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.
In this Notice, we use terms like “we,” “us” or “our” or “Foresight” to refer to Foresight Mental Health, P.C. and its affiliates. We may share your protected health information to provide you with health care services, to treat you, to pay for your care, and to conduct our business operations (e.g., quality assurance, compliance, and utilization review).
What is “Protected Health Information” or “PHI?”
“Protected health information,” or “PHI” for short, is information that identifies who you are and relates to your past, present, or future physical or mental health condition, the provision of health care to you, or past, present, or future payment for the provision of health care to you, in some cases PHI can include voice recordings. PHI does not include information about you that is in a summary form that does not identify who you are.
Purpose of this Notice
In the course of doing business, we gather and maintain PHI about our members. We respect the privacy of your PHI and understand the importance of keeping this information confidential and secure. We are required by law to maintain the privacy of your PHI by implementing reasonable and appropriate safeguards. We are also required to explain to you by this Notice our legal duties and privacy practices with respect to PHI. We are also required by law to notify affected individuals following a breach of unsecured PHI.
How We Protect Your PHI
We restrict access to your PHI to those employees who need access in order to provide services to our members. We have established and maintain appropriate physical, electronic and procedural safeguards to protect your PHI against unauthorized use or disclosure. We train all employees on protecting your PHI.
Types of Use and Disclosure of PHI We May Make Without Your Authorization
1. Treatment, Payment and Health Care Operations
Federal and state law allow us to use and disclose your PHI in order to provide health care services to you. For example, we may use your PHI to authorize referrals to specialists and to review the quality of care provided.
We may also use or disclose your PHI, for example, to recommend to you treatment alternatives, to inform you about health-related benefits and services that we offer, or to contact you to remind you of your appointments.
Federal and state law also allow us to use and disclose your PHI as necessary in connection with our health care operations. For example, we may use your PHI for resolution of any grievance or appeal that you file if you are unhappy with the care you have received. We may use your PHI to perform certain business functions and disclose your PHI to our business associates, who must also agree to safeguard your PHI as required by law.
2. Other Types of Use and Disclosures (No Authorization Required)
We are also allowed by law to use and disclose your PHI without your authorization for the following purposes:
1. When required by law – In some circumstances, we are required by federal or state laws to disclose certain PHI to others, such as public agencies for various reasons;
2. For public health activities – Such as reports about communicable diseases, defective medical devices or work-related health issues;
3. Reports about child and other types of abuse or neglect, or domestic violence;
4. For health oversight activities – Such as reports to governmental agencies that are responsible for licensing or disciplinary action against physicians or other health care providers;
5. For lawsuits and other proceedings – In connection with court proceedings or proceedings before administrative agencies;
6. For law enforcement purposes – In response to a warrant, or to report a crime;
7. Reports to coroners, medical examiners, or funeral directors – To assist them in performance of their legal duties;
8. For tissue or organ donations – To organ procurement or transplant organizations to assist them;
9. For research – To medical researchers with an approval of an institutional review board (IRB) or privacy board that oversees studies on human subjects. Researchers are also required to safeguard your PHI;
10. To avert a serious threat to the health or safety of you or other members of the public;
11. For specialized government functions and activities; and
12. In connection with services provided under workers’ compensation laws.
Uses and Disclosures Requiring You to Have the Opportunity to Agree or Object
Before we make certain uses and disclosures of your PHI without your written authorization, we must provide you with an opportunity to agree or object. We may disclose your PHI to your family members or other persons if they are involved in your care or payment for that care. We may disclose your PHI to notify and assist disaster relief organizations in their relief efforts. We will provide you with the opportunity to agree or object prior to these disclosures. If you cannot agree or object because you are incapacitated or otherwise unavailable, we will use our professional judgment.
Special Rules for Highly Confidential PHI
There are some types of PHI, such as HIV test results or mental health information, which are protected by stricter laws. However, even such PHI may be used or disclosed without your written authorization if required or permitted by law.
Uses and Disclosures Requiring Your Authorization
We must obtain your written authorization prior to the following uses and disclosures of your PHI:
1. Marketing Activities – We must obtain your written authorization in order to use your PHI to send you marketing materials. However, no authorization is required for the following communications: (1) information relating to your treatment, including case management, care coordination or recommendation of treatment alternatives; (2) refill reminders or other communications about drugs that are currently prescribed for you; (3) information about health-related products or services; (4) marketing information provided to you during a face-to-face communication; and (5) promotional gifts of nominal value. We will not share your information for marketing purposes unless you give us written permission. if you do give us written permission, you have the right to revoke your permission at any time by contacting Foresight and submitting a written request to ().
2. Psychotherapy Notes – With very limited exceptions, we must obtain your authorization in order to disclose any notes recorded by a mental health professional about you in a counseling session.
All other uses and disclosures of your PHI that are not described in this Notice require your written authorization.
