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NOTICE OF PRIVACY PRACTICES

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

Unity Care Group, Inc. is committed to protecting the confidentiality of your protected health information (PHI). Unity Care takes the job of protecting your PHI seriously. We maintain policies and procedures to protect PHI, and all employees receive training on how to protect PHI. We also use physical and electronic safeguards to limit employee access to PHI. Access to your PHI is restricted only to employees who “need to know” the information.

1. Introduction to Privacy Notice

This Notice of Privacy Practices describes how Unity Care Group, Inc. may use and disclose your PHI. It describes how this information may be used and disclosed and how you can get access to it. It also explains your rights regarding your personal health information. The law says that we must explain this notice and give you a copy (if you would like one). We must get your signature acknowledging that we have done so.

We understand that the information we maintain about you and your health is personal. We are committed to protecting this information. We create and maintain a record of the care and services you receive at UNITY CARE GROUP, INC. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by or available to UNITY CARE GROUP, INC.'s workforce (which may include any health care professional who enters information into your health care record, volunteers, finance staff, information services staff, etc.).

This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.

We are required by law to:

make sure that clinical information that identifies you is kept private;
give you this notice of our legal duties and privacy practices with respect to clinical information about you; and
follow the terms of the notice that is currently in effect.

“PHI" includes your demographic information such as name, address, telephone number, social security number, birth date and gender, as well as information regarding your health, illnesses and injuries; past, present, or future information about your physical or mental health or condition; and information about the clinical services provided to you, including payment information, if any of that information may be used to identify you. We collect PHI from:

You or your guardian (when you complete intake or program forms)
Your prior transactions with Unity Care Group, Inc.
Your physician, clinicians and other healthcare providers
Your transactions with others (including probation officers, referring government representatives, school officials)

The Notice describes uses and disclosures of PHI for treatment, payment and healthcare operations and those that are permitted or required by state or federal law. Also, it advises you of your rights to access and control your PHI. We are required by law to maintain the privacy of your PHI.

We may amend this Notice of Privacy Practices periodically and you may obtain a current copy of the Notice by contacting a Unity Care Group, Inc. employee. We reserve the right to make the revised or changed Notice effective for PHI that we already have about you as well as for any PHI we receive in the future. We will provide updates of any material changes of this Notice, as required by law.

2. Safeguarding PHI within Unity Care Group, Inc. Facilities

We have in place appropriate administrative, technical, and physical safeguards to protect the privacy of your PHI. We regularly train our staff on the obligation to protect the privacy of your PHI. We hold clinical records in a secure area within each facility. Only staff members who have a "need to know" are permitted access to your clinical records and other PHI. We use physical and electronic safeguards to limit employee access to PHI.

3. Uses and Disclosures of PHI for Treatment, Payment and Health Care Operations

Unity Care Group, Inc. will use and disclose your PHI for the following types of activities:

Treatment. We may use clinical/medical information about you to provide you with treatment or services. We may disclose clinical/medical information about you to doctors, nurses, clinicians, interns, MATs, or other UNITY CARE GROUP, INC. personnel who are involved in treating you. For example, a clinician treating you for an anger disorder may need to know if you have physically acted out in the past. With this knowledge the treatment team may create a safety plan to protect you and the people around you when/if you or your child begins to act out. In addition, the clinician may need to tell a physician if your symptoms are not improving. The physician may explore prescribing medication or recommend testing. Different departments of UNITY CARE GROUP, INC. may share information about you in order to coordinate the different things you need, such as food, additional treatment, and medical attention. We also may disclose information about you to people outside UNITY CARE GROUP, INC. who may be involved in your treatment, or as a part of coordinating follow up care. These people may include family members, social workers, school employees, neighbors, clergy, county employees, or others involved in providing services that are part of your care.
Payment. We may use and disclose medical/clinical information about you so that the treatment and services you receive at UNITY CARE GROUP, INC. may be billed to and payment may be collected from you, the county, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received at UNITY CARE GROUP, INC. so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about treatment we are recommending, to obtain prior approval or to determine whether your plan will cover the treatment.
Health Care Operations. We may use and disclose clinical/medical information about you for UNITY CARE GROUP, INC. operations. These uses and disclosures are necessary to run UNITY CARE GROUP, INC. and make sure that all of our children & families receive quality care. For example, we may use clinical/medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine clinical/medical information about many UNITY CARE GROUP, INC. clients to decide what additional services UNITY CARE GROUP, INC. should offer, what services are not needed, and whether certain programs are effective. We may also disclose information to doctors, nurses, interns, clinicians, and other UNITY CARE GROUP, INC. personnel for review and learning purposes. We may provide information to representatives of organizations with responsibility for compliance, licensure, quality of care, and funding purposes.
Fundraising and Marketing. We may use clinical/medical information about you to contact you in an effort to raise money for UNITY CARE GROUP, INC. and its operations. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at UNITY CARE GROUP, INC. If you do not want UNITY CARE GROUP, INC. to contact you for fundraising efforts, you must notify the Director of Fund Development in writing.
Individuals Involved in Your Care. If in Unity Care Group, Inc.'s judgment it is in your best interest, we will disclose PHI to your family members or close friends, or legal guardian or person holding your power of attorney for health care (if applicable), who are involved in your health care. You may restrict disclosures of PHI to certain family members and other relatives, or to only such persons that you identify as permitted to receive PHI.
Contacting You. We may contact you to provide you with a reminder of an upcoming appointment, or information about alternative treatment options or health-related benefits and services that may be of interest to you.

