Effective Date: September 23, 2013NOTICE OFPRIVACY PRACTICEUNIVERSITY OF CALIFORNIASAN FRANCISCO UCSF HEALTH SYSTEMTHIS NOTICE DESCRIBES HOW HEALTHINFORMATION ABOUT YOU MAY BE USED ANDDISCLOSED AND HOW YOU CAN GET ACCESSTO THIS INFORMATION.PLEASE REVIEW IT CAREFULLY.862-082 (Rev. 09/13) WorkflowOneUNIVERSITY OF CALIFORNIA, SAN FRANCISCONOTICE OF PRIVACY PRACTICE
2How We May Use and Disclose HealthInformation About You (cont.)For Treatment. We may use Health Information about you toprovide you with medical and mental health treatment or services.We may disclose Health Information about you to doctors,nurses, technicians, students, or other health systempersonnel who are involved in taking care of you in thehealth system. For example, a doctor treating you for a brokenleg may need to know if you have diabetes because diabetesmay slow the healing process. A doctor treating youfor a mental condition may need to know what medicationsyou are currently taking, because the medications may affectwhat other medications may be prescribed to you. We mayalso share Health Information about you with other non-UCSF Health System providers. The disclosure of yourHealth Information to non-UCSF Health System providersmay be done electronically through a health informationexchange that allows providers involved in your care toaccess some of your UCSF Health system records to coordinateservices for you.For Payment. We may use and disclose Health Informationabout you so that the treatment and services you receive atUCSF Health System or from other entities, such as anambulance company, may be billed to and payment may becollected from you, an insurance company or a third party.For example, we may need to give information to your healthplan about surgery or therapy you received at UCSF HealthSystem so your health plan will pay us or reimburse you forthe surgery or therapy. We may also tell your health planabout a proposed treatment to determine whether your planwill pay for the treatment.For Health Care Operations. We may use and discloseHealth Information about you for our business operations.For example, your Health Information may be used to reviewthe quality and safety of our services, or for business planning,management and administrative services. We may contactyou about alternative treatment options for you or aboutother benefits or services we provide. We may also use anddisclose your health information to an outside company thatperforms services for us such as accreditation, legal, computeror auditing services. These outside companies arecalled “business associates” and are required by law to keepyour Health Information confidential. We may also discloseinformation to doctors, nurses, technicians, medical andother students, and other health system personnel for performanceimprovement and educational purposes.Appointment Reminders. We may contact you to remindyou that you have an appointment at UCSF Health System.Fundraising Activities. We may contact you to provideinformation about UCSF Health System sponsored activities,including fundraising programs and events. We may usecontact information, such as your name, address and phonenumber, date of birth, physician name, the outcome of yourcare, department where you received services and the datesyou received treatment or services at UCSF Health System.You may opt-out of receiving fundraising information for theUCSF Health System by contacting us at Records Manager,UCSF, Box 0248, San Francisco, CA 94143-0248, orHIPAAOptOut@support.ucsf.edu, or 1-888-804-4722.Hospital Directory. If you are hospitalized, we may includecertain limited information about you in the hospital directory.This is so your family, friends and clergy can visit you in thehospital and generally know how you are doing. This informationmay include your name, location in the hospital, yourgeneral condition (e.g., fair, stable, etc.) and your religiousaffiliation. The directory information, except for your religiousaffiliation, may also be released to people who ask for youby name. Your religious affiliation may be given to membersof the clergy, such as ministers or rabbis, even if they don’task for you by name. You have the opportunity to limit therelease of directory information by telling UCSF Health Systemat the time of your hospitalization.Our disclosure of this information about you if you are hospitalizedin a psychiatric hospital will be more limited.3UNIVERSITY OF CALIFORNIA, SAN FRANCISCONOTICE OF PRIVACY PRACTICE
