SALT - Lyssa Kerrigan, LPCC 4626
Carisa Kelso APCC 9684 Supervised by Lyssa Kerrigan, LPCC 4626
Avery Hoppe APCC 12913 supervised by Lyssa Kerrigan LPCC 4626
Bailey Godber AMFT 142721 supervised by Lyssa Kerrigan LPCC 4626
Ashley Jensen APCC 10796 Supervised by Lyssa Kerrigan LPCC 4626
Donna Petit, Certified Life Coach
Sam Ellis, Certified Life Coach
302 N. El Camino Real Suite 216 San Clemente, Ca 92672
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION: We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information kept about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:
• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of legal duties and privacy practices with respect to health information. • Follow the terms of the notice that is currently in effect.
• We can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in office, and on SALT website.
II. HOW SALT MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what is meant and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. When you designate that your records be shared with others. The doctor, psychologist, social worker, or licensed marriage and family therapist in charge of your care must approve. Professional staff cannot be forced to reveal information that was given to them in confidence by members of your family. Cal. Welf. & Inst. Code §5328(b).
2. In communication between a qualified professional person (a staff person at a facility) to another professional (outside the facility) who does not have responsibility for your care. Cal. Welf. & Inst. Code §5328(a).
3. To your attorney, except for information given in confidence to professional persons and staff by members of your family. Cal. Welf. & Inst. Code §5328(j).
4. To a county patients’ rights advocate providing services to you. Cal. Welf. & Inst. Code §5541.
5. To an insurer, if you apply for life or disability insurance. Cal. Welf. & Inst. Code §5328(i).
6. A 24-hour facility must make reasonable efforts to notify your designated family member(s) or another person of your admission. Unless you ask that this information not be provided. Upon request, the facility must also give to your designated family member(s) or another person information about your diagnosis, prognosis, medications, progress, release, transfer, serious illness, or death. But only after telling you such information has been requested and only if you authorize the release. Specific rules apply if you are unable to give authorization. Also, the facility must tell you of your right to keep this information confidential. Cal. Welf. & Inst. Code §5328.1.
7. If you have been convicted of a crime, information may be released to the probation officer who is evaluating you. But only if the facility you were in thinks the information is relevant, and only if you agree in writing. The information can be released only until you have been sentenced for the crime. After that, it must be kept confidential. The information released must be kept separate from your probation report. Also, the information given in confidence by your family members must be kept confidential. Cal. Welf. & Inst. Code §5328(k).
8. To a government, law enforcement agency investigating a crime if the records relate to you and you are confined under certain penal commitment categories. Cal. Welf. & Inst. Code §5328.01.
9. To a qualified physician or psychiatrist representing an employer when the information is required for an employment application. Unless the person responsible for your care thinks the release would not be in your best interest. Cal. Welf. & Inst. Code §5328.9.
10. To you or your authorized representative if you are appealing a benefits decision.
11. Between county agencies if you are an older adult and in the opinion of a multidisciplinary team there are signs of elder abuse/neglect. The disclosure must not include information about treatment or services provided. Welf. & Inst. Code §5328.05.
12. To a qualified professional who is providing genetic counseling to you or a member of your family. Cal. Welf. & Inst. Code §5328(q).
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:
1. If you are a minor, ward, or conservatee and your parent, guardian, guardian ad litem, or conservator consents in writing. However, professional persons and staff cannot be forced to reveal information that was given to them in confidence by members of your family. Cal. Welf. & Inst. Code §5328(d).
2. A requesting family member may be told of your presence in a facility if you are unable to authorize such a release of information (unless prohibited by federal law). Cal. Welf. & Inst. Code §5328.1.
3. Information may be released to prevent, investigate, or treat child, elder, and dependent adult abuse. Disorders involving lapses of consciousness may also be released. Only required, relevant information may be released. Full access to your records is not authorized. Cal. Welf. & Inst. Code §5328.5. Cal. Penal Code §11165-11174. Cal. Health & Safety Code §103900. 17 C.C.R. §2810. See also 65 Ops. Cal. Atty. Gen. 345 (1982); People v. Stritzinger, 34 Cal. 3d 505 (1983).
4. Between people on a “multidisciplinary personnel” team if the information is relevant to the prevention, identification, management, or treatment of an abused child or his or her parents, an abused elder, or abused dependent adult. Cal. Welf. & Inst. Code §5328(l). Cal. Welf. & Inst. Code §5328(v).
5. When your psychotherapist thinks you are a serious danger of violence to a reasonably foreseeable victim(s), information may be released to the possible victim(s) and to law enforcement. Cal. Welf. & Inst. Code §5328(r).
6. Information about denial of rights (but not your identity) must be released to your conservator or guardian, the local mental health director, the state legislature, the Office of Patient’s Rights, or county patient’s rights advocates if they request it. Cal. Welf. & Inst. Code §5326.1.