Please note that not every type of possible use or disclosure is listed in this Notice.

4. Uses and Disclosures of PHI Based Upon Your Written Authorization

Except as otherwise described in this Notice, we may not use or disclose PHI without your written authorization, which you may revoke.

You may request that we use or disclose all or part of your protected health information. Use and disclosure may be authorized to specified individuals or other recipients for a defined purpose over a particular timeframe. While most authorizations must be in writing, in certain circumstances, we will accept oral authorizations to the extent permitted by California law. The minimum necessary amount of your protected health information will be disclosed to comply with your authorization.

You may revoke your authorization at any time, but only regarding future uses or disclosures and only to the extent we have not already used or disclosed your protected health information in reliance on your authorization.

5. Uses and Disclosures of PHI that are Permitted or Required by Law

In some circumstances, we may use or disclose your PHI without your authorization. State and federal privacy law permit or require such use or disclosure regardless of your authorization because it is in the best interest of our society at large that the use or disclosure of PHI be made in these situations.

Emergencies. If you are incapacitated and require emergency clinical treatment, we will use and disclose your PHI to ensure you receive the necessary clinical services.
Communication barriers. If we try but cannot obtain your authorization to use or disclose your PHI because of substantial communication barriers and your physician, using his or her professional judgment, infers that you authorize the use or disclosure, Unity Care Group, Inc. will make the use or disclosure.
Required by law. We may disclose PHI to the extent required by law and in a manner limited to the specific requirements of the law.
Public health activities. We may disclose your PHI to an authorized public health authority to prevent or control disease, injury, or disability or to comply with state child abuse or neglect law. We may disclose your PHI in connection with reports that we may be required or authorized to make regarding adult abuse, neglect or domestic violence. Such disclosure will be limited to the extent required by law, or if disclosure is authorized but not required, will be made as necessary to prevent serious harm to you or others. We may also make such disclosure if you agree to it. To the extent that the disclosure will be made, we will promptly inform you or your Personal Representative, unless we believe that informing you or your Personal Representative would place you at risk of serious harm.
Health oversight activities. We may disclose your PHI to a health oversight agency for audits, investigations, inspections, and other activities necessary for the appropriate oversight of the health care system and the government benefit programs such as Medicaid and Medicare.
Judicial and administrative proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order expressly directing disclosure and within certain limits in response to a subpoena, discovery request, or other lawful process.
Law enforcement activities. We may disclose your PHI to a law enforcement officer for law enforcement purposes. For example, we may release information in response to a court order, warrant, subpoena or similar legal process; or about a victim of a crime if, under limited circumstances, we are unable to obtain the person's agreement; or in emergency circumstances, to report a crime, the location of the crime or victim, or the identity, description or location of the person who committed the crime.
Coroners, clinical examiners, & funeral directors. We may disclose your PHI to a coroner or clinical examiner for the purpose of identifying a deceased person, determining a cause of death, or other lawful duties. We also may disclose your PHI to enable a funeral director to carry out his or her lawful duties.
Research. We may disclose your PHI for certain clinical or scientific research where the researchers have a protocol to ensure the privacy of your PHI.
Serious threats to health or safety. We may disclose your PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Armed forces personnel & national security. We may disclose the PHI of members of the armed forces for activities deemed necessary by appropriate military command authorities to assure proper execution of the military mission. We also may disclose your PHI to certain federal officials for lawful intelligence, counterintelligence, and other national security activities.
Correctional facilities. Regarding inmates, we may disclose your PHI to a correctional institution or law enforcement official to the extent required by law, by court order or as authorized by law or rule.
Workers' compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with the California workers’ compensation laws or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
DHHS. We must disclose your PHI to the Secretary of the U.S. Department of Health & Human Services to investigate or determine Unity Care Group, Inc.'s compliance with the privacy laws.