4How We May Use and Disclose HealthInformation About You (cont.)Individuals Involved in Your Care or Payment for YourCare. We may release medical information to anyoneinvolved in your medical care, e.g., a friend, family member,personal representative, or any individual you identify. Wemay also give information to someone who helps pay foryour care. We may also tell your family or friends about yourgeneral condition and that you are in the hospital.Disaster Relief Efforts. We may disclose Health Informationabout you to an entity assisting in a disaster relief effort sothat others can be notified about your condition, status andlocation.Research. The University of California is a research institution.We may disclose Health Information about you forresearch purposes, subject to the confidentiality provisionsof state and federal law. All research projects involvingpatients or the information about living patients conductedby the University of California must be approved through aspecial review process to protect patient safety, welfare andconfidentiality.In addition to disclosing Health Information for research,researchers may contact patients regarding their interest inparticipating in certain research studies. Researchers mayonly contact you if they have been given approval to do soby the special review process. You will only become a part ofone of these research projects if you agree to do so and signa specific permission form called an Authorization. Whenapproved through a special review process, other studiesmay be performed using your Health Information withoutrequiring your authorization. These studies will not affectyour treatment or welfare, and your Health Information willcontinue to be protected.As Required By Law. We will disclose Health Informationabout you when required to do so by federal or state law.To Prevent a Serious Threat to Health or Safety. We mayuse and disclose Health Information about you when necessaryto prevent or lessen a serious and imminent threat toyour health and safety or the health and safety of the publicor another person. Any disclosure would be to someone ableto help stop or reduce the threat.Organ and Tissue Donation. If you are an organ donor, wemay release your Health Information to organizations thatobtain, bank or transplant organs, eyes or tissue, as necessaryto facilitate organ or tissue donation and transplantation.Military and Veterans. If you are or were a member of thearmed forces, we may release Health Information about youto military command authorities as authorized or required bylaw.Workers’ Compensation. We may use or disclose HealthInformation about you for Workers’ Compensation or similarprograms as authorized or required by law. These programsprovide benefits for work-related injuries or illness.Public Health Disclosures. We may disclose Health Informationabout you for public health activities such as:• preventing or controlling disease (such as cancer andtuberculosis), injury or disability;• reporting vital events such as births and deaths;• reporting child abuse or neglect;• reporting adverse events or surveillance related to food,medications or defects or problems with products;• notifying persons of recalls, repairs or replacements ofproducts they may be using;• notifying a person who may have been exposed to a diseaseor may be at risk of contracting or spreading a diseaseor condition;5UNIVERSITY OF CALIFORNIA, SAN FRANCISCONOTICE OF PRIVACY PRACTICE
6How We May Use and Disclose HealthInformation About You (cont.)Abuse and Neglect Reporting. We may disclose yourHealth Information to a government authority that is permittedby law to receive reports of abuse, neglect or domesticviolence.Health Oversight Activities. We may disclose Health Informationto governmental, licensing, auditing, and accreditingagencies as authorized or required by law.Lawsuits and Other Legal Proceedings. We may discloseHealth Information to courts, attorneys and court employeesin the course of conservatorship, writs and certain other judicialor administrative proceedings. We may also discloseHealth Information about you in response to a court oradministrative order, or in response to a subpoena, discoveryrequest, warrant, or other lawful process.Law Enforcement. If asked to do so by law enforcement,and as authorized or required by law, we may release HealthInformation:• To identify or locate a suspect, fugitive, material witness,certain escapees, or missing person;• About a suspected victim of a crime if, under certain limitedcircumstances, we are unable to obtain the person’sagreement;• About a death suspected to be the result of criminalconduct;• About criminal conduct at UCSF Health System; and• In case of a medical emergency, to report a crime; thelocation of the crime or victims; or the identity, descriptionor location of the person who committed the crime.Coroners, Medical Examiners and Funeral Directors. Wemay disclose medical information to a coroner or medicalexaminer. This may be necessary, for example, to identify adeceased person or determine cause of death. We may alsodisclose medical information