Expanded Notice of Privacy Practices
Effective April 14, 2004
CALM is required by law to:
- Make sure that health information which identifies you is kept private
- Give you this notice of our legal duties regarding your private health information
- Follow the terms of this notice
CALM may use or disclose your health information without requiring your consent in the following circumstances:
- In order to pay for your covered health expenses
- In order to perform our agency activities, such as quality assessment or data management
- To comply with the laws regarding reporting public health concerns to public health agencies and reporting possible abuse to agencies protecting victims of abuse or neglect.
- To obtain required oversight from government agencies as required by law
- To comply with a police warrant or police inquiry about the victim of a crime
- To prevent a serious threat to your health and safety or that of another person
- To comply with state law regarding workers’ compensation programs.
Other Uses or Disclosures of your Protected Health Information
Will only be made with your written consent. This written consent can be revoked by you at any time, except to the extent that we have already taken action on the information disclosed.
Your rights regarding your Protected Health Information
Following a written request you have the following rights:
- Right to access to your protected health information
- Right to amend your protected health information. We may deny your request in a written response (if, for example, you ask us to change information that we did not create or if we believe the record is accurate and complete) and you have the right to submit a written statement of disagreement with our decision.
- Right to an accounting of disclosures we have made about your protected health information, except for those related to payment or our heath care operations.
- Right to request restrictions on the use and disclosure of your protected health information. We have the right to refuse this request.
- Right to receive communication from us in a confidential manner, if to do so otherwise would endanger you.
Your Rights Concerning this Notice
You have the right to receive a paper copy of this notice at any time.
Health Information Security
All CALM employees are required to follow CALM’s security policies and procedures concerning the confidentiality of health information. In addition, CALM maintains physical, administrative and technical security measures to safeguard your protected health information.
Changes to this Notice
We reserve the right to change the terms of this notice at any time. We will provide you with a copy of the new notice whenever we make material changes to the privacy practices described in this notice. We also post a copy of the current notice on the bulletin board in our reception area and on our website at www.calm4kids.org.
If you believe your privacy rights have been violated, you may file a complaint with our privacy officer, Cecilia Rodriguez MFT at 805 965-2376 extension 138 or with the Secretary of the Department of Health and Human Services. Forms for filing a complaint are available in our reception area.