6. Your Rights Regarding PHI

We must disclose your PHI to you upon request. You also have the following rights:

Right of access to PHI. Except for limited circumstances under state or federal laws or regulations, you have the right to inspect and obtain a copy of your PHI in a "designated record set" (your clinical and billing records) as long as we maintain the PHI in such format. However, you do not have a right of access to psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal, or administrative proceeding. Also, your right of access may be limited if providing certain PHI to you may endanger the health or safety of yourself or others. If you are denied access to your designated record set for any reason, we will inform you about the reason and your rights to challenge this decision. To request access to your PHI, please make your request in writing to our Compliance Officer. Unless California law or rules provide otherwise, we will respond to your request as soon as possible, but no later than 30 days from the date of your request, unless we provide you with written Notice regarding a delay. We have the right to charge a reasonable fee for providing copies of your PHI.
Right to request restriction of uses and disclosures. You have the right to request that we not use or disclose any part of your PHI unless it is a use or disclosure required by law. Please advise us of the specific PHI you wish restricted and the individual(s) who should not receive the restricted PHI. We are not required to agree to your restriction request, but if we do agree to the request, we will not use or disclose the restricted PHI unless it is necessary for emergency treatment. In that case, we will ask that the recipient not further use or disclose the restricted PHI. We have the right at our discretion to terminate our agreement to the restriction, if certain conditions are met.
Right to confidential communications. You have the right to reasonable accommodation of a request to receive communication of PHI by alternative means or at alternative locations. Please make your request in writing to our Compliance Officer and we will agree if the request is reasonable. We will not require an explanation of your reasons for the request, but we will ask that you specify the alternative address or other method of contact and that you inform us of how payment for our clinical services will be handled.
Right to amend PHI. You have the right to request that we amend the PHI in your "designated record set" for as long as we maintain the PHI in such format. Please make your request in writing to our Compliance Officer. We will respond to your request as soon as possible, but no later than 60 days from the date of your request, unless we provide you with written Notice regarding a delay. If we deny your request for amendment, you have the right to submit a written statement of reasonable length disagreeing with the denial and we have the right to submit a rebuttal statement. A record of any disagreement about amendment will become part of your clinical records and may be included in subsequent disclosures of your PHI. We will not delete any health information or PHI in your records. We will require that you identify persons who have received disclosure of the PHI that you have corrected, clarified or amended and will request your agreement to share the corrected, clarified or amended PHI with such person(s) and with our Business Associates or others that may have relied on the PHI to your detriment.
Right to accounting of disclosures. Subject to certain limitations, you have the right to a written accounting of disclosures by us of your PHI for not more than 6 years prior to the date of your request. Your right to an accounting applies to all disclosures except: those for treatment, payment, or health care operations; to yourself, to your legal guardian or persons with Power of Attorney involved in your care; provided for national security or intelligence purposes; to correctional institutions or law enforcement officials; made pursuant to a valid authorization; that are part of a limited data set; that occurred prior to April 14, 2003, or pursuant to an incidental disclosure. Please make your request in writing to our Compliance Officer. We will respond to your request as soon as possible, but no later than 60 days from the date of your request, unless we provide you with written Notice regarding a delay. We will provide you with one accounting every 12 months free of charge. We will charge a reasonable fee based upon our costs for any subsequent accounting requests.
Right to a copy of our Notice of Privacy Practices. We will ask you to sign a written acknowledgement of receipt of our Notice of Privacy Practices. We may periodically amend this Notice of Privacy Practices and you may obtain an updated Notice from our Compliance Officer at any time.

7. Complaint Procedure

If you have a complaint about the denial of any of the specific rights listed in Section 6 above, about our Notice of Privacy Practices, or about our compliance with state and federal privacy law, please make your complaint in writing to our Compliance Officer. We will respond to your complaint in writing within the time frames listed in Section 6 above or in any case within 60 days of the date of your complaint.

Unity Care Group, Inc.

Attn: Compliance Officer

237 Race Street
San Jose, CA 95173

If you believe that we are not complying with our legal obligations to protect the privacy of your PHI, you may file a complaint with the Secretary of the U.S. Department of Health & Human Services. You must make your complaint to the Secretary in writing within 180 days of the act or omission forming the basis of your complaint. You will not be retaliated against for filing a complaint.

If you have any questions about Unity Care Group, Inc.'s Notice of Privacy Practices, please contact our Compliance Officer at 408-971-9822.