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.
Follow This Notice
This Notice describes Mental Health America of Los Angeles [“MHA”] practices and that of:
All employees, staff and other MHA personnel,
volunteer or member of a volunteer group we allow to help you
while you are in our facility or program.
Our Pledge to You Regarding Your 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
through our facility or 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 care generated
by our program(s). As required and when appropriate, we will ensure
that the minimum necessary information is released in the course
of our duties.
This Notice tells you about the ways in which we may use and disclose
medical information about you. It also describes your rights and
certain obligations regarding the use and disclosure of medical
The law requires us to:
Keep your medical information, known as “protected
health information” or “PHI,” private;
you this Notice of our legal duties and privacy practices
with respect to your PHI; and
Follow the terms of the Notice
that is currently in effect.
How We May Use and Disclose Your Protected Health Information
The following categories describe the different ways that we may
use and disclose your protected health information. For each category
of uses or disclosures we will explain what we mean, and try to
give some examples. Obviously not every use or disclosure in a
category can be listed. However, all the ways we are permitted
to use and disclose information will fall within one of the categories.
For Treatment: We create a record of the services and treatment
you receive in our facility or program. We may use and disclose
your PHI in order to provide you with services and medical treatment.
We may disclose your PHI to doctors, nurses, personal service coordinators
(PSCs) and other MHA staff members such as financial planners,
employment or community integration specialists, medical or social
work students or other personnel who are involved in your care
at our facility or program. For example, a doctor treating you
for a chemical imbalance may need to know if you have problems
with your heart because some medications affect your blood pressure.
We may share your PHI in order to coordinate the different things
you need, such as prescriptions, blood pressure checks and lab
tests, and to determine a correct diagnosis. We may also disclose
your PHI to healthcare professionals outside our facility or program,
but only if they are directly involved in your care or treatment
[such as your therapist at the Department of Mental Health, or
your pharmacist or other similar persons], and it is for the coordination
and management of your care.
For Payment: We may use and disclose your PHI in order to get
paid for the services we provide to you. For example, we may need
to give Medi-Cal, the Department of Mental Health or your private
insurance plan information about services, medication or other
treatment you receive through us so that they will pay us. We may
also tell them about treatment you are proposing that you receive,
in order to obtain prior approval or to determine if they will
cover the cost of the treatment.
For Health Care Operations: We may use and disclose your PHI to
carry out activities that are necessary to run our facilities or
programs, and to make sure that all our members receive quality
care. For example, we may use medical information to review our
services and to evaluate the performance of our staff in their
care of and services to you. We may also combine medical information
about our members in order to decide what additional services we
should offer, what services may not be needed, and whether certain
services or new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical or social
work students or other MHA program personnel for review and learning
Appointment Reminders: We may use and disclose your PHI to contact
you as a reminder that you have an appointment for services or
treatment in our facility or program. For example, we may call
your home and leave a message that identifies our agency and reminds
you that you have an appointment with us.
Treatment Alternatives and Health-Related
Products and Services: We may use and disclose your PHI to recommend possible treatment
options or alternatives that may be of interest to you. We may
use and disclose PHI to tell you about health-related benefits
or services that may be of interest to you (for example, Medi-Cal
eligibility or Social Security benefits).
Individuals Involved in Your Care or
Payment of Your Care: We
may disclose your PHI to a friend or family member who is involved
in your medical care or payment related to your care, provided
you agree to this disclosure, or we give you an opportunity to
object to this disclosure. However, if you are not available or
are unable to agree or object, we will use our judgment to decide
whether this disclosure is in your best interests.
Disaster Relief Purposes: We may disclose your PHI to an entity
assisting in disaster or emergency relief efforts, so that your
family can be notified about your condition, status and location.
We will give you the opportunity to agree to this disclosure or
object to this disclosure, unless we decide that we need to disclose
your PHI in order to respond to the emergency circumstances.
