Madera County Department of Public Health

This notice describes how protected health information about you may be used and disclosed. This notice also describes how you can get access to this information.

Please review it carefully.

Why am I receiving this Notice?

Madera County is required by law to maintain the privacy of your health information. We are required to inform you of our legal duties and privacy practices where your protected health information (PHI) is concerned.

We agree to follow the terms of the Notice of Privacy Practices (NPP). We also have the right to change the terms of this notice if it becomes necessary, and to make the new notice effective for all health information we maintain. If we need to make any changes, we will have an updated notice ready for you. You have the right to request a paper copy of the NPP.

How does Madera County use and disclose my health information?

Madera County Department of Public Health (MCDPH) stores health-related records about you, including program eligibility, case management records, and prior authorizations for health services. We use this information and give it to others for the following reasons:

• Treatment: Madera County Department of Public Health uses your PHI to coordinate your health care. We disclose it to hospitals, clinics, physicians, and other health care providers to enable them to provide health care services to you.

• Payment: Madera County Department of Public Health uses and discloses your PHI so that we may, if needed, receive payment for health care services you received, including determining your eligibility for benefits for the appropriate health care program.

• Health Care Operations: Madera County Department of Public Health uses and discloses your PHI as necessary to allow us to operate our facilities. For example, we may use your PHI to review our treatment plan and services, or to evaluate the quality of our staff who care for you. We also disclose information regarding your children's immunization history to the Central Valley Immunization Information System, a regional web based Immunization Registry.

• Contact: Madera County Department of Public Health may contact you and provide appointment reminders or information about treatment options available to you. We may also contact you about other health related services that may interest you.

Can others involved in my health care receive information about me?

Yes, we may release medical information to a family member, a friend, or a parent who is involved in your care as we judge necessary for their participation. This includes responding to telephone inquires about your treatment or eligibility in a specific health care program. If you disagree, you must do so in writing.

Can my protected health information (PHI) ever be released without my permission?

Yes, we may disclose PHI without your authorization to government agencies and private individuals and organizations in a variety of situations that we are required or authorized by law to do so. The following are general types of disclosures we may be required or allowed to make without your authorization.

• Disclosures that are required by state or federal law
• Disclosures to public health authorities or to other persons in connection with public health activities
• To government agencies authorized to receive reports of abuse or neglect of children or dependent adults, or domestic violence
• To agencies responsible for overseeing the health care system, for audits, inspections or investigations
• For judicial and administrative proceedings, such as lawsuits
• To law enforcement agencies
• To coroners and medical examiners
• To organ procurement agencies, if you are an organ donor or a possible donor
• To researchers conducting research under the auspices of an Institutional Review Board or privacy board
• To avoid a serious threat to health or safety
• To assist authorized federal officials in national security activities, or for the provision of protective services to officials
• If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI about you to the institution or official
• To other agencies administering government health benefit programs, as authorized or required by law
• To comply with worker's compensation laws

Are there instances when my Protected Health Information (PHI) is not released?

Your protected health information may be subject to restrictions that may limit or prevent some disclosures. For example, there are special restrictions on the disclosure of PHI relating to HIV/AIDS status, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment. We comply with these restrictions in our use of your PHI.

We will not permit other uses and disclosures of your PHI without your written permission, or authorization which you may revoke at any time in the manner described in our "Authorization Revocation Form" (2.6.2.5.PH.F.1).

Your Individual Rights

What rights do I have as a client?

You have the right to ask us to restrict certain uses and disclosures of your health information. However, Madera County Department of  Public Health is not required to agree to any restrictions requested by its clients.

You have the right to receive confidential communications from the Department of Public Health at a specified phone number or address if you wish.

You have the right to see and copy any of your health records that the Public Health Department maintains. We must receive your request in writing. We will respond to your request within 30 days. If your records are stored in another location, please allow 60 days for us to respond to your request. We may charge a fee to cover the cost of copying your records. Under certain circumstances, the Department of  Public Health may deny your request. If your request is denied, we will tell you the reason why in writing. You have the right to appeal the denial.

If you feel the information in our records is inaccurate, you have the right to request us to amend the records. We may deny your request in certain circumstances. If your request is denied, you have the right to submit a statement for inclusion in the record.

You have the right to receive a report of non-routine disclosures that we have made of your PHI, up to six years prior from the date of your request. Exceptions are: disclosures that were made for our own use for purposes of treatment and health care operations and disclosures made to you. You have a right to a paper copy of your non-routine disclosures from us at any time.

How can I take advantage of these rights?

You can take advantage of your rights any time by giving us a written request to our Privacy Officer listed below or by calling us at the number below.

How do I file a complaint if my privacy rights are violated?

You have the right to file a complaint with our Privacy Officer. Use the Community Feedback Form, or contact MCDPH as shown below to request a copy.  Please provide specific, written information to support your complaint. You may also file a complaint with the Secretary of Health and Human Services.

Madera County Department of Public Health will not punish you in any way for filing a complaint. Filing a complaint will not affect the quality of health care services you receive from us.

Contact

Madera County Department of Public Health
Attn: Privacy Officer
1604 Sunrise Avenue
Madera, CA 93638
Email: publichealth@maderacounty.com
Phone: (559) 675-7893

To contact the Secretary of Health and Human Services please send your written complaint to:

Secretary of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Room 509W, HHH Building
Washington, DC 20201

Effective date of this notice: April 14, 2003

Revised 4/30/04