PRIVACY PRACTICES OF THE CENTER FOR CREATIVE GROWTH
(We are required by Federal Law to provide you with these Privacy Practices)
I. 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.
II. WE HAVE A LEGAL DUTY TO
SAFEGUARD YOUR PROTECTED HEALTH lNFORMATION (PHI)
We are legally required to protect the privacy of your PHI, which includes
information that can be used to identify you that we've created or received
about your past, present, or future health or condition, the provision of
health care to you, or the payment of this health care. We must provide you
with this Notice about our privacy practices, and such Notice must explain how,
when, and why we will "use" and "disclose" your PHI. A
"use" of PHI occurs when we share, examine, utilize, apply, or
analyze such information within our practice; PHI is "disclosed" when
it is released, transferred, has been given to, or is otherwise divulged to a
third party outside of our practice. With some exceptions, we may not use or
disclose any more of your PHI than is necessary to accomplish the purpose for
which the use or disclosure is made. And, we are legally required to follow the
privacy practices described in this Notice.
However, we
reserve the right to change the terms of this Notice and our privacy policies
at any time. Any changes will apply to PHI on file with us already. Before we
make any important changes to our policies, we will promptly change this Notice
and post a new copy of it in our office and on our website (if applicable). You
can also request a copy of this Notice from us, or you can view a copy of it in
our office or at our website, which is located at www.creativegrowth.com.
III. HOW WE MAY USE AND DISCLOSE
YOUR PHI.
We will use and disclose your PHI for many different reasons. For some of these
uses or disclosures, we will need your prior authorization; for others,
however, we do not. Listed below are the different categories of our uses and
disclosures along with some examples of each category.
A. Uses and Disclosures Relating to
Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written
Consent. We can use
and disclose your PHI without your consent for the following reasons:
B. Certain Uses and Disclosures Do
Not Require Your Consent. We can use and disclose your PHI without your consent or authorization
for the following reasons:
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
D. Other Uses and Disclosures
Require Your Prior Written Authorization. In any other situation not described in sections III
A, B, and C above, we will ask for your written authorization before using or
disclosing any of your PHI. If you choose to sign an authorization to disclose
your PHI, you can later revoke such authorization in writing to stop any future
uses and disclosures (to the extent that we haven't taken any action in
reliance on such authorization) of your PHI by us.
IV. WHAT RIGHTS YOU HAVE REGARDING
YOUR PHI
You have the following rights with respect to your PHI:
A. The Right to Request Limits on
Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and
disclose your PHI. We will consider your request, but we are not legally
required to accept it. If we accept your request, we will put any limits in
writing and abide by them except in emergency situations. You may not limit the
uses and disclosures that we are legally required or allowed to make.
B. The Right to Choose How We Send
PHI to You. You
have the right to ask that we send information to you to at an alternate
address (for example, sending information to your work address rather than your
home address) or by alternate means (for example, e-mail instead of regular
mail). We must agree to your request so long as we can easily provide the PHI to
you in the format you requested.
C. The Right to See and Get Copies
of Your PHI. In
most cases, you have the right to look at or get copies of your PHI that we
have, but you must make the request in writing. If we don't have your PHI but
we know who does, we will tell you how to get it. We will respond to you within
30 days of receiving your written request. In certain situations, we may deny
your request. If we do, we will tell you, in writing, our reasons for the
denial and explain your right to have our denial reviewed. If you request
copies of your PHI, we will charge you not more than $.25 for each page.
Instead of providing the PHI you requested, we may provide you with a summary
or explanation of the PHI as long as you agree to that and to the cost in
advance.
D. The Right to Get a List of the
Disclosures We Have Made.
You have the right to get a list of instances in which we have disclosed your
PHI. The list will not include uses or disclosures that you have already
consented to, such as those made for treatment, payment, or health care
operations, directly to you, or to your family. The list also won't include
uses and disclosures made for national security purposes, to corrections or law
enforcement personnel, or disclosures made before April 15, 2003.
We will
respond to your request for an accounting of disclosures within 60 days of
receiving your request. The list we will give you will include disclosures made
in the last six years unless you request a shorter time. The list will include
the date of the disclosure, to whom PHI was disclosed (including their address,
if known), a description of the information disclosed, and the reason for the
disclosure. We will provide the list to you at no charge, but if you make more
than one request in the same year, we will charge you a reasonable cost based
fee for each additional request.
E. The Right to Correct or Update
Your PHI. If you
believe that there is a mistake in your PHI or that a piece of important
information is missing, you have the right to request that we correct the
existing information or add the missing information. You must provide the
request and your reason for the request in writing. We will respond within 60
days of receiving your request to correct or update your PHI. We may deny your
request in writing if the PHI is (i) correct and complete, (ii) not created by
us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our
written denial will state the reasons for the denial and explain your right to
file a written statement of disagreement with the denial. If you don't file
one, you have the right to request that your request and our denial be attached
to all future disclosures of your PHI. If we approve your request, we will make
the change to your PHI, tell you that we have done it, and tell others that
need to know about the change to your PHI.
F. The Right to Get This Notice by
E-Mail. You have
the right to get a copy of this notice by e-mail. Even if you have agreed to
receive notice via e-mail, you also have the right to request a paper copy of
it.
V. HOW TO COMPLAIN ABOUT OUR PRIVACY
PRACTICES
If you think that we may have violated your privacy rights, or you disagree
with a decision we made about access to your PHI, you may file a complaint with
the person listed in Section VI below. You also may send a written complaint to
the Secretary of the Department of Health and Human Services at 200
Independence Avenue S.W., Washington, D.C. 20201. We will take no retaliatory
action against you if you file a complaint about our privacy practices.
VI. PERSON TO CONTACT FOR
INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you have any questions about this notice or any complaints about our privacy
practices, or would like to know how to file a complaint with the Secretary of
the Department of Health and Human Services, please contact us at:
Center for Creative Growth
1221 Marin Avenue
Berkeley, CA 94706
510/527-2100
staff@creativegrowth.com
VII. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on April 14, 2003.
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