Privacy Policy
Notice of Privacy Practices for Protected Health Information
This notice describes how medical information may be used and disclosed and how you can get access to this information. Please review it carefully.
Introduction
During the course of providing services and care to you, Alzheimer's Family Services Center gathers, creates, and retains certain personal information about you that identifies who you are and relates to your past, present, or future physical or mental condition, the provision of health care to you, and payment for your health care services. This personal information is characterized as your “protected health information.” This Notice of Privacy Practices describes how Alzheimer's Family Services Center maintains the confidentiality of your protected health information, and informs you about the possible uses and disclosures of such information. It also informs you about your rights with respect to your protected health information.Alzheimer's Family Services Center’s Responsibilities
Alzheimer's Family Services Center is required by federal and state law to maintain the privacy of your protected health information. Alzheimer's Family Services Center is also required by law to provide you with this Notice of Privacy Practices that describes the agency’s legal duties and privacy practices with respect to your protected health information. Alzheimer's Family Services Center will abide by the terms of this Notice of Privacy Practices. The agency reserves the right to change this or any future Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that it maintains, including protected health information already in its possession. If Alzheimer's Family Services Center changes its Notice of Privacy Practices, it will personally deliver or mail a revised notice to you at your current address.Use and Disclosure With Your Authorization
Alzheimer's Family Services Center will require a written authorization from you before it uses or discloses your protected health information, unless a particular use or disclosure is expressly permitted or required by law without your authorization. Alzheimer's Family Services Center has prepared an authorization form for you to use that authorizes Alzheimer's Family Services Center to use or disclose your protected health information for the purposes set forth in the form. You are not required to sign the form as a condition of receiving services/treatment or having your care paid for. If you sign an authorization, you may revoke it at any time by written notice. Alzheimer's Family Services Center then will not use or disclose your protected health information, except where it has already relied on your authorization.How Alzheimer's Family Services Center May Use and Disclose Your Protected Health Information Without Your Authorization
Mandatory Disclosures
Alzheimer's Family Services Center will disclose protected health information to outside persons or entities without your written authorization as required by law in the following circumstances:Court Order; Order of Administrative Tribunal
Alzheimer's Family Services Center will disclose protected health information in accordance with an order of a court or of an administrative tribunal of a government agency.Subpoena
Alzheimer's Family Services Center will disclose protected health information in accordance with a valid subpoena issued by a party to adjudication before a court, an administrative tribunal, or a private arbitrator. Reasonable efforts will be made to notify you of the subpoena, or attempts will be made to obtain an order or agreement protecting your protected health information.Law Enforcement Agencies
Alzheimer's Family Services Center will disclose protected health information to law enforcement agencies in accordance with a search warrant, a court order or court-ordered subpoena, or an investigative subpoena or summons.Coroner
Alzheimer's Family Services Center will disclose protected health information to a coroner where the coroner requests the information to identify a decedent; to notify next of kin; or to investigate deaths that may involve public health concerns, suspicious circumstances, elder abuse, or organ or tissue donation.Elder Abuse Reporting
Alzheimer's Family Services Center will disclose protected health information about a participant who is suspected to be the victim of elder abuse to the extent necessary to complete any oral or written report mandated by law. Under certain circumstances, Alzheimer's Family Services Center may disclose further protected health information about the participant to aid the investigating agency in performing its duties. Alzheimer's Family Services Center will promptly inform the participant about any disclosure unless the agency believes that informing the participant would place the participant in danger of serious harm, or would be informing the participant’s personal representative, whom the agency believes to be responsible for the abuse, and believes that informing such person would not be in the participant’s best interest.Other Disclosures Required by Law
Alzheimer's Family Services Center will disclose protected health information about a participant when otherwise required by law.
