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
USES AND DISCLOSURE OF HEALTH INFORMATION
San Diego Detox 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 San Diego Detox
LLC duties with respect to the privacy of PHI, San Diego Detox LLC’ use of and disclosure of
PHI, client rights, and contact information for comments, questions, and complaints.
SAN DIEGO DETOX LLC PRIVACY PROCEDURES AND LEGAL OBLIGATIONS
San Diego Detox 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.
San Diego Detox LLC is required by law to provide you with this notice and to abide by the
terms of the Notice currently in effect San Diego Detox LLC reserves 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 we created or received prior
to the effective date of the revised notice. Any revised notice will be mailed to you or provided
San Diego Detox LLC is required by law to maintain the privacy of PHI. San Diego Detox LLC
will comply with federal law and will comply with any state law that further limits or restricts
the uses and disclosures discussed below. In order to comply with these state and federal laws,
San Diego Detox LLC has adopted policies and procedures that require its 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, San Diego Detox LLC will not use or disclose your PHI without your
written authorization. The authorization form is available from San Diego Detox LLC (at the
address and phone number below). You have the right to revoke your authorization at any time,
except to the extent that San Diego Detox LLC has taken action in reliance on the authorization.
The law permits San Diego Detox 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 your PHI in order 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 us in getting paid for our services. For example, we may
release information such as dates of treatment to an insurance company in order to obtain
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 on your
employee services. We may also disclose PHI to other persons not in San Diego Detox LLC’s
workforce or to companies who help us perform our health services (referred to as “Business
Associates”) we require these business associates to appropriately protect the privacy of your
As Permitted or Required By The Law: In some cases, we are required by law to disclose PHI.
Such as disclosers may be required by statute, regulation court order, government agency, we
reasonably believe an individual to be a victim of abuse, neglect, or domestic violence: for
judicial and administrative proceedings and enforcement purposes.
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 when
required 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: Sometimes we may want to contact you
regarding service reminders, health-related products or services that may be of interest to you,
such as health care providers or settings of care or to tell you about other health-related products
or services offered at San Diego Detox LLC. You have the right not to accept such information.
Incidental Uses and Disclosures: Incidental uses and disclosures of PHI are those that cannot
be reasonably prevented are limited in nature and that occur as a by-product of a permitted use or
disclosure. Such incidental uses and disclosures are permitted as long as San Diego Detox LLC
use reasonable safeguards and use or 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. We will act
according to your written instructions in your chart and our ability to verify the identity of
anyone claiming to be your personal representative.
To Family and Friends: We may disclose PHI to persons that you indicate are involved in your
care or the payment of care. These disclosures may occur when you are not present, as long as
you agree and do not express an objection. These disclosures may also occur if you are
unavailable, incapacitated, or facing an emergency medical situation and we determine that a
limited disclosure may be in your best interest. We may also disclose limited PHI to a public or
private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a
family member or other person that may be involved in caring for you. 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 client access. A designated record set contains
medical and billing and case management information. If we do not have your PHI recordset but
know who does, we will inform you how to get it. If our PHI is a copy of the information
maintained by another health care provider, we may direct you to request the PHI from them. If
San Diego Detox LLC produces copies for you, we may charge you up to $1.00 per page up to a
maximum fee of $50.00. Should we deny your request for access to the information contained in
your designated record set, you have the right to ask for the denial to be reviewed by another
healthcare professional designated by San Diego Detox LLC.
Amendments to Certain Records: You have the right to request certain amendments to your
PHI if, for example, you believe a mistake has been made or a vital piece of information is
missing. San Diego Detox LLC is not required to make the requested amendments and will
inform you in writing of our response to your request.
Accounting of Disclosures: You have the right to receive an accounting of disclosures of your
PHI that were made by San Diego Detox LLC for a period of six (6) years prior to the date of
your written request. This accounting does not include for purposes of treatment, payment,
health care operations, or certain other excluded purposes, but includes other types of
disclosures, including disclosures for public health purposes or in response to a subpoena or
Restrictions: You have the right to request that we agree to restrictions on certain uses and
disclosures of your PHI, but we are not required to agree to your request. 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 San Diego Detox LLC has already relied upon the prior authorization.
Delivery by Alternate Means or Alternate 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 San Diego Detox LLC at the address and/or
phone number indicated below. You also have the right to file a complaint with the Secretary of
the United States Department of Health and Human Services in Washington, D.C. San Diego
Detox LLC will not retaliate against you for filing a complaint.
If you believe your privacy rights have been violated, you may make a complaint by contacting
the Secretary for the Department of Health and Human Services. No individual will be retaliated
against for filing a complaint.
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201