West Los Angeles Handbook 2023 - 33

currently receiving services, please contact your
counselor. Once you are no longer receiving services,
contact the Health Information Department. Under
certain circumstances, Hazelden Betty Ford has the
right to deny your request to amend your records
and will notify you of this denial as provided in the
HIPAA regulations. If your requested amendment to
your records is accepted, a copy of your amendment
will become a permanent part of the medical
record. When we " amend, " a record, we may append
information to the original record, as opposed to
physically removing or changing the original record.
If your requested amendment is denied, you will be
informed of your right to have a brief statement of
disagreement placed in your medical record.
E. Right to Receive an Accounting of Disclosures. Upon
request, you may obtain a list of instances that we
have disclosed your protected health information
other than when you gave written authorization
OR those related to your treatment and payment
for services, or our health care operations. The
accounting will apply only to covered disclosures
prior to the date of your request provided such
period does not exceed six years and does not apply
to disclosures that occurred prior to April 14, 2003. If
you request an accounting more than once during a
twelve (12) month period, there will be a charge. You
will be told the cost prior to the request being filled.
F. Right to Receive Notification of Breach. You will
be notified in the event we discover a breach has
occurred such that your protected health information
may have been compromised. A risk analysis will
be conducted to determine the probability that
protected health information has been compromised.
Notification will be made no more than 60 days after
the discovery of the breach, unless it is determined
by a law enforcement agency that the notification
should be delayed.
G. Right to Receive a Paper Copy of This Notice. Upon
request, you may obtain a paper copy of this notice.
H. For Further Information and Complaints. If you
desire further information about your privacy and
confidentiality rights, you may contact the Hazelden
Betty Ford Privacy Office at 1-888-257-7800 x 4438.
You may call this number if you are concerned that
we have violated your privacy rights, if you disagree
with a decision that we made about access to your
protected health information, or if you wish to
complain about our breach notification process.
I. You may also file a written complaint with the
Secretary of the United States Department of Health
and Human Services. Upon request, we will provide
32
you with the correct address. We will not retaliate
against you if you file a complaint.
Violation of federal law and regulations on
Confidentiality of Substance Use Disorder Patient
Records is a crime and suspected violations of
42 CFR Part 2 may be reported to the United
States Attorney in the district where the violation
occurs. Upon request, we will provide you with the
appropriate agency contact information.
VII. Effective Date and Duration of This Notice
A. Effective Date. This notice is effective on April 14,
2020.
B. Right to Change Terms of This Notice. We may
change the terms of this notice at any time. If we
change this notice, we may make the new notice
terms effective to all protected health information
that we maintain, including any information created
or received prior to issuing the new notice. If we
change this notice, we will post the new notice in
public access areas at our service sites and on our
Internet site at HazeldenBettyFord.org. You may also
obtain any new notice by contacting the Hazelden
Betty Ford Privacy Office.
C. Privacy Office. You may contact the Hazelden Betty
Ford Privacy Office at 1-888-257-7800 x 4438.
California Marketing Laws
Hazelden Betty Ford Foundation's California locations are
licensed and/or certified by the Department of Public Health
https://www.cdph.ca.gov (Residential levels of care ) and the
Department of Health Care Services http://www.dhcs.ca.gov
(Outpatient levels of care)
Confidentiality Releases
You have the right to confidential treatment. This means
that Hazelden Betty Ford will not notify or release
information to medical or mental health professional
or referring professional outside Hazelden Betty Ford
Foundation's continuum of care without your written
permission. Any information released to family,
employer, or any other agency or person has to be
approved in writing by you. You may be asked to sign
a release of information upon admission to allow us
to communicate with helping professionals and your
family members in order to provide you with the most
appropriate care. You also have the right to refuse or
revoke permission at any time. State and federal laws
require that we protect patient confidentiality, but there
are some exceptions. If you have any questions about
https://www.hazeldenbettyford.org/ https://www.cdph.ca.gov http://www.dhcs.ca.gov
West Los Angeles Handbook 2023

Table of Contents for the Digital Edition of West Los Angeles Handbook 2023
