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Notice of Privacy Practices


Easterseals Bay Area Responsibilities & Patient/Client Information and Rights

Last Updated June 21, 2017

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.

Understanding Protected Health Information and the Health Record

We are Medical and mental health treatment information and records are personal and private. The medical and treatment information we create and maintain is known as protected health information, or PHI. We are committed to protecting health information that belongs to you, the Patient/Client.

Medical and mental health treatment information and records are personal and private. Easterseals Bay Area is committed to protecting your health information. The medical and treatment information we create and maintain is known as Protected Health Information, or PHI. We are required by Federal and State laws to protect the privacy of your medical information and obtain a signed authorization before we make certain disclosures.

Easterseals Bay Area Responsibility For Your Health Information

Information privacy and security

Easterseals Bay Area is required to provide this Notice of our legal duties and privacy practices with respect to medical information. This Notice explains how we may legally use and disclose your protected health information, and your rights regarding the privacy of your protected health information. We are required to follow all the terms of this Notice. Easterseals Bay Area will post and make the Notice available at all locations, and make it available on the Easterseals Bay Area website at: http://www.easterseals.com/bayarea/. Easterseals Bay Area reserves the right to change the provisions of this Notice and make it effective for all health information we maintain.

For any questions or additional information, please contact the Customer Service Department at (925) 849-8973 or [email protected].

Your Rights Related to Health Information

We are required to follow the terms of this Notice and give you a copy of the Notice. We will post and make the Notice available at all locations, and on the Easterseals Bay Area website at: http://www.eastersealsbayarea.

Choose a representative

You have the right to assign medical power of attorney or to have a legally authorized representative exercise these rights on your behalf, and otherwise make choices about your health information.

Inspect or receive an electronic or paper copy of the medical record

Upon request, you or your legally authorized representative may inspect and/or receive an electronic or paper copy of the medical records, billing records, and other records that we use to make decisions about your care. We will provide a copy or a summary of your health information, usually within 30 days of your request. You also may ask us to forward a copy of your health information to a third party. A reasonable copying/labor charge may apply.

Revoke an authorization to share or disclose health information

At any time, you or your legally authorized representative may revoke a written authorization that allows us to use and disclose your protected health information. The revocation must be in writing. When we receive a revocation of authorization, we will stop sharing your protected health information. Such a revocation will not apply to any information that we have already shared in reliance on your authorization. 

We are required by law to retain your medical treatment records, regardless of any authorization to use or share the information.

Request confidential communications

You or your legally authorized representative may request to receive communications related to medical information and services in a confidential manner, and may request that contact is made in a specific way (e.g., phone, email, specific numbers or addresses to send information to, etc.). All reasonable requests will be honored.

Breach notification

You have the right to receive notification of a breach of unsecured health information, to the extent that it affects your personal health information.

Request to correct or amend paper or electronic health record

You or your legally authorized representatives may ask us to correct or amend protected health information about you that you believe is incorrect or incomplete. We may deny this request after providing a reason in writing within 60 days, if we determine that the protected health information or record that is the subject of the request:

  • Was not created by us, unless you provide a reasonable basis to believe that the originator of the protected health information is no longer available to act on the requested amendment;
  • Is not part of your medical or billing records;
  • Is not available for inspection as set forth above; and/or
  • Is accurate and complete.

You do not have the right to have accurate information removed from your record. Any amendments will be an addition to, and not a replacement of, already existing records.

Ask to limit the information used and shared

You or your legally authorized representative may request restrictions on how we use or disclose certain health information for treatment, payment or operations.

If health care services are paid in full out-of-pocket, we will abide by a request to not share information about such services, for the purposes of payment or operations, with your health insurer, unless otherwise required by law. We have and reserve the right not to agree to any other requested restriction on use/disclosure of the information.

Receive a copy of this privacy notice

You or your legally authorized representative may receive this Notice of Privacy Practices at the time of enrollment, and at any other time by request.

Receive an accounting of disclosures of shared information

You or your legally authorized representative may request an accounting of all the times we have shared your health information with other persons or organizations, for up to six years prior to the request. The accounting will identify to whom the information was shared, and the purpose for sharing, except for disclosures made:

  • To carry out treatment, payment and health care operations;
  • To persons involved in your care or for other notification purposes as provided by law;
  • To correctional institutions or law enforcement officials as provided by law;
  • For national security or intelligence purposes;
  • Incidental to other permissible uses or disclosures; or
  • Involving only a limited data set (information where certain direct personal identifiers have been removed).

