Effective Date: 04/14/03
Last Updated: 02/29/08

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND SHARED OR DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact:
HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126
408.792.5040

OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is private and confidential. We are committed to protecting your medical information that is created and maintained by the Santa Clara County Public Health Department. We need this information to provide you with quality care and to meet certain legal requirements. This notice will tell you about the ways in which we may use and share your protected health information (“PHI”). It also describes your rights and certain actions we must take when using or sharing your PHI with other people or organizations.
The Santa Clara County Public Health Department is required by law to:

• make sure that PHI linked to you is kept private and confidential (with some exceptions);
• let you know - if you are interested - when and with whom we have shared your PHI, except if we shared it for treatment, payment, and operations as defined below;
• give you this notice of Privacy Practices about our responsibilities and practices to safeguard your PHI;
  and 
• follow the terms of our Notice that is currently in effect. Except as outlined below, we will not use or share your PHI unless you have signed an authorization form that allows us to do so. You have the right to cancel the permission by writing to the Privacy Coordinator of the Santa Clara County Public Health Department.

HOW WE MAY USE AND SHARE PROTECTED HEALTH INFORMATION
The following sections describe different ways that we use and share or disclose your PHI without your authorization or written permission. We will describe each category of uses and disclosures, and give some examples. The law limits how much we can use and disclose some PHI related to treatment of drug and alcohol abuse, HIV infection, mental health status and genetic testing program. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following categories.

For Treatment
We may use your PHI to provide you with treatment or services. We may share it with doctors, nurses, technologists, medical students, or other healthcare personnel who are involved in your care. For example, we may share your medical record with any doctor treating you. We may share your PHI with a lab outside of the Santa Clara County Public Health Department that performs tests requested by your doctor. We may also share your PHI with nursing homes or other community healthcare agencies to arrange for on-going treatment after you leave the hospital.

For Payment
We may use and share your PHI to collect payment for the healthcare services you receive from us. We may also share PHI with another provider so that he/she can collect payment for services he/she provided to you directly. For example we may share your PHI with your health plan about a particular treatment you need, or to ask whether your plan will pay for the treatment.

For Health Care Operations
We may use and share PHI for health care operations at Santa Clara County Public Health Department facilities. These uses and disclosures are necessary to improve the quality of care, training programs within Santa Clara County Public Health Department or medical staff activities. We may use and share your PHI to comply with laws and regulations, for contractual obligations, patients' claims, business planning, marketing, and to operate the Santa Clara County Public Health Department. For example, we may use PHI to review our treatments and services, and to evaluate our staff performance in caring for you. We may combine PHI we have with that from other health care systems or business associates to compare how we are doing, and to see where we can improve the care and services we offer. When required by law, we may share your PHI with authorized representatives of federal and state regulatory agencies that monitor our operations.

Public Health Risks
In general, the Public Health Department is authorized by law to collect, receive or use your PHI for the purpose of preventing or controlling disease, injury, or disability, including, but not limited to, the reporting of disease, injury, vital events, and the conduct of public health surveillance, public health investigation, and public health interventions.
These activities include, but are not limited the following:

• to prevent or control disease (such as cancer or tuberculosis), injury or disability;
• to report births and deaths;
• to report the abuse or neglect of children, elders and dependent adults;
• to report reactions to medications, or problems with healthcare products;
• to notify patients of recalls, repairs, or replacement of products they may be using;
• to notify a person who may have been exposed to a disease or may be at risk for getting or
• spreading a disease or condition;
• to notify the appropriate government authority if we believe a patient has been the victim of abuse,
  neglect or domestic violence. We will share your PHI only if you agree or when it is required or
  authorized by law.

Appointment Reminders
We may use and share PHI to schedule an appointment, or to remind you that you have an appointment for treatment or other health care you may need.

Treatment Alternatives
We may use and share PHI to tell you about possible service and treatment options that may interest you. Health-Related Products and Services.

Health-Related Products and Services
We may use and share PHI to tell you about our health-related products or services that may interest you. For example, we may tell you about a new drug or procedure or about educational or health management activities.

Fundraising Activities
We may use or share limited contact information, such as your name, address, phone number and the dates you received treatment or services to contact you to ask for your support of our operations.

Marketing
We may use or share your PHI to contact you about benefits, services, or supplies that we can offer you in addition to your Santa Clara County Public Health Department's own health related products or services.

Communications with family and others when you are present
Sometimes a family member, friend, personal representative or anyone else involved in your care will be present when we are discussing your PHI with you. If you object, please tell us and we won't discuss your PHI or we will ask the person to leave. Communications with family and others when you are not present We may share your PHI with anyone who helps pay for your care. Unless you tell us not to do so in writing, we may also tell your family or friends about your condition and that you are in the hospital. In addition, we may share your PHI with an organization involved in disaster relief so that your family may learn about your condition, status and location.

