Easterseals Bay Area Responsibilities & Patient/Client Information and Rights
Last Updated October 1, 2016
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.
This Notice explains how we may legally use and disclose your protected health information and the rights regarding the privacy of your protected health information. We reserve the right to change the provisions of this Notice and make it effective for all health information we maintain.
What are Our Responsibilities under This Notice of Privacy Practices?
Information privacy and security
We are required by Federal and State law to protect the privacy of your protected health information .
Copy of this Notice
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.
In the event of a breach that may have compromised the privacy or security of your protected health information, we will ensure that you receive prompt notification of the circumstances of the breach, as it affects your information.
We will obtain written permission through an authorization for uses and disclosures of your health information not covered by this Notice. You or your legally authorized representative may revoke this authorization in writing at any time, and we will stop disclosing your health information for the reasons stated in the written authorization. Any disclosures made prior to the revocation are not affected by the revocation.
What are Your Rights in Regards to Health Information?
You and your legally authorized representatives have certain rights with respect to the information in your health record. To exercise the rights below, please contact the ESBA Customer Service Department at 925.849.8973 or [email protected].
Choose a representative
You have the right to:
- Assign medical power of attorney; or
- Have a legally authorized representative exercise your rights and make choices about your health information.
We will make sure that your representative has this authority and can act for you before we take any action.
Inspect or receive an electronic or paper copy of the medical record
- Upon request, you and your legally authorized representative have the right to inspect and/or receive the medical records, billing records, and other records we use to make decisions about you.
- You can also 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
You and your legally authorized representative have the right to revoke a written authorization to use and disclose protected health information at any time.
The revocation must be given in writing. When we receive a revocation of authorization request, we will stop sharing the protected health information, except to the extent that we have already taken action in reliance on your authorization.
Easterseals Bay Area is required by law to retain your medical treatment records, regardless of authorization to use or share the information.
Request confidential communications
You and your legally authorized representative have the right to request to receive communications related to medical information and services in a confidential manner, and may request us to contact you in a specific way (e.g., phone, email, specific numbers or addresses to send information to, etc.). We will honor all reasonable requests.
Request to correct or amend paper or electronic health record
You and your legally authorized representative have the right to ask us to correct or amend protected health information you think is incorrect or incomplete.
We may deny the request 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 creator 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.
We will provide a reason for denying the request in writing within 60 days.
We will deny requests for 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 and your legally authorized representative have the right to request restrictions on how we use or disclose certain health information for treatment, payment, or our operations.
If you pay for health care services in full or out-of-pocket, you can request for us to not share information about such services for the purposes of payment or operations with the Patient/Client health insurer, unless a law requires us to share that information.
We have and reserve the right not to agree to any other requested restriction, and we may deny the request if it would affect your care.
Receive a copy of this Notice
You and your legally authorized representative have the right to receive a copy of this Notice upon enrollment, and at any time by request.
Receive an accounting of disclosures of shared information
Upon request, you and your legally authorized representative have the right to receive a list (accounting), for up to 6 years prior to the request, of:
- All the times we have shared your health information to other persons or organizations,
- Who we have shared your information with, and
- The purpose for sharing.
We will include all disclosures except for those made:
- To carry out treatment, payment and health care operations as provided above;
- 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).
We will provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
File a complaint for any perceived violation of privacy rights
You can file a complaint 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.
We will not retaliate against you for making any complaint.
Complaints to Easterseals Bay Area may be filed with:
Easterseals Bay Area Compliance Officer:
Email: [email protected]
Complaints to the Department of Health and Human Services Office for Civil Rights may be filed with:
Department of Health and Human Services
Office for Civil Rights
Address: 200 Independence Avenue, S.W., Washington, D.C. 20201
What are Your Choices in Regards to Health Information?
For certain health information, you and your legally authorized representative can choose what we can share.
Right and choice to allow sharing
You and 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.
If you or your legally authorized representative are not able to tell us your preference, we may share your health information if we believe it is in your best interest.
We may also share your information if it is needed to lessen a serious and imminent threat to health or safety.
Written authorization required prior to sharing
We will never share your information without written authorization from you or your legally authorized representative for:
- Sale of your client information; and
- Most sharing of psychotherapy notes.
Choice regarding fundraising
We may contact you for the purpose of fundraising efforts, unless you or your legally authorized representative has requested to not be contacted.
How Do We Typically Use or Disclose Your Health Information?
Below are the most common instances when we will 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
Easterseals Bay Area may use and share Patient/Client health information to run the organization and improve care.
- Example: Using health information to identify what treatments are most effective 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 determinations of eligibility and coverage and other utilization review activities.
- Example: Giving Patient/Client information to health insurance plan in order to obtain payment for services.
How Else Do We Use or Disclose Your Health Information?
We are allowed or required to share your health information for the reasons listed below, after meeting any applicable laws.
Help with public health and safety issues
We can share your health information in certain situations for public health or safety, such as:
- Preventing the spread of disease;
- Helping with product recalls;
- Reporting adverse reactions to medications;
- Reporting suspected abuse, neglect, or domestic violence; and
- Preventing or reducing a serious threat to anyone’s health or safety."
We can 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.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Responding to lawsuits and legal actions
We can 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 can also use or share health information about you for the following purposes:
- Workers’ compensation claims;
- Law enforcement purposes or with a law enforcement official;
- With health oversight agencies for 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 can share health information with a coroner, medical examiner, or funeral director when a Patient/Client dies.
Business Associate communication
There are some services provided in our organization through contracts with business associates. Examples include providing treatment, surveying for patient satisfaction, and accountant, legal services, etc.
When services are provided by contracted business associates, we may disclose the appropriate portions of health information to them so they can perform the job we have asked them to do. However, our business associates are also required by law to safeguard your information.
Language Assistance Services
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-925-849-8973
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-925-849-8973
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
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-925-849-8973
ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք
توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما
تماس بگیرید 1-925-849-8973
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-925-849-8973
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم1-925-849-8973
ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ।
ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ 1-925.849.8973
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-925.849.8973
ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं।
เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-925.849.8973