Privacy & Disclaimer
Effective Date: July 20, 2011
THIS NOTICE DESCRIBES HOW CLINICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this notice, please contact our corporate office:
Understanding Behavior, Inc.
744 Montgomery Street Suite 400
San Francisco, CA 94111
Summary of Rights and Obligations Concerning Clinical Information
Understanding Behavior, Inc is committed to preserving the privacy and confidentiality of your behavioral health information, which is required both by federal and state law, as well as by ethics of our certified ABA Providers. We are required by law to provide you with this notice of our legal duties, your rights, and our privacy practices, with respect to using and disclosing your behavioral health information that is created or retained by Understanding Behavior, Inc.
Each time we visit you, we make a record of our visit. Typically, this record contains your diagnoses, chief complaints and symptoms, presenting behaviors, treatment services that took place, recommendations that were given to you and a plan for future care or treatment. We have an ethical and legal obligation to protect the privacy of your behavioral health information, and we will only use or disclose this information in limited circumstances. In general, we may use and disclose your behavioral health information to:
- plan your care and treatment;
- provide treatment by us or others;
- communicate with other providers such as referring physicians;
- receive payment from you, your behavioral health plan, or your behavioral health insurer;
- make quality assessments and work to improve the care we render and the outcomes we achieve, known as behavioral health care operations;
- make you aware of services and treatments that may be of interest to you; and
- comply with state and federal laws that require us to disclose your behavioral health information.
We may also use or disclose your behavioral health information where you have authorized us to do so.
You have certain rights to your behavioral health information. You have the right to:
- ensure the accuracy of your behavioral health record;
- request confidential communications between you and your ABA Provider and request limits on the use and disclosure of your behavioral behavioral health information; and
- request an accounting of certain uses and disclosures of behavioral health information we have made about you.
We are required to:
- maintain the privacy of your behavioral health information;
- provide you with notice, such as this Notice of Privacy Practices, as to our legal duties and privacy practices with respect to information we collect and maintain about you;
- abide by the terms of our most current Notice of Privacy Practices;
- notify you if we are unable to agree to a requested restriction; and
- accommodate reasonable requests you may have to communicate behavioral health information by alternative means or at alternative locations.
WE RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE THE NEW PROVISIONS EFFECTIVE FOR ALL YOUR BEHAVIORAL HEALTH INFORMATION THAT WE MAINTAIN.
Should our information practices change, a revised Notice of Privacy Practices will be available upon request. If there is a material change, a revised Notice of Privacy Practices will be distributed to the extent required by law.
We will not use or disclose your behavioral health information without your authorization, except as described in our most current Notice of Privacy Practices.
In the following pages, we explain our privacy practices and your rights to your behavioral health information in more detail.
If you have limited proficiency in English, you may request a Notice of Privacy Practices in the language you are most familiar with.
We May Use or Disclose Your Behavioral Health Information In The Following Ways
- Treatment. We may use and disclose your behavioral health information to provide you with treatment or services. For example, we may use your behavioral health information to prescribe a course of treatment. We will record your current behavioral healthcare information in a record so, in the future, we can see your behavioral health history to help in diagnosing and treatment, or to determine how well you are responding to treatment. We may provide your behavioral health information to other behavioral health or medical providers, such as referring or specialist, clinician or physician to assist in your treatment.
- Payment. We may use and disclose your behavioral health information so that we may bill and collect payment for the services that we provided to you. For example, we may contact your behavioral health and/or medical insurer to verify your eligibility for benefits, and may need to disclose to it some details of your condition or expected course of treatment. We may use or disclose your information so that a bill may be sent to you, your behavioral health and/or medical insurer, or a family member. The information on or accompanying the bill may include information that identifies you and your diagnosis, as well as services rendered.
- Behavioral Health Care Operations. We may use and disclose your behavioral health information to assist in the operation of our practice. For example, members of our staff may use information in your behavioral health record to assess the care and outcomes in your case and others like it as part of a continuous effort to improve the quality and effectiveness of the behavioral healthcare and services we provide. We may use and disclose your behavioral health information to conduct cost-management and business planning activities for our practice. We may also provide such information to other behavioral health care entities for their behavioral health care operations. For example, we may provide information to your behavioral health insurer for its quality review purposes.