7. Under certain circumstances, information must be released to Disability Rights California for the protection and advocacy of the rights of individuals identified as mentally ill. Cal. Welf. & Inst. Code §5328.06.
8. In the course of conservatorship proceedings. Cal. Welf. & Inst. Code §5328(a).
9. Treatment facilities must release your information to county officers if the release will help a conservatorship investigation. Cal. Welf. & Inst. Code §5354.
10. Under limited circumstances, if you are released from a 72 hour hold (5150) or a 14 day treatment hold (5250) and a request has been made for notification of your release by law enforcement who placed you on the hold. Cal. Welf. & Inst. Code §5328(p).
11. In some circumstances, limited information must be released to law enforcement if you are an involuntary patient or under a penal code commitment in a facility and are being moved, are under criminal investigation, or escaped from the hospital. Cal. Welf. & Inst. Code §5328.2, 5328.3, 5328.01, 7325.5. See also Cal. Penal Code §4536(b), 1370.5(b).
12. If you are an involuntary patient and “gravely disabled,” information may be released if you disappear from your facility or are transferred between state hospitals. Cal. Welf. & Inst. Code §5328.3, 7325.
13. In communications between qualified professionals regarding services or appropriate referrals if the professionals work in the same facility or have responsibility for your care. Cal. Welf. & Inst. Code §5328(a).
14. When a law enforcement officer personally lodges an arrest warrant showing you are wanted for a serious or violent felony, the facility must inform the officer if you are in the facility. Cal. Welf. & Inst. Code §5328(u).
15. Information may be released to law enforcement if you are a “mentally disordered or developmentally disabled person” and someone believes you are a crime victim. Cal. Welf. & Inst. Code §5004.5.
16. To a government law enforcement agency if your facility or physician has probable cause to believe that you have committed, or have been the victim of, a crime while hospitalized. Release depends on the level of the crime involved. It must be limited to the facts of the crime. It must not relate to your mental state, admission, commitment, or treatment. Cal. Welf. & Inst. Code §5328.4.
17. Certain inpatient facilities must provide you and your legal representative (or other person you designate) aftercare plan information when you are discharged from the facility. Cal. Health & Safety Code §1262; Cal. Welf. & Inst. Code §5622, 5768.5.
18. To process a claim for aid, insurance, or medical assistance, but only to the extent necessary. Cal. Welf. & Inst. Code §5328(c).
19. To the courts, as necessary for the administration of justice. Cal. Welf. & Inst. Code §5328(f).
20. To the Youth Authority and Adult Correctional Agency as necessary for the administration of justice. Cal. Welf. & Inst. Code §5328.02.
21. To law enforcement agencies to protect federal and state elective constitutional officers and their families. Cal. Welf. & Inst. Code §5328(g).
22. To the Senate or Assembly Rules Committees for legislative investigation. Cal. Welf. & Inst. Code §5328(h).
23. To a quality assurance committee established in compliance with Cal. Welf. & Inst. Code §4070 and 5624. Cal. Welf. & Inst. Code §5328(n).
24. To a licensing board for mental health professionals when the Department of Mental Health reasonably believes a licensing violation has occurred. The records must be relevant. They cannot include your name and must be sealed after the board makes a decision. Cal. Welf. & Inst. Code §5328.15(b).
25. For research, if the Director of Mental Health sets rules for the research and it is reviewed by the appropriate board. Researchers must first try to get your informed consent. Also, they must agree not to release your information to unauthorized persons and must keep your identity private in publishing research findings. Cal. Welf. & Inst. Code §5328(e).
26. To licensing personnel (with the Department of Health Services or the Department of Social Services) regarding licensing and inspection of facilities. The information can be used in certain hearings and judicial proceedings. The information can only be released to the parties and must be kept private when the matter is over. Cal. Welf. & Inst. Code §5328.15(a).
27. To the Director of Mental Health for statistical data. Cal. Welf. & Inst. Code §5329.
28. Information about your treatment must be released to the coroner if you die in a state hospital. The information should be kept private and not made public. It should not include information about your personal life. Cal. Welf. & Inst. Code §5328.8.
29. To a domestic violence death review team. Cal. Pen. Code §11163.3(g)(1)(B). 30. To an elder death review team. Cal. Pen. Code §11174.8.
30. To the “designated officer” of an “emergency response employee” (see the Ryan White Comprehensive AIDS Resources Emergency Act of 1990) or from the designated officer to an emergency response employee, regarding possible exposure to HIV or AIDS. But only if necessary to comply with the Ryan White Act. Cal. Welf. & Inst. Code §5328(t).
31. To the Secretary of Health and Human Services when required to determine compliance with the Health Insurance Portability and Accountability Act (HIPAA). 45 C.F.R. 164.502(a)(2).
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
1. Disclosures to family, friends, or others. we may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose How we Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost based fee for doing so.
5. The Right to Get a List of the Disclosures we Have Made.
You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on October 19, 2023.