This Notice Describes how health information about you may be used and disclosed and how you can get to this information. Please review it carefully.

If you have any questions about this notice, please contact the Privacy Officer at Alameda Family Services at (510) 629-6300 or, if you are receiving substance abuse or mental health services, you may call Alameda County Behavioral Health Care Service’s Consumer Assistance Office at (800) 779‑0787.

If you are receiving substance abuse or mental health services, you have been admitted to receive services from a site of the Alameda County Behavioral Health Care Services Program (ACBHCS). The Alameda County BHCS Program consists of a comprehensive range of services provided at various sites throughout Alameda County. Alameda Family Services is a component of the Alameda County Behavioral Health Care System.

Purpose Of This Notice:

This notice describes the privacy practices of Alameda Family Services, its departments and programs and the individuals who are involved in providing you with health care services.

Healthcare professionals and other individuals include:

Physical health care professionals (such as medical doctors, nurses, technicians, medical students); Behavioral health care professionals (such as psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, and interns); Other individuals who are involved in taking care of you at this agency or who work with this agency to provide care for its clients, including Alameda County Behavioral Health Care Services employees, staff, and other personnel who perform services or functions that make your health care possible.

These people may share health information about you with each other and with other health care providers for purposes of treatment, payment, or health care operations, and with other persons for other reasons as described in this notice.

Our Responsibility:

Your health information is confidential and is protected by certain laws. It is our responsibility to protect this information as required by these laws and to provide you with this notice of our legal duties and privacy practices. It is also our responsibility to abide by the terms of this notice as currently in effect.

This notice will:

Identify the types of uses and disclosures of your information that can occur without your advance written  approval.

Identify the situations where you will be given an opportunity to agree or disagree with the use or disclosure of your information.

Advise you that other disclosures of your information will occur only if you have provided us with a written authorization.

Advise you of your rights regarding your personal health information.

How We May Use and Disclose Your Health Information After Your Consent to Receive Services at Alameda Family Services:
The types of uses and disclosures of health information can be divided into categories described below. Not every type of use and disclosure can be listed, but all uses and disclosures will fall within one of these categories. It is important for you to know that in California there are protected kinds of healthcare information that have to be kept and handled in special ways. Included in these protected kinds of information are mental health treatment, drug/alcohol abuse treatment and HIV/AIDS treatment information.

Treatment:

We may use or share your health information to provide you with medical treatment or other health services. The term "medical treatment" includes physical health care treatment and also “behavioral healthcare services” (mental health services or alcohol or drug treatment services) that you might receive. For example, a licensed clinician may arrange for a psychiatrist to see you about possible medication and might discuss with the psychiatrist his or her insight about your treatment. Or, a member of our staff may obtain a referral to an outside physician for a physical exam. If you obtain health care from another provider, we may also disclose your health information to your new provider for treatment purposes.

Payment:

We may use or share your health information to enable us to bill you or an insurance company or third party for payment for the treatment and services that we had provided to you. For example, we may need to give your health plan information about treatment or counseling you received here or that we plan to provide so that they will pay us or reimburse you for the services. If you obtain health care from another provider,we may also disclose your health information to your new provider for payment purposes.

Health Care Operations:

We may use and disclose health information about you for our own operations. For example, Alameda Family Services may use your health information:

• to review our treatment and services and to evaluate the performance of the staff in caring for you.

• to help decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.

• for the review or learning activities of doctors, nurses, clinicians, technicians, other healthcare staff, students, interns and other agency staff.

• to help us with our fiscal management and compliance with laws.

If you obtain health care from another provider, we may also disclose your health information to your new provider for certain types of health care operations. In addition, we may remove information that identifies you from this set of health information so that others may use it to study health care and health care delivery without learning the identity of specific patients.

If you receive mental health or substance abuse services, you should know that Alameda County Behavioral Health Care Services includes several departments that provide operations support, such as the Auditor-Controller, County Administrator, County Counsel, and others, and they may share portions of your health information with these departments but only to the extent necessary for the performance of important functions in support of health care operations. These uses and disclosures are necessary to the successful operation of the Alameda County Behavioral Health Care Services and to make sure that clients receive quality care.

Disclosures Where We are Not Required to Give You an Opportunity to Agree or Object:

In addition to the above situations, the law permits us to share your health information without first obtaining your permission. These situations are described next.

As required by law:

We will disclose health information about you when required to do so by federal, state, or local law. For example, information may be disclosed to the Department of Health and Human Services to insure that your rights have not been violated.

Suspicion of Abuse or Neglect:

We will disclose the minimum necessary health information to appropriate agencies in cases of suspected child abuse/neglect or elder/dependant abuse/neglect.

Public Health Risks:

We may disclose health 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 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.

