This organization’s policy is to maintain the privacy of its clients and not disclose an individual’s personally identifiable health information (also referred to as Protected Health Information (PHI)) or their confidential educational information in accordance with current State and Federal regulations, including but not limited to 42 CFR 2.1 et. seq. It is also this organization’s policy to allow clients and/or their legally authorized representative(s) to control how their health information is used.
- Upon admission, the client and/or legal representative will receive for review and sign, as necessary, the following:
- Admission Agreement
- Notice of Privacy Practices
- Authorization for Release of Confidential Protected Health Information and Educational Information
- HIPAA Client Consent Form
- Staff will be trained in maintaining PHI for each client.
- Requests for PHI from any person outside of the client’s treatment team, shall be analyzed and reviewed to ensure compliance with State and Federal regulations.
- Unauthorized disclosures of PHI will be immediately handled pursuant to Company’s privacy policies, and applicable state and federal law.
HIPAA Privacy Notice and Rights
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This HIPAA Notice of Privacy Practices (the “Notice“) contains important information regarding your medical information. Our current Notice is posted on our website at https://evolvetreatment.com/privacy-policy. You also have the right to receive a paper copy of this Notice and may ask us to give you a copy of this Notice at any time. If you received this Notice electronically, you are entitled to a paper copy of this Notice. If you have any questions about this Notice please contact us at [email protected].
The effective date of this Notice is August 20, 2021.
At Evolve, we understand the importance of privacy and are committed to maintaining the confidentiality of your Protected Health Information (PHI). We make a record of the services we provide and sometimes we may receive PHI about you from others. We use these records to provide quality services to you and to transmit to other providers to assist with continuity of care. These records are also used to obtain payment for services provided to you which enables us to meet our professional and legal obligations to operate our organization.
We are required by law to maintain the privacy of PHI and we will not disclose your information except in accordance with state and federal law, including HIPAA, 42 CFR 2.1 et seq, and California Civil Code section 56.10.
This Notice is to provide you with information concerning our legal duties and privacy practices, and to notify affected individuals following a breach of unsecured PHI.
Section 1A: How we may use and disclose your PHI:
- Treatment: When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by providers. We may disclose medical information about you to health care providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
- Payment: When and as appropriate, we may use and disclose medical information about you to determine your eligibility for your health plan benefits, to facilitate payment for treatment and services you receive from us, to determine benefit responsibility and coverage with health plans, or to coordinate your coverage for your care. For example, we may disclose information about your medical history to a physician (including your physician) to determine whether a particular treatment is experimental, investigational, or medically necessary, or to decide if a health plan will cover treatment. Additionally, we may share medical information with another entity to assist with the adjudication or subrogation of health claims.
- Healthcare Operations: When and as appropriate, we may use and disclose medical information about you for our operations, as needed. For example, we may use medical information in connection with: conducting quality assessments and administration improvements; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general administrative activities.
We will always try to ensure that the medical information used or disclosed is limited to a “Designated Record Set” and to the “Minimum Necessary” standard, including a “limited data set,” as defined in HIPAA.
Section 1B: Other Permitted Uses & Disclosures of Your PHI
- In response to law enforcement or other government requests. For example, state healthcare agencies with oversight over our organization may request information to carry out their responsibilities.
- Respond to lawsuits, legal actions, and subpoenas. For example, we may receive a subpoena arising out of a pending lawsuit requesting information about you. We will request that proper confidentiality agreements are in place prior to sharing such information.
- Complete any required mandated government reporting. For example, our clinicians are mandated reporters for purposes of child abuse and may use your PHI to report child abuse to government officials.
- To avert a serious thereat to health or safety. For example, health information may be provided in an emergency to paramedics to assure you are treated properly.
- To our business associates to help us administer your care. We enter contracts with these entities to keep your information as we are permitted to do so under HIPAA.
- Other individuals as mandated by law.
Other uses and disclosures other than those described or listed in this notice will be made only with your written authorization, which you may revoke at any time pursuant to then existing state and federal laws.
Section 2. Your Health Information Rights are listed below. To make any requests connected with your rights, please email us at [email protected]:
- Inspect and copy – With some exceptions, you have the right to inspect and obtain a digital or hard copy of your health information maintained in your designated record set. We may charge a fee for the associated cost of labor, mailing, or other supplies. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access, you may request a review of the denial.
- Amend – This means you may request an amendment of health information about you for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact the Privacy Information Officer if you have questions about amending your medical record.
- Accounting of Disclosures – You have the right to request an “accounting of disclosures” (that is, a list of certain disclosures we have made of your health information). Generally, you may receive an accounting of disclosures if the disclosure is required by law, made in connection with public health activities, or in situations similar to those listed above as “Other Permitted Uses and Disclosures”. You do not have a right to an accounting of disclosures where such disclosure was made:
- For treatment, payment, or health care operations.
- To you about your own health information.
- Incidental to other permitted disclosures.
- Where authorization was provided.
- To family or friends involved in your care (where disclosure is permitted without authorization).
- For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances.
- As part of a limited data set where the information disclosed excludes identifying information.
- Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a procedure or lab test that you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
- Request Confidential Communications – You have the right to request to receive communications of health information by alternate means or at alternative locations. We will strive to accommodate all reasonable requests.
- Paper copy of this Notice – You may request a paper copy of this Notice at any time, even if you have agreed to receive this Notice electronically.
Section 3. Our Duties.
In the event your information is acquired by an unauthorized party, we will provide notification to you.
Notice will be given without unreasonable delay, and will include a description of the breach, the types of information involved in the breach, steps you should take to protect yourself from harm, and a brief description of what we are doing to investigate the breach. We will also provide you with contact information of who you may contact for more information.
We are required by law to maintain the privacy of PHI, to provide you with this Notice of our legal duties and privacy practices with respect to protected PHI/ePHI, and to notify you if you are affected by a breach of unsecured protected health information.
We are also required to abide by the terms of this Notice currently in effect.
Section 4. Changes to this Notice.
We reserve the right to change the terms of our Notice and to make the new Notice provisions effective for all protected health information that we maintain. We will send you a copy of the revised notice by email (if unavailable, by mail) for existing clients and those who discharged within the past year, and will also post it on our website.
Section 5. Complaints. You may complain to us and to the Secretary of Health and Human Services if you believe that privacy rights have been violated. You can send any complaint to us by sending an email to [email protected]. You will not be retaliated against for filing a complaint.
Section 7. Contact
If you ever have any questions or concerns about the information contained in this Notice, we encourage you to contact our Privacy Officer at 300 N. Pacific Coast Highway Suite 2060 El Segundo, CA 90245 Tele: 1-800-665- 4769; or by electronic mail at [email protected]