Uses And Disclosures Of Your Medical Information
That Do Not Require Your Authorization
Research: We may disclose your PHI to medical researchers who
request it for approved medical research projects; However, such
disclosures must be cleared through a special approval process
before any PHI is disclosed to the researchers who will be required
to safeguard the PHI they receive.
As Required by Law: We will disclose your PHI when required to
do so by federal, state or local law.
Worker’s Compensation: We may release your PHI for worker’s
compensation or similar programs. These programs provide benefits
for work-related injuries or illness.
Public Health Risks: We may disclose medical information about
you for public health activities, such as those aimed at preventing
or controlling disease, preventing injury or disability, and reporting
the abuse or neglect of children, elders and dependent adults.
Health Oversight Activities: We may disclose your PHI to a health
oversight agency for activities authorized by law. Examples of
these oversight activities include audits, investigations, inspections
and licensing. 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 dispute,
we may disclose your PHI in response to a court or administrative
order. We may also disclose your PHI 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 a written notice to you) or
to obtain an order protecting the requested PHI.
Law Enforcement: We may disclose PHI to government law enforcement
agencies in the following circumstances:
In response to a court order, warrant, subpoena, summons
or similar process issued by a court;
If a psychotherapist
believes that it is likely that you present a serious danger
of violence to another person;
If we believe you have committed
or have been the victim of a crime, and you are currently hospitalized;
disclosures must be limited
to information that directly relates to the factual circumstances
and must not include any information that relates to your
mental health or the circumstances of your treatment;
your discharge, if you were involuntarily detained after a
peace officer initiated a 72-hour hold for evaluation and
In certain circumstances, if you have been admitted
to a facility and have disappeared or been transferred.
Coroners, Medical Examiners and Funeral
Directors: We may release
PHI to a coroner or medical examiner. This may be necessary, for
example, to identify a deceased person or to determine a cause
of death. We may also release medical information to funeral directors
if it is necessary for them to have it to carry out their duties.
Specialized Government Functions: We may disclose your PHI to
authorized federal officials for intelligence, counterintelligence
or other national security activities as authorized by law. We
may also disclose your PHI to authorized federal officials so that
they may provide protection to the President, other authorized
persons or foreign heads of state or to conduct special investigations.
Inmates: If you are an inmate or under the custody of a law enforcement
official, we may release your PHI to the correctional institution
or law enforcement official. This release would be necessary: (1)
for the institution to provide you with health care, (2) to protect
your health and safety or the health and safety of others, or (3)
for the safety and security of the correctional institution.
Other Uses of Your Medical Information
Other uses and disclosures of your PHI not covered by this Notice
or the laws that apply to us will be made only with your written
authorization. If you provide us authorization to use or disclose
your PHI you may revoke that authorization, in writing, at any
time. If you revoke your authorization, we will no longer use or
disclose your PHI for the reasons covered by the authorization,
except that we are unable to take back any disclosures we have
already made when the authorization was in effect, and we are required
to retain our records of the care and services that we provided
Your Rights Regarding Your PHI
You have the rights listed below regarding your PHI contained
in our records.
Right to Inspect and Copy: With certain exceptions, you have the
right to inspect and copy your PHI from our records. Usually, this
includes treatment and billing records.
MHA has historically maintained and will continue to maintain
a policy that permits members to review their charts at any mutually
convenient time. MHA also has and will continue to maintain a policy
permitting members to add their own notes to their charts. To review
the PHI we maintain about you that may be used to make decisions
about you, simply place an oral request with your PSC or the site
director of your program. Arrangements will then be made to sit
down with you to review your chart, and if you wish you may add
your notes at that time.
If you request a copy of your PHI, you must do so in writing.
We will provide you with a form entitled “Member Request
for a Copy of Records” to make this request. We may charge
you a fee for the costs of copying, mailing and other supplies
associated with your request.
We may deny your request to inspect and copy your records in certain
circumstances. If you are denied the right to inspect and copy
your PHI in our records, you may request that the denial be reviewed.