- Business Associates. Understanding Behavior, Inc sometimes contracts with third-party business associates for services. Examples include answering services, information database services, billing services, consultants, and legal counsel. We may disclose your behavioral health information to our business associates so that they can perform the job we have asked them to do. To protect your behavioral health information, however, we require our business associates to appropriately safeguard your information and to formally agree to our non-disclosure policy.
- Treatment Options. We may use and disclose your behavioral health information in order to inform you of alternative treatments.
- Release to Family/Friends. Our behavioral health professionals, using their professional judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, your behavioral health information to the extent it is relevant to that person’s involvement in your care or payment related to your care. We will provide you with an opportunity to object to such a disclosure whenever we practicably can do so. We may disclose the behavioral health information of minor children to their parents or legal guardians unless such disclosure is otherwise prohibited by law.
- Behavioral Health-Related Benefits and Services. We may use and disclose behavioral health information to tell you about behavioral health-related benefits or services that may be of interest to you. In face- to-face communications, such as appointments with your ABA Provider, we may tell you about other services that may be of interest you.
- Newsletters and Other Communications. We may use your personal information in order to communicate to you via mailings, or other means regarding treatment options, behavioral health related information or other community based initiatives or activities in which our practice is participating.
- Disaster Relief. We may disclose your behavioral health information in disaster relief situations where disaster relief organizations seek your behavioral health information to coordinate your care, or notify family and friends of your location and condition. We will provide you with an opportunity to agree or object to such a disclosure whenever we practicably can do so.
- Marketing. In most circumstances, we are required by law to receive your written authorization before we use or disclose your behavioral health information for marketing purposes. Under no circumstances will we sell our patient lists or your behavioral health information to a third party without your written authorization.
- Public Behavioral health Activities. We may disclose behavioral heatlh information about you for public behavioral health activities. These activities generally include the following:
- licensing and certification carried out by public behavioral health authorities;
- prevention or control of disease, injury, or disability;
- reports of child abuse or neglect;
- notifications to appropriate government authorities if we believe a client has been the victim of abuse, neglect, or domestic violence. We will make this disclosure when required by law, or if you agree to the disclosure, or when authorized by law and in our professional judgment disclosure is required to prevent serious harm.
- Behavior Consultation/Therapy Notes. Under most circumstances, without your written authorization we may not disclose the notes an ABA Provider took during a behavior consultation/therapy session. However, we may disclose such notes for treatment and payment purposes, for state and federal oversight of the behavioral health professional, to avert a serious threat to behavioral health or safety, or as otherwise authorized by law.
- Workers Compensation. We may disclose your behavioral health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
- Law Enforcement. We may release your behavioral health information:
- in response to a court order, subpoena, warrant, summons, or similar process if authorized under state or federal law;
- to identify or locate a suspect, fugitive, material witness, or similar person;
- about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- about a death we believe may be the result of criminal conduct;
- about criminal conduct at [name of provider];
- to coroners or medical examiners;
- in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime;
- to authorized federal officials for intelligence, counterintelligence, and other
- national security authorized by law; and
- to authorized federal officials so they may conduct special investigations or provide protection to the President, other authorized persons, or foreign heads of state.
- De-identified Information. We may use your behavioral health information to create “de-identified” information or we may disclose your information to a business associate so that the business associate can create de-identified information on our behalf. When we “de-identify” behavioral health information, we remove information that identifies you as the source of the information. Behavioral health information is considered “de-identified” only if there is no reasonable basis to believe that the behavioral health information could be used to identify you.
- Personal Representative. If you have a personal representative, such as a legal guardian, we will treat that person as if that person is you with respect to disclosures of your behavioral health information. If you become deceased, we may disclose behavioral health information to an executor or administrator of your estate to the extent that person is acting as your personal representative.
- Limited Data Set. We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research, public behavioral health, and behavioral health care operations. We may not disseminate the limited data set unless we enter into a data use agreement with the recipient in which the recipient agrees to limit the use of that data set to the purposes for which it was provided, ensure the security of the data, and not identify the information or use it to contact any individual.