If you need an authorization form, we will send you one for you or your personal representative to complete. When you receive the form, please fill it out and send it to the following address:
Foresight Mental Health
3017 Telegraph Ave, Suite 210
Berkley, CA 94705
You may revoke or modify your authorization at any time by writing to us at the same address. Please note that your revocation or modification may not be effective in some circumstances, such as when we have already taken action relying on your authorization.
3. Change of Ownership – In the event that Foresight is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another provider.
Your Rights Regarding Your PHI
Access to Your PHI
You may request to inspect and obtain a copy your PHI that we maintain in medical and billing records, for as long as we maintain such records. If you wish to access your PHI, please provide a detailed written description of the PHI you wish to review at the address given below. If you would like a copy of the information we have, your request must be in writing and sent to such address. If you do not have access to our website, a copy of the release form will be provided to you upon request.
We will respond to your request and tell you when and where you can review your PHI in our possession within our normal business hours. If we provide you with a copy of your PHI, we may charge a reasonable administrative fee for copying your PHI to the extent permitted by applicable law. If we don’t have your PHI, but know who does, we will tell you whom to contact.
In limited circumstances, we may deny your request to inspect or obtain copies of your PHI. We will explain in writing the reason for our denial, and you will have the opportunity, unless limited exceptions apply, to request review of the denial. We will comply with the outcome of the review. In addition, federal law does not entitle individuals to have access to the following: (1) psychotherapy notes, (2) information compiled in reasonable anticipation of, or use in, legal proceedings, and (3) other PHI to which access is prohibited by federal law.
Right to Amend Your PHI
You have the right to request amendments to your PHI for so long as the information is maintained in our medical and billing records. If you wish to have your PHI corrected or updated, please write to us and tell us what you want changed and why. We will respond to you in writing, either accepting or denying your request. If we deny your request, we will explain why. You may also send us an addendum that is no longer than 250 words in length for each item you believe is incorrect. Please clearly indicate that you want the addendum to be included in your PHI. If we accept your request, we will attach your addendum to the record(s) of your PHI. Your amended PHI will be available for your review upon request.
Right to Receive an Accounting of Disclosures of Your PHI
You have the right to request an accounting of certain disclosures that we make of your PHI. An accounting lists disclosures we have made prior to the date of your request. You can request an accounting by writing to us. We will respond to your request within a reasonable period of time, but no later than 60 days after we receive your written request. Please note that certain disclosures need not be included in the accounting we provide to you, such as disclosures made for treatment, payment or health care operations, and disclosures made more than 6 years prior to the date of your request.
Right to Receive a Copy of This Notice
You have the right to request and receive a paper copy of this Notice, even if you have agreed to receive the Notice electronically. You may contact us for a copy, and one will be provided to you at no charge.
Right to Request Restrictions
You have the right to request restrictions on how we use and disclose your PHI for our treatment, payment, and health care operations. All requests must be made in writing. Upon receipt, we will review your request and notify you whether we have accepted or denied your request. If we agree to your request, we will comply with the restriction unless a disclosure is required in order to provide you with emergency treatment. Please note that we are not required to accept your request for restrictions, except that we are required, based on your written request, to restrict disclosure of your PHI to a health plan if (1) the purpose of the disclosure is to carry out payment or health care operations, (2) the disclosure is not otherwise required by law, and (3) the PHI pertains solely to a health care item or service for which you or someone other than the health plan have paid in full without any contribution from your health plan.
Your PHI is critical for providing you with quality health care. We believe we have taken appropriate safeguards and internal restrictions to protect your PHI, and that additional restrictions may be harmful to your care.
Right to Confidential Communications
You have the right to request that we provide your PHI to you in a confidential manner. For example, you may request that we send your PHI by an alternate means (e.g., sending by a sealed envelope, rather than a post card) or to an alternate address (e.g., calling you at a different telephone number, or sending a letter to you at your office address rather than your home address). We will accommodate any reasonable requests, unless they are administratively too burdensome, or prohibited by law.
Right to Complain
We must follow the privacy practices set forth in this Notice while in effect. If you have any questions about this Notice, wish to exercise your rights, or file a complaint, please direct your inquiries to:
Foresight Mental Health
3017 Telegraph Ave, Suite 210
Berkley, CA 94705
You also have the right to directly complain to the Secretary of the United States Department of Health and Human Service. We will not retaliate against you for filing a complaint against us.
Rights Reserved by Personal Care
We will use and disclose your PHI to the fullest extent authorized by law. We reserve the rights as expressed in this Notice. We reserve the right to revise our privacy practices consistent with law and make them applicable to all of your PHI that we maintain, regardless of when it was received or created. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Unless the changes are required by law, we will not implement material changes to our privacy practices before we revise our Notice. You may request a copy of the Notice currently in effect at any time.
When California law is permitted to impose a more stringent requirement than the federal law, California law will control our use and disclosure of your PHI.
The effective date of this Notice is December 7th, 2020.