With the exception of a few circumstances that are not subject
to review, a licensed healthcare professional within MHA, who was
not involved in the denial, will review the decision. We will comply
with the outcome of that review.
Right to Request an Amendment: As stated above, members may add
their own personal notes to their chart at any time. However, if
you feel that your PHI in our records is incomplete or incorrect
and you want us to amend [delete or change] information in your
chart, you must make this request in writing. You have the right
to request amendments for as long as we keep your PHI.
To request an amendment, ask for a “Request to Amend Protected
Health Information” form. Complete this form and give it
to your PSC or the site director of your program.
We may deny your request for an amendment if it is not in writing
or does not include a reason to support your request. In addition,
we may deny your request if you ask us to amend PHI that:
Was not created by us, unless you can provide us with
a reasonable basis to believe that the person or entity who
created the PHI is no longer available to make the amendment;
Is not part of the PHI kept for or by MHA;
Is not part of
the PHI 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 at Statement of Disagreement. This written Statement
should not exceed 250 words, and should address the specific item
or information in your record you believe is incorrect or incomplete.
If you clearly indicate that you want the written Statement to
be a part of your record, we will attach it to your record and
include it whenever we make a disclosure of the item or record
you believe to be incomplete or incorrect.
Right to Accounting of Disclosures: You have the right to request
an “accounting of disclosures.” This is a list of the
disclosures we have made of your PHI other than for our own uses
for treatment, payment and healthcare operations [described earlier
in this document] and with other exceptions allowed by law.
To request this list or “accounting of disclosures,” ask
for a “Request for Accounting of Uses and Disclosures of
Protected Health Information” form from your PSC or the site
director of your program. Your request must state the time period
[that may not be longer than six years] and may not include dates
before April 14, 2003. The first list you request in any 12-month
period is free. We may charge you fees for the cost of producing
any additional list(s) you request within the same 12-month period.
The fees are listed on the request form, and you may withdraw or
modify your request before any costs are incurred.
Right to Request Confidential Communications: You have the right
to request that we communicate with you about your health/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 communications, you must put your request in writing
and give it to your PSC or the site director of your program. Your
request must specify how and/or where you wish to be contacted.
We will work to accommodate all reasonable requests.
Right to Request Restrictions: You may request that we follow
additional, special restrictions when using or disclosing your
PHI for treatment, payment or health care operations. You may also
request that we follow additional, special restrictions when using
or disclosing your PHI to someone who is involved in your care
of the payment of your health care, like a family member or friend.
For example, you could ask that we not use or disclose that you
are receiving services at our facility. We are not required to
agree with your request. However, if we do agree, we will comply
with your request unless the information is needed to provide you
with emergency treatment.
To request restrictions, ask for a “Opportunity for Member
to Object to Uses and Disclosures of Protected Health Information
for Three Special Purposes” form from your PSC or the site
director of your program.
Right to a Paper Copy of This Notice: You have a right to receive
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 chosen to receive
this Notice electronically [for example, by fax or by downloading
it from our website], you are still entitled to a paper copy of
this Notice. You may obtain a copy of this Notice at our website:
http://www.mhala.org. To obtain a paper copy of this Notice, contact
your PSC or the site director of your program.
Changes to This Notice
We reserve the right to change the terms of this Notice. We reserve
the right to make the revised or changed Notice effective for medical
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
at our program sites. The Notice will contain the effective date
in the footnote section of document. If we change our Notice, you
may obtain a copy of the revised Notice by visiting our website
at http://www.mhala.org, or you may request one from your PSC or
site director of your program.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Los Angeles County Department of Mental Health. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.
To file a complaint with us, or if you have questions or comments about our privacy practices, contact: Recovery Performance Officer, Mental Health America of Los Angeles, 100 W. Broadway, Suite 5010, Long Beach CA 90802. If you are not happy with the outcome of your complaint to us, you may file a complaint with DMH: Los Angeles County Department of Mental Health, Patient’s Rights Division, 550 South Vermont Avenue, Los Angeles, CA 90020, (213) 738-4949.