- Authorization for Other Uses of Behavioral Health Information
Uses of behavioral health information not covered by our most current Notice of Privacy Practices or the laws that apply to us will be made only with your written authorization.
If you provide us with authorization to use or disclose behavioral health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose behavioral health information about you for the reasons covered by your written authorization, except to the extent that we have already taken action in reliance on your authorization or, if the authorization was obtained as a condition of obtaining insurance coverage and the insurer has the right to contest a claim or the insurance coverage itself. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain our records of the care that we provided to you.
Your Behavioral Health Information Rights
You have the following rights regarding behavioral health information we gather about you:
- Right to Obtain a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.
- Right to Inspect and Copy. You have the right to inspect and copy behavioral health information that may be used to make decisions about your care. Usually, this includes clinical and billing records.
To inspect and copy behavioral health information, you must submit a written request to Understanding Behavior, Inc. We will supply you with a form for such a request. If you request a copy of your behavioral health information, we may charge a reasonable fee for the costs of labor, postage, and supplies associated with your request. We may not charge you a fee if you require your behavioral health information for a claim for benefits.
We may deny your request to inspect and copy in certain limited circumstances.
If you are denied access to behavioral health information, you may request that the denial be reviewed. A licensed behavioral healthcare professional who was not directly involved in the denial of your request will conduct the review. We will comply with the outcome of the review.
If your behavioral healthcare information is maintained in an electronic behavioral health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity. We may charge you a reasonable cost based fee limited to the labor costs associated with transmitting the electronic behavioral health record.
- Right to Amend. If you feel that behavioral health information we have about you 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 retain the information.
To request an amendment, your request must be made in writing and submitted to Understanding Behavior, Inc. In addition, you must provide a reason that supports your request. 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 Understanding Behavior Inc, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the medical information kept by or for [name of provider];
- is not part of the information which you would be permitted to inspect and copy; or
- is accurate and complete.
If we deny your request for amendment, you may submit a statement of disagreement.
We may reasonably limit the length of this statement. Your letter of disagreement will be included in your behavioral health record, but we may also include a rebuttal statement.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or behavioral health care operations. If you paid out-of-pocket for a specific item or service, you have the right to request that medical information with respect to that item or service not be disclosed to a behavioral health plan for purposes of payment or behavioral health care operations, and we are required to honor that request.
You also have the right to request a limit on the medical information we communicate about you to someone who is involved in your care or the payment for your care.
Except as noted above, we are not required to agree to your request. If we do agree, we will comply with your request unless the restricted information is needed to provide you with emergency treatment. To request restrictions, you must make your request in writing to our privacy officer. In your request, you must tell us:
- what information you want to limit;
- whether you want to limit our use, disclosure, or both; and
- 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 behavioral health matters in a certain way or at a certain location. For example, you can ask that we only contact you at home or by e-mail.
To request confidential communications, you must make your request in writing to our privacy officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
G. Right to Receive Notice of a Breach. We are required to notify you by first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breaches of Unsecured Protected Behavioral health Information as soon as possible, but in any event, no later than 60 days following the discovery of the breach.
“Unsecured Protected Behavioral Health Information” is information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of health and Human Services to render the Protected Behavioral health Information unusable, unreadable, and undecipherable to unauthorized users. The notice is required to include the following information:
- a brief description of the breach, including the date of the breach and the date of its discovery, if known;
- a description of the type of Unsecured Protected health Information involved in the breach;
- steps you should take to protect yourself from potential harm resulting from the breach;
- a brief description of actions we are taking to investigate the breach, mitigate losses, and protect against further breaches;
- contact information, including a toll-free telephone number, e-mail address, Web site or postal address to permit you to ask questions or obtain additional information.
If you believe your privacy rights have been violated, you may file a complaint with Understanding Behavior, Inc. To file a complaint with us, send written complaints to 744 Montgomery Street Suite 400 San Francisco, CA 94111 Attn: Understanding Behavior Inc. All complaints must be submitted in writing and should be submitted within 180 days of when you knew or should have known that the alleged violation occurred. You will not be penalized for filing a complaint.