Uses and Disclosure of Health Information

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.

This notice is effective as of April 15, 2003.

Retreat at South Coast LLC is committed to protecting the privacy of the personal and health information we collect or create as part of providing health care services to our clients, known as “Protected Health Information” or “PHI”. PHI typically includes your name, address, date of birth, billing arrangements, care, and other information that relates to your health, health care provided to you, or payment for the health care provided to you. PHI does not include information that is de-identified or cannot be linked to you.

This Notice of Health Information Privacy Practices (the “Notice”) describes Retreat at South Coast LLC’s duties with respect to the privacy of PHI, our use and disclosure of PHI, client rights, and contact information for comments, questions, and complaints.

Retreat at South Coast LLC Privacy Procedures and Legal Obligations

Retreat at South Coast LLC obtains most of its PHI directly from you, through care applications, assessments, and direct questions. We may collect additional personal information depending upon the nature of your needs and consent to make additional referrals and inquiries. We may also obtain PHI from community health care agencies, other governmental agencies, or health care providers as we set up your service arrangements.

Retreat at South Coast LLC is required by law to provide you with this notice and to abide by its terms. We reserve the right to amend this Notice at any time to reflect changes in our privacy practices. Any such changes will be applicable and effective for all PHI that we maintain, including PHI created or received prior to the effective date of the revised notice. Any revised notice will be mailed to you or provided upon request.

Retreat at South Coast LLC is required by law to maintain the privacy of PHI and will comply with federal law and any state law that further limits or restricts the uses and disclosures discussed below. To comply with these laws, we have adopted policies and procedures that require employees to obtain, maintain, use, and disclose PHI in a manner that protects client privacy.

Uses and Disclosures With Your Authorization

Except as outlined below, Retreat at South Coast LLC will not use or disclose your PHI without your written authorization. The authorization form is available upon request. You have the right to revoke your authorization at any time, except to the extent that Retreat at South Coast LLC has already taken action in reliance on that authorization.

The law permits Retreat at South Coast LLC to use and disclose your PHI for the following reasons without your authorization:

For Your Treatment: We may use or disclose your PHI to physicians, psychologists, nurses, and other authorized healthcare professionals who need it to conduct an examination, prescribe medication, or otherwise provide health care services to you.
To Obtain Payment: We may use or disclose your PHI to insurance companies, government agencies, or health plans to assist in obtaining payment for our services. For example, we may release dates of treatment to an insurance company to obtain payment.
For Our Health Care Operations: We may use or disclose your PHI in the course of activities necessary to support our health care operations, such as performing quality checks. We may also disclose PHI to business associates who help us perform health services — we require these associates to appropriately protect the privacy of your information.
As Permitted or Required By Law: In some cases we are required by law to disclose PHI, such as disclosures required by statute, regulation, court order, government agency, or when we reasonably believe an individual to be a victim of abuse, neglect, or domestic violence.
For Public Health Activities: We may disclose your PHI for public health purposes, such as reporting communicable disease results to public health departments as required by law or for law enforcement purposes.
For Health Oversight Activities: We may disclose your PHI in connection with governmental oversight, such as for licensure, auditing, and the administration of government benefits.
To Avert Serious Threat to Health and Safety: We may disclose PHI if we believe in good faith that doing so will prevent or lessen a serious or imminent threat to the health and safety of a person or the public.
Disclosures of Health-Related Benefits or Services: We may contact you regarding service reminders or health-related products and services that may be of interest to you. You have the right not to accept such information.
Incidental Uses and Disclosures: Incidental uses and disclosures that cannot reasonably be prevented are permitted, as long as we use reasonable safeguards and disclose only the minimum amount of PHI necessary.
To Personal Representatives: We may disclose PHI to a person designated by you to act on your behalf and make decisions about your care, in accordance with state law.
To Family and Friends: We may disclose PHI to persons you indicate are involved in your care or the payment of care. You have the right to limit or stop these disclosures.

Your Rights Concerning Privacy

Access to Certain Records: You have the right to inspect and copy your PHI in a designated record set, except where state law may prohibit access. If we produce copies for you, we may charge up to $1.00 per page, up to a maximum of $50.00. If we deny your request, you have the right to ask for the denial to be reviewed by another healthcare professional.
Amendments to Certain Records: You have the right to request amendments to your PHI if you believe a mistake has been made or information is missing. We are not required to make the requested amendments and will inform you in writing of our response.
Accounting of Disclosures: You have the right to receive an accounting of disclosures of your PHI made by Retreat at South Coast LLC for a period of six years prior to the date of your written request.
Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI, though we are not required to agree. You cannot place limits on uses and disclosures that we are legally required or allowed to make.
Revoke Authorizations: You have the right to revoke any authorizations you have provided, except to the extent that we have already relied upon them.
Delivery by Alternate Means or Address: You have the right to request that we send your PHI by alternate means or to an alternate address.

Complaints & How to Contact Us

If you believe your privacy rights have been violated, you have the right to file a complaint by contacting Retreat at South Coast LLC directly. You also have the right to file a complaint with the Secretary of the United States Department of Health and Human Services. Retreat at South Coast LLC will not retaliate against you for filing a complaint.

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-Free: 1-877-696-6775