Effective Date: February 2016
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 notice, please contact your healthcare provider or the Privacy Officer who can be reached at (415) 419-3602.
WHO WILL FOLLOW THIS NOTICE
This notice describes Jewish Family and Children’s Services (JFCS) practices and that of:
- Any health care professional authorized to enter information into your healthcare record.
- Any member of a volunteer group we allow to help you while you receive health care services from us.
- All health care employees, staff and other personnel at any of our sites or locations providing health care services to you.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive from our health care professionals through our programs. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your health care generated by our health care providers. Your personal doctor or other community-based providers may have different policies or notices regarding their use and disclosure of your medical information created in their offices, clinics or facilities.
This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that identifies you is kept private (with certain exceptions);
- Notify all affected individuals of a breach of unsecured protected health information;
- Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the Notice that is currently in effect.
If we significantly change our privacy practices we will revise this Notice and make it available to you at your next appointment. We will also post the revised Notice on our website and in our facilities.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosure 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. Some types of information, such as HIV test results, mental health information and drug and alcohol treatment program information, are subject to stricter rules and will be treated with even greater confidentiality in some situations.
DISCLOSURES AT YOUR REQUEST
We may disclose information when requested by you. This disclosure at your request may require your written authorization. For example, you may authorize us to release information about you to a patients’ rights advocate. You may take back (“revoke”) your authorization in writing at any time and it will take effect upon receipt, except to the extent that others have previously acted in reliance upon your authorization.
We may use medical information about you to provide you with medical treatment or services. Treatment includes providing, coordinating, or managing your health care needs. Treatment can also include consultation and referrals on a need to know basis between providers. For example, if JFCS is providing homecare services to you and our nurse needs to talk with your physician, JFCS can disclose your health information to coordinate your care. Or, your mental health provider may need to talk with your primary care physician about certain medications that have been prescribed. Different staff also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We may use medical information to provide you with treatment options or alternatives that might be of interest to you or to tell you about health-related products or services that may be of interest to you. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at JFCS.
We may use and disclose medical information about you so that the treatment and services you receive at JFCS 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 mental health services you have received so your health plan will pay us or reimburse us. 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.
FOR HEALTH CARE OPERATIONS
We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to run JFCS and make sure that all of our clients receive quality care. For example, we may use medical information about you to review our treatment and services and to evaluate the performance of our staff in caring for you.
We may use medical information about you, or disclose such information to a foundation related to JFCS, to contact you in an effort to raise money for JFCS and its operations. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services. If you do not want JFCS to contact you for fundraising efforts, you must notify the Privacy Office in writing.
TO INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE
With your permission, we may release information about you to a friend or family member who is involved in your medical care or to someone who helps pay for your care. In addition, we may disclose general medical information about you to an entity assisting in a disaster relief effort so that your family can by notified about your condition, status and location. If you develop a serious condition and are unable to communicate, we will attempt to contact someone we believe can make health care decisions for your (e.g., a family member or agent under a health care power of attorney).
Under certain circumstances, we may use and disclose medical 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 information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but 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, as long as the medical information they review does not leave JFCS.
AS REQUIRED BY LAW
We will disclose medical information about you when required to do so by federal, state or local law, for example to report information about victims of abuse or neglect, or to warn of serious threats. We must also report certain information for public health activities, or for government health oversight activities, for example if the Medical Board of California is investigating a licensee. We must disclose information if required by a court order. We must provide information to the Department of Health and Human Services if there is an investigation to determine our compliance with the law. We may provide mental health information to courts, attorneys and court employees in the course of conservatorship or administrative proceedings.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
We may use and disclose medical 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. Any disclosure, however, would only be to someone able to help prevent the threat.
MILITARY AND VETERANS
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.
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 ACTIVITIES
We may disclose medical 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 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 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;
- To notify emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws.
HEALTH OVERSIGHT ACTIVITIES
We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, 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, we may disclose medical information about you in response to a court or administrative order. We may also disclose general medical 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.
We may release medical 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, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of a criminal conduct;
- About criminal conduct at one of our facilities or against a member of our staff; and
- 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.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may release medical information when required by law to report a death 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 about patients to funeral directors as necessary to carry out their duties.
NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES
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
We may disclose medical information about you to government law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
SPECIAL CATEGORIES OF INFORMATION
In some circumstances, your health information may be subject to restrictions that may limit or preclude some uses or disclosure described in this notice. For example, there are special restrictions on the use or disclosure of certain categories of information, for example, tests for HIV or treatment for mental health conditions or alcohol and drug abuse. Government health benefit programs, such as Medicaid, may also limit the disclosure of beneficiary information for purposes unrelated to the program.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you.
RIGHT TO INSPECT AND COPY
You have the right to inspect and copy medical 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 copy medical information that may be used to make decisions about you, you must submit your request in writing to the JFCS Medical Records 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 certain very limited circumstances. If you are denied access to medical 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. If your request to see your mental health information is denied you may arrange to have a third party professional person review the record on your behalf.
RIGHT TO AMEND
If you feel that medical 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.
To request an amendment, your request must be made in writing and submitted to the JFCS Medical Records 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. In addition, 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 JFCS;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
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 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 pursuant to the law.
To request this list or accounting of disclosures, you must submit your request in writing to the JFCS Medical Records Department. Your request must state a time period which may not be longer than six years prior to the date of your request. 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, 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.
If we maintain records electronically, we can provide you with a list of all disclosures beginning in January 2011. This list may not be longer than three years prior to the date of your request and will only reflect electronic records maintained on or after January 1, 2011.
RIGHT TO REQUEST RESTRICTIONS
You have the right to request a restriction or limitation on the medical 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 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 mental health treatment you might be receiving. We are not required to agree to your request for restrictions. If we do agree, we will comply with your request unless information is needed to provide emergency treatment. We are required to honor your request that we restrict disclosures to your health plan for services paid out of pocket in full.
To request restrictions, you must make your request in writing to the JFCS Medical Records Department. In your request, you must tell us 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; 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 we communicate with you about medical 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 communications, you must make your request in writing the JFCS Medical Records 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.
You may obtain a copy of this notice at our website: www.jfcs.org
To obtain a paper copy of this notice please contact your provider or the Privacy Officer.
If you believe your privacy rights have been violated, you may make a complaint to JFCS by calling or writing the Privacy Officer as follows:
Nancy Masters, Associate Executive Director
Jewish Family and Children’s Services
2150 Post Street
San Francisco, CA 94115
We will review your claim and take corrective action as needed. You also have the right to file a complaint with the Department of Health and Human Services (HHS) within 180 days of your discovery of the incident leading to your complaint. You can contact HHS by calling or writing:
U.S. Department of Health and Human Services
Office for Civil Rights
Attention: Regional Manager
90 7th Street, Suite 4-100
San Francisco, CA 94103
P – 800-368-1019 F 202-619-3818 TDD 800-537-7697
You will not be retaliated against for filing a complaint.
If you have any questions about this Notice and want further information, please contact Nancy Masters, Privacy Officer, Jewish Family and Children’s Services, 415-449-3602.