Permissive Disclosures
Alzheimer's Family Services Center may, in its discretion, use or disclose your protected health without your written authorization in the following circumstances:Your Care and Treatment
Alzheimer's Family Services Center may use or disclose your protected health information to provide you with or assist in your treatment, care and services. For example, Alzheimer's Family Services Center may disclose your health information to health care providers who are involved in your care to assist them in your diagnosis and treatment, as necessary. Alzheimer's Family Services Center may also disclose your protected health information to individuals who will be involved in your care if you disenroll from the center.Billing and Payment - Medicare, MediCal and Other Public or Private Health Insurers
Alzheimer's Family Services Center may use or disclose your protected health information to public or private health insurers (including medical insurance carriers, HMOs, Medicare, and Medi-Cal) in order to bill and receive payment for your treatment and services that you receive at the Alzheimer's Family Services Center. The information on or accompanying a bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.Health Care Providers
Alzheimer's Family Services Center may also disclose your protected health information to health care providers in order to allow them to determine if they are owed any reimbursement for care that they have furnished to you and, if so, how much is owed.Health Care Operations
Alzheimer's Family Services Center may use your protected health information for health care operations at the center. These uses and disclosures are necessary to manage Alzheimer's Family Services Center and to monitor our quality of services and care. For example, we may use your protected health information to review our services and to evaluate the performance of our staff in caring for you.Licensing and Accreditation
Alzheimer's Family Services Center may disclose your protected health information to any government or private entity, such as the California Department of Health Services or the California Department of Aging, responsible for licensing or accrediting the center, so that the government or private entity can carry out its oversight activities. These oversight activities include audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight.Provision of Basic Information about Participants
Alzheimer's Family Services Center allows staff to provide certain basic information about a participant to persons who ask for the participant by name and to members of the clergy. Unless you notify Alzheimer's Family Services Center that you object, it may disclose your name, your location at the center, and your general condition to anyone who asks for you by name. It will disclose your name, your location at the center, your general condition, and your religious affiliation to members of the clergy.Individuals Involved in Your Care or Payment for Your Care
Unless you specifically object, Alzheimer's Family Services Center may disclose to a family member, other relative, a close personal friend, or to any other person identified by you, all protected health information directly relevant to such person’s involvement with your care or directly relevant to payment related to your care. Alzheimer's Family Services Center may also disclose your protected health information to a family member, personal representative, or other person responsible for your care to assist in notifying them of your location, general condition, or death.Disaster Relief
Alzheimer's Family Services Center may disclose your protected health information to a public or private entity authorized to assist in disaster relief efforts.Disclosures within Provider Community
Unless you specifically object, Alzheimer's Family Services Center may disclose certain general information about you (e.g., past activities, present interests, birthday) to members of its community, including other participants and staff, by means such as newsletter or bulletin board.Business Associates
Alzheimer's Family Services Center may contract with certain individuals or entities to provide services on its behalf. Examples include data processing, quality assurance, legal, or accounting services. Alzheimer's Family Services Center may disclose your protected health information to a business associate, as necessary, to allow the business associate to perform its functions on Alzheimer's Family Services Center’s behalf. Alzheimer's Family Services Center will have a contract with its business associates that obligate the business associates to maintain the confidentiality of your protected health information.Fundraising
Alzheimer's Family Services Center may use certain protected health information to contact you in an effort to raise money for the center and its operations. Alzheimer's Family Services Center may disclose the protected health information to business associates or to related foundations that it uses to raise funds for its own benefit. Alzheimer's Family Services Center will disclose only your name, address, and phone number and the dates you receive health care services. You may notify Alzheimer's Family Services Center in writing if you object to such disclosures.Research
Alzheimer's Family Services Center may disclose your protected health information for research purposes, provided that an outside Institutional Review Board overseeing the research approves the disclosure of the information without a written authorization.Public Health Activities
Alzheimer's Family Services Center may disclose protected health information to any public health authority that is authorized by law to collect it for purposes of preventing or controlling disease, injury, or disability.Hospital Peer Review
Alzheimer's Family Services Center may disclose your protected health information to hospital medical staffs to aid in the credentialing of applicants and in the peer review of members.Organ Procurement
Alzheimer's Family Services Center may disclose your protected health information following your death to an organ procurement agency or tissue bank in order to aid in using your organs or tissues in transplantation.Coroner
Alzheimer's Family Services Center may disclose protected health information to the coroner to allow the coroner to perform its duties.Members of Workforce
It is Alzheimer's Family Services Center’s policy to allow members of its workforce to share participants’ protected health information with one another to the extent necessary to permit them to perform their legitimate functions on the center’s behalf. The center’s workforce includes all employees, volunteers and trainees, and board and committee members. At the same time, Alzheimer's Family Services Center will work with and train its workforce members to ensure that there are no unnecessary or extraneous communications that will violate the rights of its participants to have the confidentiality of their protected health information maintained.