about patients of UCSF HealthSystem to funeral directors as necessary to carry out theirduties.National Security and Intelligence Activities. As requiredby law, we may disclose Health Information about you toauthorized federal officials for intelligence, counterintelligence,and other national security activities.Protective Services for the President and Others. Asrequired by law, we may disclose Health Information aboutyou to authorized federal officials so they may conduct specialinvestigations or provide protection to the President,other authorized persons or foreign heads of state.Inmates. If you are an inmate of a correctional institution orunder the custody of law enforcement officials, we mayrelease Health Information about you to the correctionalinstitution as authorized or required by law.Psychotherapy Notes. Psychotherapy notes means notesrecorded (in any medium) by a health care provider who is amental health professional documenting or analyzing thecontents of conversation during a private counseling sessionor a group, joint, or family counseling session and that areseparated from the rest of the individual’s medical record.Psychotherapy notes have additional protections under federallaw and most uses or disclosures of psychotherapyrequire your written authorization.Marketing or Sale of Health Information. Most uses anddisclosures of your Health Information for marketing purposesor any sale of your Health Information would requireyour written authorization.7UNIVERSITY OF CALIFORNIA, SAN FRANCISCONOTICE OF PRIVACY PRACTICE
8Other Uses and Disclosuresof Health InformationOther uses and disclosures of Health Information not coveredby this Notice will be made only with your writtenauthorization. If you authorize us to use or disclose yourHealth Information, you may revoke that authorization, inwriting, at any time. However, the revocation will not beeffective for information that we have already used and disclosedin reliance on the authorization.Your Rights RegardingYour Health InformationYour Health Information is the property of UCSF HealthSystem. You have the following rights regarding theHealth Information we maintain about you:Right to Inspect and Copy. With certain exceptions, youhave the right to inspect and/or receive a copy of yourHealth Information. If we have the information in electronicformat then you have the right to get your Health Informationin electronic format if it is possible for us to do so. If not wewill work with you to agree on a way for you to get the informationelectronically or as a paper copy.To inspect and/or to receive a copy of your Health Information,you must submit your request in writing to Health InformationManagement Services, UCSF Medical Center, 400Parnassus Ave., Room A-88, San Francisco, CA 94143-0308. If you request a copy of the information, there is a feefor these services.We may deny your request to inspect and/or to receive acopy in certain limited circumstances. If you are deniedaccess to Health Information, in most cases, you may havethe denial reviewed. Another licensed health care professionalchosen by UCSF Health System will review yourrequest and the denial. The person conducting the reviewwill not be the person who denied your request. We willcomply with the outcome of the review.Right to Request an Amendment or Addendum. If you feelthat Health Information we have about you is incorrect orincomplete, you may ask us to amend the information or addan addendum (addition to the record). You have the right torequest an amendment or addendum for as long as the informationis kept by or for UCSF Health System.Amendment. To request an amendment, your request mustbe made in writing and submitted to Patient Relations, UCSFMedical Center, 350 Parnassus Ave., Suite 150, Box 0208,San Francisco, CA 94143-0208, phone 1-415-353-1396, fax1-415-353-8556. You must be specific about the informationthat you believe to be incorrect or incomplete and you mustprovide a reason that supports the request.We may deny your request for an amendment if it is not inwriting, we cannot determine from the request the informationyou are asking to be changed or corrected, or yourrequest does not include a reason to support the change oraddition. In addition, we may deny your request if you ask usto amend information that:• Was not created by UCSF Health System;• Is not part of the Health Information kept by or for UCSFHealth System;• Is not part of the information which you would be permittedto inspect and copy; or• UCSF Health System believes to be accurate and complete.Addendum. To submit an addendum, the addendum mustbe made in writing and submitted to Patient Relations, UCSFMedical Center, 350 Parnassus Ave., Suite 150, Box 0208,San Francisco, CA 94143-0208, phone 1-415-353-1396, fax1-415-353-8556. An addendum must not be longer than 250words per alleged incomplete or incorrect item in yourrecord.Right to an Accounting of Disclosures. You have the rightto receive a list of certain disclosures we have made of yourHealth Information.9UNIVERSITY OF CALIFORNIA, SAN FRANCISCONOTICE OF PRIVACY PRACTICE
