NOTICE OF PRIVACY PRACTICES

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 agency provides many types of social and behavioral health services. The agency staff must collect information about you to provide these services. We call this information “protected health information” (PHI). The agency knows that information collected about you and your health is private. River Oak Center for Children is required to protect this information by Federal and State law.

This Notice of Privacy Practices will tell you how River Oak Center for Children may use or disclose information about you. Not all situations will be described. River Oak Center for Children is required to give you a notice of our privacy practices for the information we collect and keep about you. The agency is required to follow the terms of the notice currently in effect.

River Oak Center for Children May Use and Disclose Information Without Your Specific Authorization for the following reasons:

* For Treatment. The agency may use or disclose information with health care providers who are involved in your health care. For example, information may be shared between River Oak staff to create and carry out plans for your treatment and care.

* For Payment. The agency may use or disclose information to get payment or to pay for the health care services you receive. For example, the agency may provide PHI to bill the County or your health plan for health care services provided to you.

* For Health Care Operations. River Oak Center for Children may use or disclose information in order to manage its programs and activities. For example, the agency may use PHI to review the quality or appropriateness of services you receive.

* Appointments and Other Health Information. River Oak Center for Children may send you reminders for appointments or meetings. The agency may send you information about health services that may be of interest to you.

* To Avoid Harm. River Oak Center for Children may disclose PHI, as required and permitted by law, in order to avoid a serious threat to the health and safety of a person or the public.

*í For Research. River Oak Center for Children uses information for studies and to develop reports, to review, improve and track our services. These reports will not identify you.

* Disclosures to Others. River Oak Center for Children may disclose information to your family or other persons who are already identified as being involved in your medical care. You have the right to object to the sharing of this information.

Your PHI Privacy Rights

Other Uses and Disclosures Require Your Written Authorization

For other situations, River Oak Center for Children will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. Any uses or disclosures already made with your authorization cannot be undone or revoked.

When information is maintained by River Oak Center for Children as a contracted public health agency, the public health records are governed by other State and Federal laws and are not subject to the rights described below.

* Right to See and Get Copies of Your Records. In most cases, you have the right to look at or get copies of your records. You must put the request in writing. You may be charged a fee for the cost of copying your records. The agency may refuse or limit this right if we believe it may cause harm. River Oak Center for Children may deny your request to look at, copy or change your records. If River Oak Center for Children denies your request, the agency will send you a letter that tells you why your request is being denied and how you can ask for a review of the denial.

* Right to Request to Correct or Update Your Records. You may ask River Oak Center for Children to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request. The agency has the right to refuse this request.

* Right to Get a List of Disclosures. You have the right to ask River Oak Center for Children for a list of disclosures of your PHI made after April 14, 2003. You must make the request in writing. This list will not include the time that information was disclosed for treatment, payment, or health care operations. The list may not include information provided directly to you or your family or information that was sent with your authorization.

* Right to Request limits on Uses or Disclosures of PHI. You have the right to ask that River Oak Center for Children to limit how your information is used or disclosed. You must make the request in writing and tell River Oak Center for Children what information you want to limit and to whom you want the limits to apply. River Oak Center for Children is not required to agree to the restriction. You can also request in writing or verbally that the restrictions be terminated.

* Right to Revoke Permission. If you sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the cancellation in writing. This will not affect information that has already been disclosed.

* Right to Choose How We Communicate With You. You have the right to ask that River Oak Center for Children share information with you in a certain way or in a certain place. For example, you may ask River Oak Center for Children to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the reason for your request.

* Right to File a Complaint. You have the right to file a complaint if you do not agree with how River Oak Center for Children has used or disclosed information about you.

* Right to Get a Paper Copy of this Notice. You have the right to ask for a copy of this notice at any time.

How to contact River Oak Center for Children to Review, Correct, or Limit Your Protected Health Information (PHI)

You may contact your clinical team at the local River Oak Center for Children office or the River Oak Center for Children Privacy Officer at the address listed at the end of this notice, in order to:

* Ask to look at or copy your records.

* Ask to correct or change your records.

* Ask to limit how information about you is disclosed.

* Ask for a list of the dates River Oak Center for Children used or disclosed information about you.

* Ask to cancel your authorization of disclosure

How to File a Complaint or Report a Problem

You may contact any of the people listed below if you want to file a complaint or to report a problem with how River Oak Center for Children has used or disclosed information about you. Your benefits and treatment will not be affected by any complaints you make. River Oak Center for Children cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful.

River Oak Center for Children

Privacy Officer
Jaynette Underhill, MA
Vice President of Compliance and Quality Management
1150 Eastern Avenue
Sacramento, CA 95867
Phone: (916) 609-4232
Email: junderhill@riveroak.org

Office for Civil Rights

Medical Privacy, Complaint Division
U.S. Department of Health and Human Services
200 Independence Avenue, SW, HHH Building, Room 509H
Washington, D.C. 20201
Phone: 866-627-7748 TTY: 886-788-4989
Email: www.hhs.gov/ocr

For More Information

If you have any questions about this notice or need more information, please contact the Privacy Officer at the River Oak Center for Children.

In the future, River Oak Center for Children may change its Notice of Privacy Practices. Any changes will apply to information River Oak Center for Children already has, as well as any information River Oak Center for Children receives in the future. A copy of the new notice will be posted at each River Oak Center for Children site and facility and provided as required by law. You may ask for a copy of the current notice anytime you visit a River Oak Center for Children facility.

5030 El Camino Avenue, Carmichael, CA 95608, (916) 609-5100, fax (916) 609-5160
info@riveroak.org
Click here for contact info for our other program sites.