Downloadable Notice of Privacy Practices

Effective Date: 08/15/2017

This notice describes how medical information about you may be used and disclosed, and about how you can get access to this information. Please review it carefully. If you have any questions about this notice, please speak with the Administrator at your 西瓜视频 program or contact the Privacy Officer at 西瓜视频 at 510-337-7950.

Who Will Follow This Notice

We understand that your health information is personal, and we are committed to protecting this information. We create a record of the care and services you receive while at 西瓜视频. We need this record to provide you with quality care and to comply with certain legal requirements. This notice describes 西瓜视频's privacy practices and applies to all records of your care generated at 西瓜视频, whether they are made by 西瓜视频 staff, physicians, and/or consultants. This notice will be followed by any individual authorized to enter information into your clinical record and anyone who may use or disclose Protected Health Information (PHI).

This notice explains the ways in which 西瓜视频 may use and disclose health information. It also describes your rights and 西瓜视频's obligations regarding the use and disclosure of health information. Our obligations include the following:

We will make sure that health information which identifies you is kept private (with certain exceptions allowed); 
We will give you this notice of our privacy practices;
We will follow the terms of the notice that is currently in effect.

How We May Use and Disclose Your Health Information

西瓜视频 adheres to all state and federal privacy laws, including HIPAA (Health Insurance Portability and Accountability Act). If you have questions about HIPAA, or for additional resources regarding health information privacy, please visit

No health information about you will be released without your written authorization, unless it is permitted by law in the following ways:


We may use health information to provide you with treatment or services. We may disclose information to other healthcare providers and staff who are involved in your care and treatment. This information is used to plan your treatment services. It is also used to document progress, events, plans of care, observations, and evaluation of care and treatment. Health information can be provided to consultants, diagnostic services, or to other providers if you transfer to another program.


We may use and disclose health information about you so that the treatment and services you receive may be billed to a third party such as Medicare, Medicaid (MediCal), Health Maintenance Organizations (HMOs), County/Authority/Public Agencies, Insurance Companies, or to you or others who may be responsible for payment of your care. At least some health information may be provided to the payee that identifies your demographic information, the diagnosis, and any additional health information needed to support the billing.

Healthcare Operations

We may use and disclose health information for healthcare operations. These uses and disclosures are necessary to make sure that all clients receive quality care. For example, we may use health information for specific quality assurance processes, committee meetings, on-site reviews, incident reporting, and trending information for both program and corporate use. The information used for these purposes may include your health information, or it may be "de-identified" so that the key statistical information is included, but it cannot be linked to you.


Under certain circumstances, we may use and disclose health information about you for research purposes. Research is information about a group of people collected for the purpose of improving the treatment of conditions. For example, a research project may involve comparing the health and recovery of all clients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with clients' need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. However, we may, disclose health information about you to people preparing to conduct a research project, for example, to help them look for clients with specific medical need so long as the medical information they review does not leave the program. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the program.

Workers' Compensation

We may release your health information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health and Safety Risks

We may disclose health information for public health and safety, such as: to prevent or control disease, injury or disability; report births and deaths; report the abuse or neglect of children, elders, and dependent adults; report reactions to medications or problems with products; notify people of recalls of products; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; notify the appropriate government authority if we believe a client has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

As Required By Law, Emergency/Disaster, and Law Enforcement

We may release health information in the following situations:

  • to health oversight agencies for activities authorized by law, including surveys by the state, federal, and other review agencies, as well as audits, investigations, inspections, and licensure;

  • in response to a court order, subpoena, warrant, summons, or similar process;

  • to identify or locate a suspect, fugitive, material witness, or missing person;

  • in emergency circumstances regarding crimes;

  • to assist in an emergency or disaster;

  • to an entity assisting in a disaster so that your family can be notified about your condition, status, and location;

  • to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law;

  • to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or to conduct special investigations;

  • when required to do so by federal, state, or local law.

Funeral Directors and Coroner's Offices

In the event it is necessary, we may disclose health information to funeral directors and coroner's offices consistent with applicable laws as required for them to carry out their duties.

Correctional Jurisdiction

If you are under correctional jurisdiction, we may disclose health information to the extent allowed by the law. This information would be necessary (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Your Rights Regarding Health Information

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy

You have the right to inspect and copy the health information used to make decisions about your treatment.

To inspect and copy your health information, you must submit your request in writing to the privacy contact person at your program (Administrator) or the Privacy Officer at 西瓜视频.

In certain circumstances, we may deny your request to inspect and copy. If you are denied access to health information, you may request that the denial be reviewed. The outcome of that review will be provided to you.

Right to Amend

You have the right to request an amendment if you feel that your health information is incorrect or incomplete.

Your request for amendment must be made in writing and submitted to the privacy contact person at your program (Administrator) or the Privacy Officer at 西瓜视频. In addition, you must provide a reason that supports your request.

Your request may be denied if it is incomplete or not in writing. It may also be denied if the information you want to amend was (1) not created by 西瓜视频 (unless the person or organization that created the information is no longer available to make the amendment); (2) is not part of health information that 西瓜视频 maintains; (3) is not part of the information which you are permitted to inspect and copy; or (4) the information in the record is already accurate and complete.

Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your health record, we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

Right to Accounting of Disclosures

You have the right to request an "accounting of disclosures." This is a list of the disclosures 西瓜视频 has made of your health information other than for treatment, payment, and healthcare operations. To request an accounting of disclosures, you must submit your request in writing to the privacy contact person at your program (Administrator) or the Privacy Officer at 西瓜视频. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. There may be a charge for additional lists.

Right to Request Restriction

You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend.

We are not required to agree to your request. If we do agree, we will comply unless the information must be used to provide you with emergency treatment. To request restrictions, you must submit your request in writing to the privacy contact person at your program (Administrator) or the Privacy Officer at 西瓜视频. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we only contact you at work or by mail. We will not ask the reason for your request. We will accommodate all reasonable requests. You must make your request in writing to the privacy contact person at your program (Administrator) or the Privacy Officer at 西瓜视频. In your request, you must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice and may request it at any time.

Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice at our website: .

To obtain a paper copy of this notice, contact the privacy person at your program (Administrator) or the Privacy Officer at 西瓜视频.

Changes to this Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for current and future health information. We will post a copy of the current notice and will include the effective date in the top right hand corner. We will offer you a copy of the current notice each time you register or are admitted to a 西瓜视频 Program.


If you believe your privacy rights have been violated, you may file a complaint with 西瓜视频 or the Secretary of the Department of Health and Human Services. To file a complaint with 西瓜视频, contact the privacy contact person at your program (Administrator) or the Privacy Officer at 西瓜视频 at 510-337-7950. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

Other Uses of Health Information

If 西瓜视频 must use or disclose health information in a way that is not covered by this Notice, we will request and comply with your written permission. You may revoke that permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your health information covered by that written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provide to you.