Notice Of Privacy Policy For Protected Health InformationThe HIPAA Privacy Rule requires that individuals be informed of the privacy practices of their health care providers, and of their privacy rights with respect to their personal health information.
This notice is intended to inform Western Youth Services clients about their Protected Health Information and their HIPAA related rights regarding that information. It describes how your medical information may be used and disclosed and how you may obtain access to that information. Please read it carefully and feel free to ask any questions that you may have.
All Western Youth Services clients have a medical record that contains Protected Health Information (PHI). Western Youth Services maintains the privacy of your Protected Health Information in accord with State and Federal laws and regulations. The information contained in this notice is effective as of April 14, 2003, and will remain in effect until further notice.
Western Youth Services is required by law to protect the privacy of your records, and to maintain them for the following periods of time:
Adults (age 18 and over) – records are maintained for seven (7) years from the last date of service.
Minors (up to the age of 18) – records are maintained up to the age of majority (age 19) or for seven (7) years, whichever is longer.
How We May Use And Disclose Your Protected Health Information.
Your medical record may be accessed by Western Youth Services staff, as a normal part of providing services to you and your family. Western Youth Services staff and volunteers sign confidentiality agreements, agreeing to protect the privacy of your health records.
Your protected health information may be used and disclosed in order to process claims or to be reimbursed for services provided to you.
Western Youth Services supervisory or quality assurance staff may access your medical record in order to review the quality of services provided to you.
State or County personnel may review information from your medical record while conducting a quality assurance audit of the services we provide, or to provide consultation to our staff regarding our services.
Western Youth Services may not release Protected Health Information to outside agencies or individuals without a signed patient authorization.
We may disclose Protected Health Information when required to do so by law. For example, we may do so when a client is perceived to be a danger to himself/herself or others, or where there is suspected child or elder abuse. Similarly, we may be required to disclose Protected Health information in response to a court order or to a subpoena.
You have the right to request the release or disclosure of your Protected Health Information.
Western Youth Services uses specific forms for requesting the release or disclosure of Protected Health Information. All requests for records are handled according to Western Youth Services policies and procedures in order to comply with State and Federal laws, and to protect the privacy of our client’s records. You must use our written authorization to release records forms in order for us to disclosure your Protected Health Information to any outside agency or individual.
You have the right to request that we place additional restrictions on our use or disclosure of your protected health information.
We are not required to agree to those additional restrictions, but you are encouraged to tell us about your concerns and to let us try to address them.
You have a right to withdraw your authorization to release information, by providing a signed request to discontinue authorization for disclosure of your records.
You have a right to inspect and copy your Protected Health Information. You must make a request in writing to obtain access to your records.
We may charge you a fee to copy your records. We may also require that you first inspect your records in the company of your therapist so that your therapist may answer questions about the records, prior to giving you a copy. In some instances, in a manner that is consistent with California law, we may provide a summary of your records to you instead of a copy. Also, in certain instances, in a manner that is consistent with California law, we may determine that a minor child’s mental health records should not be released to their parent or guardian.
You have the right to request a correction or other amendment to your medical record, following your inspection of the record. Your request must be in writing, and must explain why the information should be amended. We may deny your request in certain circumstances.
If you would like more information about our privacy practices, or if you have questions or concerns, or if you would like to make a complaint, please contact us as follows:
Western Youth Services
Attention: Privacy Officer
23461 South Pointe, Suite 220
Lake Forest, CA., 92653
(949) 855-1556If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about access to your health information, or in response to a request that you made to amend your health records or to restrict the use or disclosure of your health information, you are encouraged to contact our Privacy Officer. You also have the right to complain to the U.S. Department of Health and Human Services and we will provide you with the address to file your complaint at your request. We support your right to the privacy of your health information and will not retaliate in any way if you disagree with us, or if you choose to complain to our organization, to the U.S. Department of Health and Human Services, or to any other governmental or regulatory agency.