PRIVACY POLICY

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NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

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

A. INTRODUCTION

During the course of providing services and care to you, Care Connexxus, Inc. gathers, creates, and retains certain personal information about you that identifies who you are and relates to your past, present, or future physical or mental condition, the provision of health care to you, and payment for your health care services. This personal information is characterized as your "protected health information." This Notice of Privacy Practices describes how Care Connexxus, Inc. maintains the confidentiality of your protected health information, and informs you about the possible uses and disclosures of such information. It also informs you about your rights with respect to your protected health information.

B. CARE CONNEXXUS, INC. RESPONSIBILITIES

Care Connexxus, Inc. is required by federal and state law to maintain the privacy of your protected health information. Care Connexxus, Inc is also required by law to provide you with this Notice of Privacy Practices that describes Care Connexxus, Inc.'s legal duties and privacy practices with respect to your protected health information. Care Connexxus, Inc. will abide by the terms of this Notice of Privacy Practices. Care Connexxus, Inc. reserves the right to change this or any future Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that it maintains, including protected health information already in its possession. If Care Connexxus, Inc. changes its Notice of Privacy Practices, it will personally deliver or mail a revised notice to you at your current address.

C. USE AND DISCLOSURE WITH YOUR AUTHORIZATION

Care Connexxus, Inc. will require a written authorization from you before it uses or discloses your protected health information, unless a particular use or disclosure is expressly permitted or required by law without your authorization. Care Connexxus, Inc. has prepared an authorization form for you to use that authorizes Care Connexxus, Inc. to use or disclose your protected health information for the purposes set forth in the form. You are not required to sign the form as a condition to obtaining treatment or having your care paid for. If you sign an authorization, you may revoke it at any time by written notice. Care Connexxus, Inc. then will not use or disclose your protected health information, except where it has already relied on your authorization.

D. HOW CARECONNEXXUS, INC. MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION

  1. Mandatory Disclosures
    Care Connexxus, Inc. will disclose protected health information to outside persons or entities without your written authorization as required by law in the following circumstances:
    • a. Court Order; Order of Administrative Tribunal
      Care Connexxus, Inc. will disclose protected health information in accordance with an order of a court or of an administrative tribunal of a government agency.
    • b. Subpoena
      Care Connexxus, Inc. will disclose protected health information in accordance with a valid subpoena issued by a party to adjudication before a court, an administrative tribunal, or a private arbitrator. Reasonable efforts will be made to notify you of the subpoena, or attempts will be made to obtain an order or agreement protecting your protected health information.
    • c. Law Enforcement Agencies
      Care Connexxus, Inc. will disclose protected health information to law enforcement agencies in accordance with a search warrant, a court order or court-ordered subpoena, or an investigative subpoena or summons.
    • d. Coroner
      Care Connexxus, Inc. will disclose protected health information to a coroner where the coroner requests the information to identify a decedent; to notify next of kin; or to investigate deaths that may involve public health concerns, suspicious circumstances, elder abuse, or organ or tissue donation.
    • e. Elder Abuse Reporting
      Care Connexxus, Inc. will disclose protected health information about a participant who is suspected to be the victim of elder abuse to the extent necessary to complete any oral or written report mandated by law. Under certain circumstances, Care Connexxus, Inc. may disclose further protected health information about the participant to aid the investigating agency in performing its duties. Care Connexxus, Inc. will promptly inform the participant about any disclosure unless Care Connexxus, Inc. believes that informing the participant would place the participant in danger of serious harm, or would be informing the participant's personal representative, whom the Provider believes to be responsible for the abuse, and believes that informing such person would not be in the participant's best interest.
    • f. Other Disclosures Required by Law
      Care Connexxus, Inc. will disclose protected health information about a participant when otherwise required by law.
  2. Permissive Disclosures
    Care Connexxus, Inc. may, in its discretion, use or disclose your protected health without your written authorization in the following circumstances:
    • a. Your Care and Treatment
      Care Connexxus, Inc. may use or disclose your protected health information to provide you with or assist in your treatment, care and services. For example, Care Connexxus, Inc. may disclose your health information to health care providers who are involved in your care to assist them in your diagnosis and treatment, as necessary. Care Connexxus, Inc. may also disclose your protected health information to individuals who will be involved in your care if you leave Care Connexxus, Inc.
    • b. Billing and Payment
      • i. Medicare, Medi-Cal and Other Public or Private Health Insurers
        Care Connexxus, Inc. may use or disclose your protected health information to public or private health insurers (including medical insurance carriers, HMOs, Medicare, and Medi-Cal) in order to bill and receive payment for your treatment and services that you receive at Care Connexxus, Inc. The information on or accompanying a bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
      • ii. Health Care Providers
        Care Connexxus, Inc. may also disclose your protected health information to health care providers in order to allow them to determine if they are owed any reimbursement for care that they have furnished to you and, if so, how much is owed.
    • c. Health Care Operations
      Care Connexxus, Inc. may use your protected health information for health care operations at Care Connexxus, Inc. These uses and disclosures are necessary to manage Care Connexxus, Inc. and to monitor our quality of services and care. For example, we may use your protected health information to review our services and to evaluate the performance of our staff in caring for you.
    • d. Licensing and Accreditation
      Care Connexxus, Inc. may disclose your protected health information to any government or private agency, such as to the California Department of Health Services and the California Department of Social Services, responsible for licensing or accrediting Care Connexxus, Inc. so that the agency can carry out its oversight activities. These oversight activities include audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight.
    • e. Provision of Basic Information about Participants
      Care Connexxus, Inc. allows staff to provide certain basic information about a participant to persons who ask for the participant by name and to members of the clergy. Unless you notify Care Connexxus, Inc. that you object, it will disclose your name, your location in Care Connexxus, Inc. and your general condition to anyone who asks for you by name. It will disclose your name, your location in Care Connexxus, Inc. your general condition, and your religious affiliation to members of the clergy.
    • f. Individuals Involved in Your Care or Payment for Your Care
      Unless you specifically object, Care Connexxus, Inc. may disclose to a family member, other relative, a close personal friend, or to any other person identified by you, all protected health information directly relevant to such person's involvement with your care or directly relevant to payment related to your care. Care Connexxus, Inc. may also disclose your protected health information to a family member, personal representative, or other person responsible for your care to assist in notifying them of your location, general condition, or death.
    • g. Disaster Relief
      Care Connexxus, Inc. may disclose your protected health information to a public or private entity authorized to assist in disaster relief efforts.
    • h. Disclosures within Provider Community
      Unless you specifically object, Care Connexxus, Inc. may disclose certain general information about you (e.g., past activities, present interests, birthday, and location if hospitalized) to members of its community, including other participants and staff, by means such as newsletter or bulletin board.
    • i. Business Associates
      Care Connexxus, Inc. may contract with certain individuals or entities to provide services on its behalf. Examples include data processing, quality assurance, legal, or accounting services. Care Connexxus, Inc. may disclose your protected health information to a business associate, as necessary, to allow the business associate to perform its functions on the Care Connexxus, Inc. behalf. Care Connexxus, Inc. will have a contract with its business associates that obligate the business associates to maintain the confidentiality of your protected health information.
    • j. Fundraising
      Care Connexxus, Inc. may use certain protected health information to contact you in an effort to raise money for Care Connexxus, Inc. and its operations. Care Connexxus, Inc. may disclose the protected health information to business associates or to related foundations that it uses to raise funds for its own benefit. Care Connexxus, Inc. will disclose only your name, address, and phone number and the dates you receive health care services. You may notify Care Connexxus, Inc. in writing if you object to such disclosures.
    • k. Research
      Care Connexxus, Inc. may disclose your protected health information for research purposes, provided that an outside Institutional Review Board overseeing the research approves the disclosure of the information without a written authorization.
    • l. Public Health Activities
      Care Connexxus, Inc. may disclose protected health information to any public health authority that is authorized by law to collect it for purposes of preventing or controlling disease, injury, or disability.
    • m. Hospital Peer Review
      Care Connexxus, Inc. may disclose your protected health information to hospital medical staffs to aid in the credentialing of applicants and in the peer review of members.
    • n. Organ Procurement
      Care Connexxus, Inc. may disclose your protected health information following your death to an organ procurement agency or tissue bank in order to aid in using your organs or tissues in transplantation.
    • o. Coroner
      Care Connexxus, Inc. may disclose protected health information to the coroner to allow the coroner to perform its duties.
    • p. Members of Workforce
      It is Care Connexxus, Inc.'s policy to allow members of its workforce to share participants' protected health information with one another to the extent necessary to permit them to perform their legitimate functions on Care Connexxus, Inc.'s behalf. At the same time, Care Connexxus, Inc. will work with and train its workforce members to ensure that there are no unnecessary or extraneous communications that will violate the rights of its participants to have the confidentiality of their protected health information maintained.

E. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION

You have the following rights with respect to your protected health information. To exercise these rights, contact Care Connexxus, Inc. at the following address: Care Connexxus, Inc. 4130 Adams Street, Suite B, Riverside, CA 92504, Attention: Program Director.

  • a. Right to Receive a Copy of the Notice of Privacy Practices
    You have the right to request and receive a copy of Care Connexxus, Inc.'s Notice of Privacy Practices for Protected Health Information in written or electronic form.
  • b. Right to Request Access
    You have the right to inspect and copy your health records maintained by Care Connexxus, Inc. In certain limited circumstances, Care Connexxus, Inc. may deny your request as permitted by law.
  • c. Right to Request Amendment
    You have the right to request an amendment to your health records maintained by Care Connexxus, Inc. If your request for an amendment is denied, you will receive a written denial, including the reasons for such denial, and an opportunity to submit a written statement disagreeing with the denial.
  • d. Right to Request Use or Disclosure Restrictions or Confidential Communications
    You have the right to request restrictions on the use and disclosure of your protected health information for treatment, payment or health care operations, or providing notifications regarding your identity and status to persons inquiring about or involved in your care. Care Connexxus, Inc. is not required to grant your request, but if it does, it will comply with your request, except in an emergency situation or until the restriction is terminated by you or Care Connexxus, Inc. You also have the right to request that Care Connexxus, Inc. communicate protected health information to the recipient by alternative means or at alternative locations.
  • e. Right to an Accounting
    You have the right to receive an accounting of disclosures of your protected health information created and maintained by Care Connexxus, Inc. Care Connexxus, Inc. is not required to provide an accounting of certain routine disclosures or of disclosures of which you already are aware.

F. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint with Care Connexxus, Inc. at the following address 4130 Adams Street, Suite B, Riverside, CA 92504, Attention: Program Director. You also have the right to submit a complaint to the Secretary of the U.S. Department of Health and Human Services, 50 United Nations Plaza – Room 322, San Francisco, CA 94102, Attention OCR Regional Manager. Care Connexxus, Inc. will not retaliate against you if you file a compliant.

G. FURTHER INFORMATION

If you have questions about this Notice of Privacy Practices or would like further information about your privacy rights, contact Care Connexxus, Inc. at the following address 4130 Adams Street, Suite B, Riverside, CA 92504, Attention: Program Director.

The effective date of this Notice of Privacy Practices is April 30, 2003.

I hereby acknowledge receipt from Care Connexxus, Inc. of a copy of its Notice of Privacy Practices for Protected Health Information effective on the date set forth above.