You have the following rights regarding your PHI that we maintain in our facilities.
Right to Inspect and Copy
Except for psychotherapy notes and information compiled by us for use in a civil, criminal or administrative action or proceeding, you have the right to request access to inspect and copy your PHI. To inspect and copy your PHI, you must send a specific, detailed request in writing to the manager of the program where you are receiving services or to the Privacy Officer, DADS, 976 Lenzen Avenue, San Jose, CA 95126. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request.
You may request a review if we deny access to inspect and copy except 1) in the circumstances noted in the first paragraph of this section; 2) you are an inmate and the copies would jeopardize your health safety, security, custody or rehabilitation or that of others; 3) the PHI is obtained in the course of research and the right to access is suspended during the progress of the research; 4) the PHI is subject to the Privacy Act and is not permitted by law; or 5) if the PHI was obtained from someone other than a healthcare provider under a promise of confidentiality and the information would reveal the source. A licensed health care provider other than the person who originally participated in the denial will review the denial and we will provide or deny access in accordance with the decision of the reviewing provider.
Right to Amend
If you feel that your PHI in our custody is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To ask for an amendment, you must send a written request with a reason that supports your request to the manager of the program where you are receiving services.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- was not created by us;
- is not part of the information kept by or for us;
- is not part of the information which you are permitted by law to inspect and copy; or
- is accurate and complete.
If we deny your request for an amendment, you have the right to submit a written addendum about any item or statement in your medical record you believe is incomplete or incorrect. The addendum cannot exceed one page per alleged incomplete or incorrect item in your record.
Right to an Accounting of Disclosures
You have the right to request a list of the use and disclosures we made of your PHI other than disclosures made 1) to you or authorized by you, 2) as part of a limited data set as permitted by law, or 5) for treatment, payment and healthcare operations (as described above). To request this accounting of disclosures, you must send your request in writing to the manager of the program where you are receiving services.
Your request must state a time period which cannot be longer than a six-year period and cannot include dates before April 14, 2003. Your request should describe the type of list you would like (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on your PHI we use or disclose for treatment, payment or healthcare operations. For example, you can ask that we not use or disclose information about medications that you received at our clinic. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you. To request restrictions, you must send a request in writing to the manager of the program where you are receiving services. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications
You have the right to request that we communicate with you about personal health matters in a certain way or at a certain location. For example, you can ask that we contact you only at work or by US mail. To request confidential communications, you must send a written request to the manager of the program where you are receiving services. We will not ask you the reason for your request, and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time in person or in writing by sending a written request to Privacy Officer, DADS, 976 Lenzen Avenue, San Jose, CA 95126.
Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain an electronic copy of this notice by visiting the Santa Clara County Portal at: www.sccgov.org and going to the "Health and Human Care" channel and clicking on "HIPAA Privacy Practices".
EXERCISE OF RIGHTS.
If you wish to exercise any of the rights listed above, you should contact the manager of the program where you are receiving services.
CHANGES TO THIS NOTICE
We reserve the right to change our Privacy practices and this Notice. We reserve the right to make the revised or changed Notice effective for the PHI we already have about you, as well as any other information we create in the future. We will post a copy of the current Notice in our facilities. The effective date of the Notice will be displayed on the first page. If you ask, each time you register at, or are admitted to one of our facilities for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect.
We welcome the opportunity to respond to your questions and concerns and to resolve any complaints you may have about the use or disclosure of your PHI. If you believe your privacy rights have been violated, you may file a complaint with us, or with the Secretary of the Department of Health and Human Services. To file a complaint with us, you may send a written notice to the manager of the program where you are receiving services; or to the DADS Patient Rights Advocate, 976 Lenzen Avenue, San Jose, CA 95126.
You will not be penalized in any way (such as having services denied or delayed) for filing a complaint.