health Care Operations: We may use and disclose your protected health information for our health care operations, such as internal administration and planning that improve the quality of cost effectiveness of the treatment that we provide you. This also include uses and disclosures to:
- Evaluate the quality and competence of our Counselors,
- Train students, or
- Identify health-related services and products that may be beneficial to your recovery and then contact you about the services and products.
We may also disclose your protected health information to third parties to assist us in these activities, but only if they agree in writing to maintain the confidentiality of your health information. We may also disclose your protected health information to your other health care providers, to enable them to conduct their own quality reviews, compliance activities and other health care operations.
In addition, Casa may use and disclose your protected health information under the following circumstances:
- Relatives, Caregivers and Personal Representatives: Under appropriate circumstances, including emergencies, we may disclose your protected health information to relatives, caregivers or personal representatives who are with you or appear on your behalf. We may also need to notify such person of your location in our facility and general condition. If you object to such disclosures, please advise your Casa counselor or Counselor.
- Public Health Activities: We may disclose your protected health information for the following public health activities:
- To report to public health authorities for the purpose of preventing or controlling disease, injury or disability;
- To report information to the U.S. Food and Drug Administration (FDA) about products and services under its jurisdiction; or
- To alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease;
- Victims of Abuse, Neglect or Domestic Violence: If we reasonably believe that you are a victim of abuse, neglect or domestic violence, we may disclose your protected health information as required by law to a social services or other governmental agency authorized by law to receive such reports.
- Health Oversight Activities: We may disclose your protected health information to a health oversight agency that is charged with the responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid (for example, for fraud and abuse investigations).
- Specialized Government Functions: We may use and disclose your protected health information to units of the government with special functions, such as the U.S. military, under certain circumstances required by law.
- Law Enforcement Officials, Judicial and Administrative Proceedings: We may disclose protected health information to police or other law enforcement officials. We also may disclose protected health information in judicial or administrative proceedings, such as in response to a subpoena.
- Coroners or Medical Examiners: We may disclose protected health information a coroner or medical examiner as required by law.
- Health or Safety: We may disclose protected health information to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- Worker’s Compensation: We may disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs or as required under laws relating to workplace injury and illness.
- As Required by Law: We may disclose protected health information when required to do so by any other law not already referred to in the preceding categories.
FOR ANY PURPOSE OTHER THAN THE ONES DESCRIBED ABOVE, WE MAY ONLY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION WHEN YOU GIVE US YOUR WRITTEN AUTHORIZATION.
Your Rights Regarding Your Health Information
Right to Request Access to Your Health Information: You may request access to your treatment record file and billing records maintained by us in order to inspect and request copies of the records. Under limited circumstances, we may deny you access to your records. If you would like access to your records, please submit a request in writing to Casa, Admissions Coordinator. If you request copies, the first set of copies will be free of charge, we will charge you a reasonable fee for copies after the first $15.00). We will also charge you for our postage costs, if you request that we mail the copies to you.
Right to Request Amendments to Your Health Information: You have the right to request that we amend your health information maintained in your medical record file or billing records. If you wish to amend your records, please submit a request in writing to Casa, Director of Programs. We will comply with your request unless we believe that the information that would be amended is already accurate and complete or other special circumstances apply.
Right to Revoke Your Authorization: You may revoke (take back) any written authorization obtained by use for use and disclosure of your protected health information, except to the extent that we have taken action in reliance upon it. Your revocation must be in writing submitted to your counselor.
Right to an Accounting of Disclosures of Your Health Information: Upon written request, you may obtain an accounting of certain disclosures of health information made by us (other than for treatment, payment or health care operations and for any disclosures made pursuant to your authorization). The period of your request cannot exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, we will charge you a reasonable fee.
Right to Request How Information is Provided to You: You may request, and we will try to accommodate, any reasonable written request for you to receive protected health information by alternative means of communication or at a different address or location.
Right to Request Restrictions on the Use of Your Health Information: You may request that we restrict the use or disclosure of your protected health information. All requests for such restrictions must be made in writing. While we will consider a request for additional restrictions carefully, we are not required to agree to a requested restriction and it is Casa general policy not to agree to such restrictions.
Right to Change Terms of this Notice
We may change the terms of this notice at any time. If we change this notice, we may make the new notice terms effective for all protected health information that we hold, including any information created or received prior to issuing the new notice. If we change this notice, we will post the revised notice in treatment areas. You may also obtain any revised notice by contacting Casa, Quality Improvement Manager.
Further Information and/or Complaints
If you believe your privacy rights have been violated, you may file a complaint with Casa or
Department of Health Care Services
Substance Use Disorder Services – Complaints & Counselor Certification Section
P.O. BOX 997413, MS# 2601, Sacramento, CA 95899-7413, Attention: Complaint Coordinator
Phone # 916-322-2911, Fax # 916-440-5094, Toll-Free 877-685-8333
The U.S. Department of Health and Human Services
200 Independence Ave. SW
Washington, DC, 20201
You will not be penalized for filing a complaint.
If you have any questions about this notice, want to exercise one of your rights that are described in this notice, or want to file a complaint, please contact:
Leah Rodemich, Executive Director
160 N El Molino Ave.
Pasadena, CA. 91101
Phone: (626) 792-2770