Pacific Psychiatry takes the responsibility for securely maintaining your protected health information very seriously. “Protected health information” means information, whether stored in analog or digital formats, that may identify you demographically or that is related to your past, present or future mental/physical health, conditions, or related health care services.

This notice describes how, in compliance with all applicable state and federal law, as well as the HIPAA Privacy Rule, we may use and/or disclose your protected health information to carry out treatment, payment or healthcare operations, and for other specified purposes as permitted or required by law. Please note: in some cases, California law limits disclosure of your medical information in ways that would otherwise be permitted under Federal law. 

For Treatment, Payment, And Healthcare Operations

Pacific Psychiatry will use your health care information to facilitate your Treatment. For example, your information will be gathered, reviewed, and documented by your clinician in order to evaluate and diagnose you, as well as prescribe your medication. Your information may also be disclosed to other health care providers for the purpose of treatment; however, this will occur only after we have obtained your written permission on the Consent for Release of Psychiatric, School or Medical Information or Records (“Release of Information” or “ROI”) form.

We may use your health care information to receive Payment for services provided to you. For example, we may contact your insurance or benefits manager to determine whether your plan will cover your treatment; if we hired an outside party or “Business Associate” to perform this task for us, said party will be required to appropriately safeguard your information. Information accompanying the claims we submit to your insurance may include your demographic identifiers, diagnosis, or session notes (if required by your insurance).

Your health care information will also be used to carry out routine Healthcare Operations, such as assessing the quality of your care, carrying out staff training, or otherwise facilitating the administrative tasks associated with your treatment. Examples include the filing of disability applications, coordination of appointment reminders, or following up with a pharmacy regarding your medications.

Other Uses & Disclosures Permitted Or Required By Law

You may authorize disclosure of your protected information to a designated person or entity after signing the Release of Information form. This may include other health care providers, a family member or friend, or any other party for whom you have signed a Release of Information form. Examples include an emergency contact, school medical personnel, or primary care physician.

We may also disclose your health care information to the following entities or under the following circumstances, as permitted or required by law. As stated above, we will request your consent via a signed Release of Information form; however, in limited circumstances disclosure of your information may be compelled by force of applicable law even in the absence of your consent – you will be informed if this is the case.

Information may be released to:

• Public health or legal authorities charged with preventing or controlling disease, injury, or disability;
•  Agents of law enforcement or correctional institutions, when necessary to protect the health and safety of the public or patient;
•  In response to a valid subpoena, court order, subpoena, discovery request, or other legal process;
•  Health oversight agencies (such as medical licensing boards) for activities such as audits, liability investigations, and inspections necessary for our licensure or for the government’s ongoing monitoring of the health care system.
•  A person or entity assigned by an insurance plan to review health care services with respect to medical necessity, level or quality of care, or justification of charges;
•  As necessary to comply with laws relating to worker’s compensation or similar programs; - Medical personnel, such as a paramedic, medical examiner/coroner, or school nurse; for example when necessary to facilitate emergency medical care, assist an identification or to determine a cause of death;
•  Governmental authorities or agencies, such as Social Services or Child/Adult Protective Services, if there is a legally compelling Duty to Warn regarding the prevention of a person’s imminent harm;
•  A person or entity that provides billing, claims management, medical data processing, or other administrative services for providers of health care or insurance coverage; - An employer, in the event that the information is lawfully requested in the course of legal proceedings, or necessary to support a medically necessary request for medical leave or accommodation
•  An insurer from whom the patient seeks coverage by or benefits from, in the course of evaluating the application for coverage/benefits;
•  A third party for purposes of encoding, encrypting, or otherwise anonymizing data; however, no information may be further disclosed by said party in any way that would reveal individually identifiable medical information;
•  Whenever compelled by applicable law.

Your information may be disclosed as outlined above; however, no information so disclosed may be further disclosed by the recipient in any way that would be in violation of the applicable laws and regulations. We will obtain your written consent before using or disclosing your protected health information for purposes other than those either listed above or otherwise permitted or required by law.

Your Rights

Requests To Restrict Or Revoke Disclosure

You have the right to request that we restrict how your protected health information is used or disclosed; such requests must be made in writing. While we are not required to agree to all requested restrictions, we will comply with reasonable requests and any such agreement will be binding.

You may revoke consent at any time; such requests must be made in writing and must specify for which party/entity you are revoking consent. Upon receiving the request for revocation, we will stop using or disclosing your protected health information, except to the extent that we have already taken action in reliance on the previously-given consent.

Alternative Means Of Communication

You have the right to request that we communicate with you by alternative means or at specified locations. For example, you may wish to specify certain locations to which we can mail information, or designated phone numbers for receiving messages; such requests should be made in writing. We will comply with reasonable requests for accommodation.

Access To Records

You have the right to inspect and/or obtain a copy of your protected health information in accordance with the local standards of care for Psychiatric and Medical Practice, for as long as we maintain your protected health information. The designated record set may include psychiatric and medical assessments, treatment recommendations, diagnostic and treatment information, psychological and/or educational testing reports, diagnostic lab results and other testing reports, outside records obtained from other medical practitioners involved in your care, communication records, information created and/or acquired during the administration of your treatment, medication information, and billing records.

Requests to inspect or receive a copy of your protected health information must be made in writing to Pacific Psychiatry, Inc. at 1551 Bishop St., Ste. 150-A San Luis Obispo, CA 93401. Such requests may incur a fee for the time and costs associated with complying with the request. In specific and very limited circumstances, in compliance with all applicable laws and regulations, we may be compelled to deny a request to inspect and/or receive a copy of protected health information. In the event your request is denied, you may request that the denial be reviewed.

Healthcare Information Amendments

If you believe that the protected health information we maintain regarding your care is incomplete or incorrect, you may request that we amend it, for as long as we are required to maintain the protected health information. A request for an amendment must be made in writing to Pacific Psychiatry, Inc. at 1551 Bishop St., Ste. 150-A San Luis Obispo, CA 93401; the request must include the reason for your request. In the event that the request for amendment is denied, you have the right to file a statement of disagreement with the decisions, which must then be maintained in your designated record set; we may file a rebuttal to the statement of disagreement.

Accounting Of Disclosures

You have the right to receive an accounting of the disclosures made of your protected health information for most purposes other than treatment, payment, or health care operations, for a timeframe of up to 6 years prior to the request date. The accounting will exclude disclosures to parties involved in your care, and disclosures for purposes you requested and for which you gave written consent.

Your request should be made in writing to Pacific Psychiatry, Inc. at 1551 Bishop St., Ste. 150-A San Luis Obispo, CA 93401; the request must specify the desired date range. The first accounting you request within a 12-month period will be provided at no cost, but further requests for accountings within that period may incur a charge for the time and costs associated with fulfilling the request; you will be notified of any cost beforehand.

Notice Of Privacy Practice

You have the right to receive a paper copy of this notice, even if you have already received the notice electronically.

For Questions Or Complaints

If you have any questions or would like additional information about our privacy practices, you may contact our office via (805) 541-6000 or by mail at 1551 Bishop St., Ste. 150-A San Luis Obispo, CA. 93401. There is no retaliation for filing a complaint.