Disclosure to parents as personal representatives of minors
In most cases, we may disclose your minor child's PHI to you. In some situations, however, we are permitted or even required by law to deny your access to your minor child's PHI. An example of when we must deny such access, based on the type of health care, is when a minor who is twelve (12) or older seeks care for a communicable disease or condition. Another situation when we must deny access to parents is when minors have adult rights to make their own health decisions. These minors include, for example, minors who were or are married or who have a declaration of emancipation from a court.

Research
Under certain circumstances, we may use and share your PHI for research purposes. All research projects must go through a special review and approval process. This process evaluates a proposed research project and its use of PHI, and tries to balance the research needs with patients’ need for privacy. Your PHI may be important to advance research efforts, and gain new knowledge. Before we use or disclose your PHI for research purposes, the project will have been approved through this process. However, we may share your PHI with scientists preparing to conduct a research project to help them find patients with specific medical needs. In these cases, your PHI may not leave our facility. Often, our researchers contact patients about their interest in participating in certain research studies. Before you can be enrolled in these studies, you must be given information about the study, be allowed to ask questions, and have agreed to participate by signing an informed consent form. We may perform other studies using your PHI without requiring your consent. These studies will not affect your treatment or welfare, and your PHI will continue to be protected. For example, a study may involve a chart
review to compare the outcomes of patients who received different types of treatments.

As Required By Law
We will use and share your PHI when required to do so by federal, state or local law. To Avert a Serious Threat to Health or Safety. We may use and share your PHI when necessary to prevent or lessen a serious threat to your health and safety, or to that of others. However, we will share your PHI only with a responsible person who is able to help prevent the threat.

HIV Test Results
We may disclose your HIV test results to you or your legal representative, conservator, or to any person authorized to consent to the test. We may also disclose test results to your provider of health care, except that we will not release your test results to your health maintenance organization (HMO) unless you provide us with a written release. In addition, we may disclose your test results to an employee or agent of your health care provider who provides direct care and treatment to you or who has been exposed to potentially infectious
materials.

The doctor who ordered the HIV test may disclose confirmed positive test results to you first and then to a person reasonably believed to be your spouse, sexual partner or a person with whom you have shared the use of hypodermic needles or to the County Health Officer. This disclosure to a third party may not include any
identifying information about you.

Where the test has been performed on a criminal defendant, test results may be disclosed to the subject of the test, a victim requesting the results, the officer in charge and the chief medical officer of any facility in which the defendant is incarcerated or detained and the state Department of Health Services.

Military Service and Veterans
If you are or have been a member of the Armed Forces, we may share your PHI when so required by the appropriate military command authorities. We may also release PHI about foreign military personnel to the appropriate military authorities as authorized or required by law.

Workers’ Compensation
We may share your PHI as permitted by law for workers’ compensation or similar programs when necessary to provide treatment, services, or benefits for work-related injuries or illness.

Health Oversight Activities
We may use and share your PHI with a healthcare oversight agency as authorized or required by law. These oversight activities include, for example: audits, investigations, inspections, accreditation and licensure surveys. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes
We may share your PHI in response to a court or administrative order, a subpoena, discovery request, warrant, summons, or other lawful process.

Law Enforcement
We may use and disclose PHI if asked to do so by a law enforcement official:

• in compliance with a court order, subpoena, warrant, summons, grand jury subpoena or similar process;
• to identify or locate a suspect, fugitive, material witness, or missing person;
• about a victim of a crime, if, under some limited circumstances, we are unable to obtain the permission directly from the victim of a crime;
• about a death we believe may be the result of criminal conduct;
• about criminal conduct in any of our facilities; and
  in emergency circumstances to report: a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors
We may use and share your PHI with a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release your PHI to funeral directors when necessary for them to carry out their duties.

National Security and Intelligence Activities
We may use and share your PHI with federal officials for intelligence, counterintelligence, and other national security activities as authorized or required by law.

Protective Services for the President and Other Persons
As authorized or required by law, we may use and share your PHI to authorized federal officials so they can protect the U.S. President, the President's family, other designated persons or foreign heads of state, or conduct special investigations.

Inmates
If you are in a jail or prison, or under the custody of law enforcement officials, we may use and share your PHI with the correctional institution or law enforcement officials where it is necessary: (1) to provide the healthcare services you need, (2) to protect your health and safety or that of others, or (3) for the safety and security of the correctional institution. Your medical information that may be released to the officer in charge of the correctional facility includes your HIV/AIDS test result.