Other Disclosures
Safety
To maintain safety, each participant is required to wear a name badge during the hours s/he is at Alzheimer's Family Services Center. The participant’s first name and last initial are printed on the front of the name badge; additional information is printed on the reverse, for purposes of identification should a participant ever exit the center. Information on the reverse side of the name badge includes the primary emergency contact name, address and phone numbers plus a secondary contact with phone numbers, and any allergies the participant has.Adult School Registration
Experienced teachers from the Huntington Beach Adult School, Newport-Mesa School District, and Coastline Community College lead classes (e.g., sing-a-longs, exercise, physical games, and trivia) for participants at Alzheimer's Family Services Center on a daily basis. These teachers help the center provide high quality programming, at no additional cost. In order to have instructors at the center, staff must register all participants with the schools on an annual basis. To streamline registration, the center enrolls participants in classes on a timely, ongoing basis, thereby ensuring that the instructors are available year-round. This involves the center releasing each participant’s name, gender, date of birth, and birthplace to the schools.
Your Rights Regarding Protected Health Information
You have the following rights with respect to your protected health information. To exercise these rights, contact Alzheimer's Family Services Center at the following address: Alzheimer's Family Services Center, 9451 Indianapolis Ave., Huntington Beach, CA 92646. Attention: Privacy Official.Right to Receive a Copy of the Notice of Privacy Practices
You have the right to request and receive a copy of Alzheimer's Family Services Center’s Notice of Privacy Practices for Protected Health Information in written or electronic form.Right to Request Access
You have the right to inspect and copy your health records maintained by Alzheimer's Family Services Center. In certain limited circumstances, Alzheimer's Family Services Center may deny your request as permitted by law.Right to Request Amendment
You have the right to request an amendment to your health records maintained by Alzheimer's Family Services Center. If your request for an amendment is denied, you will receive a written denial, including the reasons for such denial, and an opportunity to submit a written statement disagreeing with the denial.Right to Request Use or Disclosure Restrictions on Confidential Communications
You have the right to request restrictions on the use and disclosure of your protected health information for treatment, payment or health care operations, or providing notifications regarding your identity and status to persons inquiring about or involved in your care. Alzheimer's Family Services Center is not required to grant your request, but if it does, it will comply with your request, except in an emergency situation or until the restriction is terminated by you or Alzheimer's Family Services Center. You also have the right to request that Alzheimer's Family Services Center communicate protected health information to the recipient by alternative means or at alternative locations.Right to an Accounting
You have the right to receive an accounting of disclosures of your protected health information created and maintained by Alzheimer's Family Services Center. Alzheimer's Family Services Center is not required to provide an accounting of certain routine disclosures or of disclosures of which you already are aware.Complaints
If you believe that your privacy rights have been violated, you may file a complaint with Alzheimer's Family Services Center at the following address: Alzheimer's Family Services Center, 9451 Indianapolis Ave., Huntington Beach, CA 92646. Attention: Cordula Dick-Muehlke, Ph.D. You also have the right to submit a complaint to the Secretary of the U.S. Department of Health and Human Services, 50 United Nations Plaza – Room 322, San Francisco, CA 94102, Attention OCR Regional Manager. Alzheimer's Family Services Center will not retaliate against you if you file a compliant.Further Information
If you have questions about this Notice of Privacy Practices or would like further information about your privacy rights, contact Alzheimer's Family Services Center at the following address: Alzheimer's Family Services Center, 9451 Indianapolis Ave., Huntington Beach, CA 92646 Attention: Cordula Dick-Muehlke, Ph.D.