Health Oversight Activities:

We may disclose health information to a health oversight agency for activities authorized by law. Oversight activities include audits, investigations, inspections, and licensure. This is 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 health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only as authorized by law and only if efforts have been made to obtain an order protecting the information requested or we have told you about the request (which may include written notice to you). If your health information is mental health information then the information will not be disclosed in the dispute except that it may be disclosed to the court for the administration of justice, under California law.

Law Enforcement:

We may release health information if asked to do so by a law enforcement official:

• In response to a court order or similar directive.

• To identify a suspect, witness, missing person, etc.

• To provide information to law enforcement about a crime victim.

• To report criminal activity or threats concerning our facilities or staff.

Coroners, Medical Examiners and Funeral Directors:

We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.

Organ or Tissue Donation:

If you are an organ donor, we may release medical information to organizations that handle organ donations or transplants.

Research:

We may use or disclose your information for research purposes under certain limited circumstances.

To Avert a Serious Threat to Health or Safety:

We may disclose health information about you to prevent a serious threat to your health and safety, or to the health and safety of the public or another person. Any disclosure however, would only be to someone who we believe would be able to prevent the threat or harm from happening.

For Special Government Functions:

We may use or disclose your health information to assist the government in its performance of functions that relate to you. For example, if you are a member of the armed forces we may share your information with appropriate military authorities to assist in military command. Your information may be disclosed to workers’ compensation programs as permitted by law. If you are incarcerated, we may disclose your information to the correctional facility for certain security and health and safety purposes.

Disclosure, Only After You Have Been Given Opportunity To Object:

There are situations where we will not share your health information unless we have discussed it with you (if possible) and you have not objected to this sharing. These situations are:

Persons involved in your care or payment for your care:

We may disclose to a family member, a close personal friend, or another person that you have named as being involved with your health care (or the payment for your health care) your health information that is related to the person’s involvement. For example, we may notify a family member (or other person responsible for your care) about your location and medical condition provided that you do not object.

Disclosures In Communications With You:

We may have contacts with you during which we will share your health information. For example, we may use and disclose health information to contact you as a reminder that you have an appointment for treatment here, or to tell you about or recommend possible treatment options or alternatives that might be of interest to you. We may use and disclose health information about you to tell you about health-related benefits or services that might be of interest to you. We might contact you about our fundraising activities.

Other Uses of Health Information:

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

~ADDITIONAL RIGHTS REGARDING YOUR HEALTH INFORMATION~

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy:

You have the right to inspect and copy your health information. Usually this includes medical and billing records, but may not include some mental health information. Certain restrictions apply:

• You must submit your request in writing. We can provide you a form and instructions about how to submit it.

• If you request a photocopy, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.

• We may deny your request in certain circumstances. If you are denied access to health information, you may request that the denial be reviewed as provided by law.

Right to Amend:

If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. We are not required to make the amendment if we determine that the existing information is accurate and complete. We are not required to remove information from your records. If there is an error, it will be corrected by adding clarifying or supplementing information. You have the right to request an amendment for as long as the information is kept by or for the facility. Certain restrictions apply:

You must submit your request for the amendment in writing. We can provide you a form and instructions about how to submit it.

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 creator of the information is no longer available to make the amendment; is not part of the health information kept by or for our facility; is not part of the information which you would be permitted to inspect or copy.

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 health information about you in the six (6) years prior to the date you request the accounting. The accounting will not include:

• Disclosures needed for treatment, payment or health care operations.

• Disclosures that we made to you.

• Disclosures that were merely incidental to an otherwise permitted or required disclosure.

• Disclosures that were made with your written authorization.

• Certain other disclosures that we made as allowed or required by law.

To request this accounting, you must submit your request in writing. We can provide you a form and instructions about how to submit it. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. 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.

Right to Request Restrictions:

You have the right to request a restriction or limitation on the health 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 health 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 do not use or disclose any information to a friend or family member about your diagnosis or treatment.

If we agree to your request to limit how we use your information for treatment, payment, or healthcare operations we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions, you must make your request in writing to your provider. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure or both, and to whom you want the limits to apply.

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 to your provider. We will not ask you for 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 the 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 from Alameda Family Services or if you receive substance abuse or mental health services, you may also receive a copy from the Alameda County Behavioral Health Care Services’ office (please see number below). That office is generally open from Monday to Friday from 9:00 a.m. to 4:00 p.m. (except holidays).

~CHANGES TO THIS NOTICE~

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health 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 in our facilities. The notice will contain the effective date.

~COMPLAINTS~

If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer at Alameda Family Services at (510) 629-6300 or with the Secretary of the Department of Health and Human Services. If you receive substance abuse or mental health services, you may also contact the Consumer Assistance Specialist with Alameda County Behavioral Health Care Services at 1 (800) 779‑0787. All complaints must be submitted in writing. You will not be penalized for filing a complaint.