OTHER USES OF PROTECTED HEALTH INFORMATION
Other uses and disclosures of PHI not covered by this Notice, or by the laws that apply to us will be made only with your written permission. If you allow us to use or share your PHI, you may cancel that permission, in writing, at any time. If you cancel your permission, we will stop any further use or disclosure of your PHI for the purposes covered by your written permission, unless we have already done so based on your earlier permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required by law to keep records of the services or treatment we provided to you.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding your PHI that we maintain in our facilities. Right to Inspect and Copy Except for information related to treatment of mental illness, or information gathered in a civil, criminal or administrative action or proceeding, or some PHI subject to the Clinical Laboratory Improvements Amendments of 1988, you have the right to ask to inspect and copy your PHI. To inspect and
copy your PHI, you must send a specific, detailed request in writing to the Custodian of Medical Records addressed as follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

In limited situations we may deny some or all of your request to see or receive copies of your records, but if we do, we will tell you why in writing and explain your right, if any, to have your denial reviewed except: 1) in circumstances listed above; 2) you are an inmate and the copies would jeopardize your health safety, security, custody, or rehabilitation or that of others; 3) if the PHI is obtained as part of a research study, your right to access your PHI is suspended during the research; 4) if the PHI is controlled by the Privacy Act and access is not permitted by law; or 5) if the PHI was obtained from someone other than a healthcare provider under a promise of confidentiality, and access to the PHI would reveal who that person is. You must ask for a review in
writing addressed as follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

A licensed health care provider other than the person who originally participated in the denial will review the denial and we will provide or deny access in accordance with the decision of the reviewing provider. 

Right to Amend
If you feel that your PHI in our custody is incorrect or incomplete, you may ask us to correct or amend the PHI. You have the right to request a change for as long as we keep your PHI. To ask for a change, you must send a written request with a reason that supports your request to the Custodian of Medical Records addressed as
follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

We may deny your request to change your PHI if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to change information that:
was not created by us;

• is not part of the information kept by or for us;
• is not part of the information which you are permitted by law to inspect and copy; or
• is accurate and complete.

If we deny your request for a change to your PHI, you have the right to submit a written correction about any item or statement in your medical record you believe is incomplete or incorrect. The correction cannot exceed 250 words per alleged incomplete or incorrect item in your record.

Right to an Accounting of Disclosures
You have the right to request a list of how we have used or shared your PHI other than disclosures made: 1) to you or authorized by you; 2) for national security or intelligence purposes; 3) to correctional institutions or law enforcement, 4) as part of a limited data set as permitted by law, or 5) for treatment, payment and healthcare operations (as described above). To request this accounting of disclosures, you must send your request in writing to the Custodian of Medical Records addressed as follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

Your request must state a time period, which cannot be longer than a six-year period and cannot include dates before April 14, 2003. Your request should describe the type of list you would like (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions
You have the right to ask that we limit how we use or share your PHI for treatment, payment or healthcare operations. You also have the right to ask us to limit the PHI we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you can ask that we not use or share information about a surgery that you had done at SCVMC, or about a treatment you received at one of our other facilities. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you. To request restrictions, you must send a request in writing to the Custodian of Medical Records addressed as follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, sharing your PHI or both; and (3) to whom you want the limits to apply, for example, sharing with your spouse or a family member.

Right to Request Confidential Communications
You have the right to ask that we communicate with you about your PHI in a certain way or at a certain location. For example, you can ask that we contact you only at work or by US mail. To request confidential communications, you must send a written request to the Custodian of Medical Records addressed as follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

We will not ask you the reason for your request, and we will accommodate all reasonable requests. Your request 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. You may ask us to give you a copy of this notice at any time in person or in writing by sending a written request to the Privacy Coordinator addressed as follows:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain an electronic copy of this notice at our website: www.sccphd.org, then find, “Notice of Privacy Practices.”

CHANGES TO THIS NOTICE
We reserve the right to change our Privacy practices and this Notice. We reserve the right to make the revised or changed Notice effective for the PHI we already have about you, as well as any other information we create in the future. We will post a copy of the current Notice in our facilities. The effective date of the Notice will be displayed on the first page. If you ask, each time you register at, or are admitted to one of our facilities for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current Notice in
effect.

COMPLAINTS
We welcome the opportunity to respond to your questions and concerns and to resolve any complaints you may have about the use or disclosure of your PHI. If you believe your privacy rights have been violated, you may file a complaint with us, or with the Secretary of the Department of Health and Human Services. To file a complaint with us, you must send a written notice to:

HIPAA Privacy Coordinator
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126

You will not be penalized for filing a complaint.