File a complaint for any perceived violation of privacy rights

Complaints may be filed for any perceived violation of your privacy rights by contacting Easterseals Bay Area Customer Service Department or the Department of Health and Human Services Office for Civil Rights. No retaliation will result from your making any complaint.

Complaints to Easterseals Bay Area may be filed with:

Easterseals Bay Area Corporate Compliance and Privacy Officer:
Phone: (925) 849-8949

Complaints to the Department of Health and Human Services may be filed with:

Office for Civil Rights
Phone: (877) 696-6775
Website: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

Your Choices in Regard to Your Health Information

For certain health information, you or your legally authorized representative can choose what Easterseals Bay Area can share.

Both the right and the choice to decide when to allow sharing

You or your legally authorized representative have both the right and choice to tell us to:

  • Share information with family, close friends, or others involved in the care; and
  • Share information in disaster relief situations.

In the event that you or your legally authorized representative is not able to tell us your choice preference, we may share health information if we believe doing so is in your best interests.

Written authorization required prior to sharing

You or your legally authorized representative must give us written authorization before we may share your information for the purposes of marketing, sale of your information for any purpose, or for most disclosures of your psychotherapy notes.

Typical Reasons That We May Use or Disclosure Your Health Information

Below are the most common instances when we may use or disclose your health information.

For treatment purposes

Our staff may use and share your health information with others (e.g. primary care doctors) in the provision, coordination, or management of your health care.

  • Example: An Easterseals Bay Area practitioner asks another practitioner about your overall health.

For health care operations

We may use and share your health information to run the organization and improve care.

  • Example: Using health information to identify what treatments are most effective in order to improve our services.

Billing for service

We may share your health information to bill and obtain payment from health plans or other entities, including for determinations of eligibility and coverage and other utilization review activities.

  • Example: Giving your information to your health insurance plan in order to obtain payment for services

Contact for Fundraising Purposes

We may contact you for our fundraising efforts, unless you or your legally authorized representative has requested that you not be contacted.

Other Reasons We May Use or Disclose Your Health Information

We are allowed or required to share your health information as follows, after meeting any applicable laws.

Help with public health and safety issues

We may share your health information in certain situations for public health or safety, such as to:

  • Prevent the spread of disease;
  • Help with product recalls;
  • Report adverse reactions to medications;
  • Report suspected abuse, neglect, or domestic violence; and
  • Prevent or reduce a serious threat to anyone’s health or safety.

Research purposes

We may use or share your information for health research.

Complying with law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services to ensure compliance with federal privacy law.

Responding to lawsuits and legal actions

We may share health information about you in response to a court or administrative order, or in response to a subpoena.

Addressing workers’ compensation, law enforcement, health oversight, and other government requests

We may use or share your health information for:

  • Workers’ compensation claims;
  • Law enforcement purposes or with a law enforcement official;
  • Health oversight activities authorized by law; and
  • Special government functions such as military, national security, and presidential protective services.

Work with a medical examiner or funeral director

We may share your health information with a coroner, medical examiner, or funeral director if you are deceased.

Business Associate communication

Some of the services we provide are carried out by other people or companies, who are known as our business associates. Examples include patient satisfaction surveyors, accountants, and lawyers. We may disclose certain portions of your health information to these business associates, so they can do their jobs for us. Each of our business associates are also required by law to safeguard your information.

Your Authorization For Us to Use and Disclose Your Health Information

Easterseals Bay Area will obtain written authorization for other uses and disclosures of your health information not covered by this Notice. You or your legally authorized representative may revoke such an authorization in writing at any time, and we will stop disclosing your health information that was permitted by the authorization. Any disclosures made prior to the revocation will not be affected by the revocation.

Language Assistance Services

Spanish (Español ). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-925-849-8973

Chinese (繁體中文). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-925-849-8973

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Tagalog. PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-925-849-8973

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1-925-849-8973

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Japanese (日本語). 注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。
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Punjabi. ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ।

1-925.849.8973

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1-925.849.8973

Thai (ภาษาไทย). เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-925.849.8973