I. This Notice Describes How Medical Information About You Maybe Used And Disclosed
And How You Can Obtain Access To It. Please Review This Notice Carefully.
II. It Is Moonview's Legal Duty To Safeguard your Protected Health Information (PHI).
Under law Moonview is required to insure that your PHI is kept private. Moonview must comply with
HIPAA, other federal laws and regulations regarding confidentiality of alcohol and drug records and state law
regarding the confidentiality of mental health records. PHI constitutes your identifiable health related information.
It contains data about your past, present, or future health care or condition, provision of health care services to
you, or payment for such health care. Moonview is required to provide you with this Notice about its privacy
procedures. This Notice must explain when, why, and how Moonview would use and/or disclose your PHI.
The term, use of PHI, means when Moonview or its providers share, apply, utilize, examine, or analyze
identifiable health information within the program. PHI is disclosed when Moonview or its providers release,
transfer, give, or otherwise reveal it to a third party outside the program. With some minor exceptions,
Moonview may not use or disclose more of your PHI than is necessary to accomplish the purpose for which
the use or disclosure is made. Please note that Moonview reserves the right to change the terms of this Notice
and its privacy policies at any time. Any changes will apply to PHI already on file with Moonview. Before
Moonview makes any important changes to it policies, it will immediately change this Notice and post a new
copy of it at the sanctuary. You may also request a copy of this Notice from Moonview, or you can view a copy
of it on Moonview's website.
III. How Moonview Will Use And Disclose Your PHI
Moonview will use and disclose your PHI for many different reasons. Some of the uses or disclosures
will require your prior written authorization; others, however, will not. Below you will find the different
categories of Moonview's uses and disclosures of PHI, with some examples. These examples are
not meant to be exhaustive but describe the types of uses and disclosures of health related information
that may be made by Moonview.
A. Uses and Disclosures Related to Treatment, Payment or Health Care Operations Do Not
Require Your Prior Written Consent. Moonview may use and disclose your PHI without your consent
for the following reasons:
1. For treatment. Moonview may disclose your PHI to physicians, psychiatrists, psychologists,
and other licensed health care providers, who furnish you with health care services, or are otherwise
involved in your care. For example, if an outside psychiatrist is treating you, Moonview may disclose your
PHI to him or her in order to coordinate your care.
2. For health care operations. Moonview may disclose your PHI to facilitate the efficient and
professional operation of its program. Moonview may use your PHI in the evaluation of the quality of
health care services that you have received or to evaluate the performance of the health care
professionals who provided you with these services. Moonview may also provide your PHI to its
attorneys, accountants, consultants and others to make sure that it is in compliance with applicable laws.
3. To obtain payment for treatment. Moonview may use and disclose your PHI to bill and
collect payment for the treatment and services it has provided to you.
B. Certain Other Uses and Disclosures Do Not Require Your Consent. Also, Moonview may
use and/or disclose your PHI without your consent or authorization for the following reasons:
The following list is a compilation of federal and California laws.
1. Your consent is not required if you need emergency treatment provided that Moonview attempts to
get your consent after treatment is rendered.
2. When disclosure is required by federal, state, or local law, judicial, board, or administrative
proceedings or law enforcement.
3. If disclosure is compelled by a party to a proceeding before a court or an administrative
agency pursuant to its lawful authority.
4. If disclosure is required by a search warrant lawfully issued to a governmental law
5. If disclosure is compelled by you or your representative pursuant to California or federal law.
6. In order to avoid harm, Moonview may provide PHI to law enforcement personnel or persons able to
prevent or mitigate a serious threat to the health or safety of a person or the public.
7. If you are in such a mental or emotional condition as to be dangerous to yourself or the person or property
of others and a Moonview provider determines that disclosure is necessary to prevent the threatened danger.
8. If disclosure is mandated by the California Child Abuse and Neglect Reporting law. A Moonview
provider must have a reasonable suspicion of child abuse or neglect.
9. If disclosure is mandated by the California Elder/Dependent Adult Abuse Reporting law.
10. You disclose to a Moonview provider a serious or imminent threat of physical violence by you against a
reasonably identifiable victim(s).
11. For public health activities. For example, in the event of your demise, a disclosure may be done in order to give
the county coroner information about you.
12. For health oversight activities. Moonview may be required to provide information to assist the
government in the course of an investigation or inspection of a health care organization or provider.
13. For specific government functions. Moonview may disclose PHI of military personnel and
veterans under certain circumstances. Also, it may disclose PHI in the interests of national security, such as
protecting the President of the United States or assisting with intelligence operations.
14. For research purposes. In certain circumstances, Moonview may utilize or provide your PHI to an outside
source in order to conduct appropriate research.
15. For Workers' Compensation purposes. Moonview may provide PHI in order to comply with Workers'
16. Appointment reminders and health related benefits. Moonview may use PHI to
provide appointment reminders. Also, it may use PHI to give you information about alternative treatment
options or other health care services or benefits it offers.
17. If an arbitrator or arbitration panel compels disclosure. If disclosure is lawfully requested by either
party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other
provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.
