Community Behavioral Health Services - San Francisco Department ...

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A Privacy Notice that meets the requirements of the Federal Privacy Rule (HIPAA) is written andprovided to all patients/clients served in their threshold and other languages. If the document isnot available in the patient’s/client’s relevant language, verbal translation is provided.Always have available a sufficient supply of HIPAA Privacy forms. For DPH programs, forms are available onhttp://www.dph.sf.c us/InsideDPH/HIPAA/HIPAASumNotice.htm#HIPAAa) (Detailed) Notice of Privacy Practices in threshold and other languages (attached)b) Summary Notice of HIPAA Privacy Practices and Acknowledgment Form in threshold and otherlanguagesc) Authorization for Release of Patient Informationd) Request for Accounting of Disclosurese) Request to Amend Medical Recordf) Release of Information Authorization for Psychotherapy Notesg) Medical Record Disclosure LogReview the medical records (in any medium) of each day's appointment, to determine if a HIPAA PrivacyNotice has been provided to the clients/patients who are scheduled to be seen on that day.If the client/patient has not been noticed, ensure that a full Notice, and a Summary and AcknowledgementForm are provided to him/her during the appointment.14
Explain the Summary Notice to the client/patient, and ask him/her to sign the Acknowledgement form.If the client/patient refuses to sign the Acknowledgment form, document the refusal on the form, sign yourname, and date it.If the client/patient speaks only a language into which the Privacy Notice and Summary and Acknowledgmentform has not been translated, obtain interpreter service for him/her.Document that interpreter service was provided, in the client/patient's medical records. Have client/patientsign the acknowledgement form, and follow usual procedures.A Summary of the Privacy Notice is posted and visible in registration and common areas oftreatment facility.Place the HIPAA Summary Notice or Poster in a common area that is highly visible to clients/patients.Place Privacy Photo Posters in high traffic areas throughout the clinic or program site.Each disclosure of a patient's health information for purposes other than treatment, payment,or operations is documented.Document requests for confidential communication in the medical records.Confirm the identity and fax numbers of the recipient prior to sending PHI.Keep a log of non-routine PHI disclosures. Include the name and address of the requestor, relation topatient, brief description of PHI provided, name of staff who provided the PHI, and the date, time, and howPHI was provided.Authorization for disclosure of a patient's health information is obtained prior to release asrequired; that is (1) to providers outside the DPH Safety Net and (2) from a substance abuseprogram.Assure that Authorization forms meet HIPAA Privacy Rule requirements.Do not combine "consent for treatment" with "authorization for disclosure" on the same form. As a generalrule, do not use compound authorizations.Do not deny treatment on the basis of the patient's refusal to authorize the use or disclosure of his PHI.Write the authorization in plain language. It must include at a minimum;a) description of the information to be used or disclosed;b) name and address of the person or entity to whom the information will be disclosed;c) purpose or use of the disclosure;d) name of the person authorized to make the disclosure;e) signature of the individual or representative who is making the disclosure;f) date of disclosure;g) expiration date for the authorization; andh) statements that the individual has the right to proactively (not retroactively) revoke the authorizationin writing, that DPH cannot condition treatment on the authorization, the consequence of refusal tosign the authorization, and the potential for re-disclosure (if any).15
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City and County of San Fr ancisco
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CBHS 2010-2011 Provider ManualA wel
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Who is Served by the San Francisco
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Children, Youth, & Family (CYF) - M
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CYF Mental Health and School Partne
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Residential, Sub-acute and Communit
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Adult and Older Adult - Mental Heal
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CBHS Pharmacy ServiceAll clients wh
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Supportive Housing and Shelter-Base
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AOA Outpatient ServicesDesigned to
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Substance Abuse Service ProvidersDr
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Substance Abuse Outpatient Treatmen
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Driving Under the Influence (DUI) p
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AARS - Comprehensive Outreach Proje
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Alternatives Program Damon Eaves, L
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Joe Healy Medical Detox Project off
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This program provides mental health
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Languages: SpanishCATS MAP Mobile A
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Children’s System of Care (CSOC)
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Languages: Amharic, Arabic, Cantone
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Provides specialized neurobehaviora
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Languages: SpanishDSAAM Office Base
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Epiphany Center for Families in Rec
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and to develop a community support
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Languages: Basic translation servic
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1440 Chinook Ct. #A San Francisco C
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Evaluation Consultation Unit (DECU)
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2 year transitional house setting f
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1380 Howard Street, 2 nd Floor San
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Languages: Spanish, Russiansome res
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undergraduate students, and teachin
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vocational rehabilitation, housing
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Languages: SpanishProgress Foundati
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Languages: Amharic, Cantonese, Mand
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i-Ability IT Training - Serves SF C
Page 74 and 75: severely and persistently mentally
Page 76 and 77: Seneca Center Community TreatmentFa
Page 78 and 79: Behavioral Health Services to triag
Page 80 and 81: Social Model Detox for men and wome
Page 82 and 83: (SED), neglected, or abused childre
Page 84 and 85: • Opportunities to explore vocati
Page 86 and 87: Child and Adolescent Services (CAS)
Page 88 and 89: Walden House, Inc.Day Rehabilitatio
Page 90 and 91: Westside Ajani (RU#38CP3 )Shona Bau
Page 92 and 93: 888 Turk Street San Francisco CA 94
Page 94 and 95: CBHS Policies, Procedures, andAdmin
Page 96 and 97: • New! Fiscal-Cost Reporto ADP Co
Page 98 and 99: Patients’ RightsMental Health (La
Page 100 and 101: Basic Benefit Eligibility OverviewB
Page 102 and 103: Eligibility-Related Terminology:Ass
Page 104 and 105: Specific Requirements for Substance
Page 106 and 107: CBHS Client Grievance ProcedureCBHS
Page 108 and 109: Adult and Older Adult QOC FormCity
Page 110 and 111: Children QOC FormCITY AND COUNTY OF
Page 112 and 113: Staff ID and Service and Billing Pr
Page 114 and 115: Hjfh;aksjd City and County of San F
Page 116 and 117: Substance Abuse Staff Professional
Page 118 and 119: STATE OF CALIFORNIA - HEALTH AND HU
Page 120 and 121: PH Harm Reduction Policyolicy Numbe
Page 122 and 123: DPH Privacy Policy Matrix forSharin
Page 126 and 127: Authorization for disclosure of a p
Page 128 and 129: If a patient has not requested that
Page 130 and 131: • Avatar CANS Treatment Plan Step
Page 132 and 133: OverviewThe Contract Compliance Sec
Page 134 and 135: Alternatives for written materialsL
Page 137 and 138: Counselor Certification Regulations
Page 139 and 140: Behavioral Health Court: A program
Page 141 and 142: COSIGCo-Occurring State Incentive G
Page 143 and 144: psychologists, social workers, and
Page 145 and 146: Intensive Case Management: Intensiv
Page 147 and 148: NOANPINPPESNREPPNTPOBICOBOTNotice o
Page 149 and 150: Recovery:Process by which people ar
Page 151 and 152: TCMTEDSTIPTargeted Case Management
Page 153 and 154: Steven Dempsey Peer Support/ Client
Page 155 and 156: Toni Rucker Director, Grants & Trai
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