10Your Rights RegardingYour Health Information (cont).To request this accounting of disclosures, you must submityour request in writing to Health Information ManagementServices, UCSF Medical Center, 400 Parnassus Ave., RoomA-88, San Francisco, CA 94143-0308. Your request muststate a time period that may not be longer than the six previousyears. You are entitled to one accounting within any 12-month period at no cost. If you request a second accountingwithin that 12-month period, there will be a charge for thecost of compiling the accounting. We will notify you of thecost involved and you may choose to withdraw or modifyyour request at that time before any costs are incurred.Right to Request Restrictions. You have the right torequest a restriction or limitation on the Health Informationwe use or disclose about you for treatment, payment orhealth care operations. You also have the right to request alimit on the Health Information we disclose about you tosomeone who is involved in your care or the payment foryour care, such as a family member or friend.To request a restriction, you must make your request in writingto Patient Relations, UCSF Medical Center, 350 ParnassusAve., Suite 150, Box 0208, San Francisco, CA 94143-0208, phone 1-415-353-1396, fax 1-415-353-8556. In yourrequest, you must tell us (1) what information you want tolimit; (2) whether you want to limit our use, disclosure orboth; and (3) to whom you want the limits to apply, for example,only to you and your spouse. We are not required toagree to your request except in the limited circumstancedescribed below. If we do agree, our agreement must be inwriting, and we will comply with your request unless theinformation is needed to provide you emergency care.We are required to agree to a request not to share your informationwith your health plan if the following conditions aremet:• We are not otherwise required by law to share the information• The information would be shared with your insurance companyfor payment purposes• You pay the entire amount due for the health care item orservice out of your own pocket or someone else pays theentire amount for youRight to Request Confidential Communications. You havethe right to request that we communicate with you aboutyour Health Information in a certain way or at a certain location.For example, you may ask that we contact you only athome or only by mail.To request confidential medical communications, you mustmake your request in writing to Patient Relations, UCSFMedical Center, 350 Parnassus Ave., Suite 150, Box 0208,San Francisco, CA 94143-0208, phone 1-415-353-1396, fax1-415-353-8556. We will accommodate all reasonablerequests. Your request must specify how or where you wishto be contacted.Right to a Paper Copy of This Notice. You have the right toa paper copy of this Notice. You may ask us to give you acopy of this Notice at any time. Even if you have agreed toreceive this Notice electronically, you are still entitled to apaper copy of this Notice.Copies of this Notice are available throughout UCSF HealthSystem, or you may obtain a copy at our website,http://www.ucsfhealth.org.Right to be Notified of a Breach. You have the right to benotified if we or one of our Business Associates discovers abreach of unsecured Health Information about you.11UNIVERSITY OF CALIFORNIA, SAN FRANCISCONOTICE OF PRIVACY PRACTICE
Changes to UCSF Health System’sPrivacy Practice and This NoticeWe reserve the right to change UCSF Health System’sprivacy practices and this Notice. We reserve the rightto make the revised or changed Notice effective forHealth Information we already have about you as wellas any information we receive in the future. We willpost a copy of the current Notice throughout UCSFHealth System. In addition, at any time you mayrequest a copy of the current Notice in effect.12Questions or ComplaintsIf you have any questions about this Notice, pleasecontact Patient Relations, UCSF Medical Center, 350Parnassus Ave., Suite 150, Box 0208, San Francisco,CA 94143-0208, phone 1-415-353-1396, fax 1-415-353-8556.If you believe your privacy rights have been violated,you may file a complaint with UCSF Health System orwith the Secretary of the Department of Health andHuman Services, Office for Civil Rights. To file a writtencomplaint with UCSF Health System contactPatient Relations, UCSF Medical Center, 350 ParnassusAve., Suite 150, Box 0208, San Francisco, CA94143-0208, phone 1-415-353-1396, fax 1-415-353-8556. You will not be penalized for filing a complaint.