18. Communicable diseases. Moonview may disclose your PHI to a state or local agency that is authorized by law to
receive reports of diagnosed communicable disease.
19. If disclosure is otherwise specifically required by law.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
1. Disclosures to family, friends, or others. Moonview may provide your PHI to a family member, friend, or
other individual who you indicate is involved in your care or responsible for the payment for your health care, unless
you object in whole or in part. Retroactive consent may be obtained in emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not
described in Sections IIIA, IIIB, and IIIC above, Moonview will request your written authorization before
using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may
later revoke that authorization (subject to Moonview's reliance on such consent), in writing, to stop any future uses
and disclosures of your PHI by Moonview.
IV. What Rights Do You Have Regarding Your PHI
A. The Right to See and Get Copies of Your PHI. In general, you have the right to see your PHI (contained
in a designated record set) that is in Moonview's possession, or to get copies of it; however, you must make such a
request in writing. A designated record set is made up of health information, billing records and other records that
Moonview and its providers use to make treatment decisions on your behalf. If Moonview does not have your PHI
but it knows who does, it will advise you how you can obtain it. You will receive a response from Moonview within
30 days of it receiving your written request. Under certain circumstances, Moonview may feel it must deny your
request but if it does so it will give you, in writing, the reasons for the denial. Moonview will also explain in writing
your right to have its denial reviewed.
If you ask for copies of your PHI, Moonview will charge you not more than $.25 per page. Moonview and its
providers may decide to furnish you with a summary or explanation of the PHI instead but only if you agree in
advance to it, as well as to the cost of the summary.
B. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask
that Moonview limit how it uses and discloses your PHI. While Moonview will consider your request, it is not
legally bound to agree. If Moonview does agree to your request it will put those limits in writing and abide by
them, except in emergency situations. You do not have the right to limit the uses and disclosures that Moonview
is legally required or permitted to make.
C. The Right to Choose How Moonview Sends Your PHI to You. It is your right to ask Moonview
that your PHI be sent to you at an alternate address (sending information to your work address rather than
your home address) or by an alternate method (via email instead of by regular mail). Moonview is obliged to
agree to your request providing that it can furnish the PHI, without undue inconvenience,
in the format you requested.
D. The Right to Get a List of the Disclosures Moonview Has Made. You are entitled to a list of
disclosures of your PHI by Moonview. The list will not include disclosures to which you have already consented,
or those directly sent to you, neither will the list include disclosures made for national security purposes,
made to corrections or law enforcement personnel or made before April 15, 2003. After April 15, 2003,
disclosure records will be held for six years by Moonview.
Moonview will respond to your request for an accounting of disclosures within 60 days of receiving your request.
The list will include disclosures made in the previous six years unless you indicate a shorter period. The list
will include the date of the disclosure, a description of the information released, a reason for the disclosure
and to whom PHI was disclosed (including addresses if available). Moonview will provide you with this
information at no cost unless you make more than one request in the same year, in which case it will charge
you a reasonable cost for provision of the data.
E. The Right to Amend Your PHI. If you believe that there is some error in your PHI or that important
information has been omitted, it is your right to request that Moonview correct the existing information.
Your request and the reason for the request must be made in writing. You will receive a response within
60 days of Moonview's receipt of your request. Moonview may deny your request, in writing, if it finds that:
the PHI is (a) correct and complete, (b) legally can not be disclosed, (c) not part of its records, or (d) written
by someone outside of Moonview. Moonview's denial must be in writing and must state the reasons for the
denial. Also, it must explain your right to file a written statement objecting to the denial. If you do not file a
written objection, you still have the right to ask that your request and Moonview's denial be attached to any
future disclosures of your PHI. Moonview has the right to make a written rebuttal to your statement and attach
it to your PHI along with your request, Moonview's denial and your objection to the denial. If Moonview
approves your request, it will make the change(s) to your PHI. Additionally, Moonview will tell you when
the changes have been made and it will advise, if possible, all others who need to know about the
change(s) to your PHI.
Under related California law, you may have a right to request a written addendum to your PHI.
Please contact Moonview's Director of Operations at (310) 499-1212, extension 226, for further information.
The Right to Get This Notice by E-Mail. You have the right to get this notice by email and to request
a paper copy of it, as well.
V. How To File A Complaint About Moonview's Privacy Practices
If you believe that Moonview may have violated your privacy rights, you are entitled to file a complaint with
the person listed in Section VI below. You may also send a written complaint to the Secretary of the
Department of Health and Human Services at 200 Independence Avenue S.W., Washington, D.C. 20201.
If you file a complaint about Moonview's privacy practices, it will take no retaliatory action against you.
VI. Person to Contact To File A Compliant About Moonview's Privacy Practices
If you have any questions about this notice, complaints about Moonview's privacy practices, or would
like to know how to file a complaint with the Secretary of the Department of Health and Human Services,
please contact Moonview's Director of Operations at (310) 449-1212, extension 226.
VII. Effective Date Of This Notice.
This notice went into effect on April 14, 2003.