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.
The Purpose of This Notice
This notice is required by the U.S. Department of Health and Human Services to inform you of how your health information will be used, disclosed and protected, and about your rights regarding your health information.
What This Notice Covers
This notice covers the following types of information:
- Information about your health condition, healthcare treatment or payment for healthcare treatment that could reasonably identify who you are; and
- Information in the possession of any Children’s Hospital Los Angeles department or service area, wherever it may be. It also applies to all Children’s Hospital Los Angeles employees, volunteers, contractors, or anyone working at Children’s Hospital Los Angeles who might have access to your health information. In accordance with Title 45 of the Code of Federal Regulations §164.501, Children’s Hospital Los Angeles; Children’s Hospital Los Angeles Medical Group; and the University of Southern California; all three legally separate covered entities, designate themselves as an Organized Healthcare Arrangement for the sole purpose of complying with the Privacy Regulations of the Health Insurance Portability and Accountability Act of 1996. These entities will share information necessary for the joint healthcare activities of the Organized Healthcare Arrangement.
How Children’s Hospital Los Angeles May Use Your Health Information
Children’s Hospital Los Angeles is permitted to use your health information or to disclose it to others outside Children’s Hospital Los Angeles without permission from you for the following three basic types of activities:
- Treatment – We are permitted to use your health information or disclose it to others outside Children’s Hospital Los Angeles in order to provide proper medical care to you. This means we can provide your health information to nurses, technicians, doctors, medical students or outside laboratories involved in your care. For example, the dietitian may need to know your condition if it requires special meals; X-ray and laboratory technicians may need to know your condition in order to conduct the proper tests; and other physicians may need to have your information in order to advise those providing you care.
- Payment – We are also permitted to use your health information or disclose it to others outside Children’s Hospital Los Angeles in order to submit bills for the care and services you received. For example, information about your care or services may be sent to your insurance company; a government insurance program; or another company that processes the information and submits it for payment. You have the right to request that we not send information about the services you receive to your insurance company if you are paying for those services completely out-of pocket. We may also send information to your health plan about treatment you may receive so it can either approve or deny coverage for that care.
- Healthcare Operations – We are permitted to use your health information or disclose it to others outside Children’s Hospital Los Angeles in order run the hospital and assure high-quality care. For example, we may use your information to review how we provide care to you; we may disclose it to consultants to help us improve how we operate the hospital; and we may also disclose it to certain organizations to meet compliance or licensing requirements.
Children’s Hospital Los Angeles may also use your health information or disclose it to others outside the hospital without your permission under the following additional limited circumstances as described below:
- Appointment Reminders – We may use or disclose your health information to send you reminders that you have an appointment for treatment or medical care.
- Treatment Alternatives – We may use or disclose your health information to tell you about or recommend possible treatment-related options, activities, or alternatives that may be helpful to you.
- Health-Related Benefits and Services – We may use or disclose your health information to tell you about health-related benefits or services that may be of interest to you.
- Fundraising Activities – We may use or disclose certain health information (such as your name, address, phone number, e-mail address, age, gender, dates you received treatment, treating department, treating physician and outcome information) to contact you in the future to raise funds for Children’s Hospital Los Angeles. The money raised will be used to expand and improve the services and programs we provide to the community. You have the right and will be given the opportunity to opt out of receiving fundraising solicitations.
- Hospital Directory – We may include certain limited information about you in the hospital directory while you are a patient at the hospital such as your name, location in the hospital, general condition (e.g., fair, stable, etc.), and your religious affiliation. This directory information, except for your religious affiliation, may also be disclosed to people who ask for you by name. Your religious affiliation may be given to a member of the clergy. During admission you will be given an opportunity to withhold your information from the Children’s Hospital Los Angeles patient directory.
- Individuals Involved in Your Care or Disaster Relief Agency – During times of treatment, we may disclose your health information to your personal representative. We may also disclose your health information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
- Research – Under certain circumstances, we may use and disclose your health information for research purposes. For example, we may disclose your information to researchers preparing to conduct an investigation, to help them look for patients with specific medical conditions. But, in nearly all other cases, we will need your written authorization for research.
- As Required by Law – We will disclose your information when required by law.
- To Avoid a Serious Threat to Health or Safety – We may use and disclose your health information to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Organ and Tissue Donation – If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to organ donation banks to support the process.
Your Rights Regarding Your Health Information
- Right to Authorize or Deny Use of Your Information – In order for us to use or disclose your health information other than as described above, we will nearly always need to obtain your written authorization, which you may revoke at any time to stop any future uses and disclosures. Your authorization is required prior to the use of your health information for marketing purposes other than as described above.
- Right to Have Access to Your Information – In most cases, you have the right to look at or have a copy of your health information that we have. Your request for a copy of your health information must be in writing. A nominal fee will be charged for copying services.
- Right to Amend Your Information – If you believe the information we have about you is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information; however, we are not obligated to amend the medical record. If we deny the request in whole or in part, we must provide to you a written denial letter that clearly outlines our decision.
- Right to Request Your Information be Provided in a Certain Way – You may request that when we send your health information to you, we do so in a specific way that is confidential or more convenient for you. We are not required to follow your request, but we will make every reasonable effort to do so or find a mutually satisfactory alternative.
- Right to an Accounting of Our Disclosures of Your Information – You also have the right to receive a list of instances where we have disclosed your health information to others for reasons other than treatment, payment, or healthcare operations.
- Right to Be Notified of Breach – You have the right to be notified if there is a breach of your unsecured health information.
- Right to Limit Our Use or Disclosure of Your Information – You may request in writing that we not use or disclose your information for treatment, payment, operations or any other purpose except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request and respond, but we are not legally required to accept it.
- Right to Obtain a Paper Copy of This Notice – You have a right to obtain a paper copy of this notice upon request, even if you have agreed to receive the notice electronically.
Children’s Hospital Los Angeles’s Duties Regarding Your Health Information
We are legally required to protect the privacy of your health information; establish policies and procedures that do so; provide this notice about our duties and privacy practices; and follow the practices described in this notice. We reserve the right to change this notice and to make new policies or procedures that are effective for all health information (already in our possession as well as any information received after the revised notice date). When we make a significant change in how we use or disclose your health information, we will also change this notice and post the new notice in the waiting and admissions areas. You can request a written copy of the most recent version of this notice at any time.
How to File a Complaint About How Your Health Information Is Handled
If you believe we have not properly protected your privacy or violated your privacy rights, or you disagree with a decision we made about access to your records, you may file a complaint with the hospital’s Privacy Officer at email@example.com or (323) 361-2302. You also may send a written complaint to:
U.S. Department of Health and Human Services
Office of the Secretary Federal Office Building
50 United Nations Plaza, Room 322
San Francisco, CA 94102
We will not retaliate against you if you file a complaint with us or the U.S. Department of Health and Human Services.
How to Get More Information About Children’s Hospital Los Angeles’s Privacy Practices
To act on any of the information provided in this notice or for more information about our privacy practices, you may contact the hospital’s Privacy Officer at firstname.lastname@example.org or (323) 361-2302.
This notice is effective as of SEPTEMBER 23, 2013.