Patients' Rights

WHAT IS HIPAA?

HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. The HIPAA Privacy Rule protects the privacy of your health information; it says who can look at and receive your health information and gives you specific rights over that information. HIPAA is only one of several regulations we are required to follow in providing privacy protection. We are also required to follow more stringent Federal and State laws that protect your privacy regarding Mental Health, Substance Use Disorders, HIV, or Sexually Transmitted Disease treatment.

YOUR RIGHTS TO MEDICAL PRIVACY

Under HIPAA, healthcare providers are required to provide you with a Notice of Privacy Practices to inform you of your privacy rights as a patient receiving services from Placer County, and to indicate an individual to answer questions regarding your medical privacy rights.

Your health information is personal and private. Our Notice of Privacy Practices tells you how personal information about your health may be used, who may see your information, where to file a complaint, and about your rights under HIPAA. Please review it carefully!

Notice of Privacy Practices (PDF)

Aviso de Prácticas de Privacidad-Español (PDF)

Fill out the attached form if you believe there has been a privacy issue with your health information, and it will be reviewed by the Placer County Privacy Officer. 

Health Information Privacy Complaint Form (PDF)

CODE OF FEDERAL REGULATION (CFR) TITLE 42 PART 2 - 42CFR

§ 2.2 Purpose and effect.

(a) Purpose. Pursuant to 42 U.S.C. 290dd-2(g), the regulations in this part impose restrictions upon the disclosure and use of substance use disorder patient records which are maintained in connection with the performance of any part 2 program. The regulations in this part include the following subparts:

(1) Subpart B of this part: General Provisions, including definitions, applicability, and general restrictions;

(2) Subpart C of this part: Disclosures with Patient Consent, including disclosures which require patient consent and the consent form requirements;

(3) Subpart D of this part: Disclosures without Patient Consent, including disclosures which do not require patient consent or an authorizing court order; and

(4) Subpart E of this part: Court Orders Authorizing Disclosure and Use, including disclosures and uses of patient records which may be made with an authorizing court order and the procedures and criteria for the entry and scope of those orders.

(b) Effect.

(1) The regulations in this part prohibit the disclosure and use of patient records unless certain circumstances exist. If any circumstance exists under which disclosure is permitted, that circumstance acts to remove the prohibition on disclosure but it does not compel disclosure. Thus, the regulations do not require disclosure under any circumstances.

(2) The regulations in this part are not intended to direct the manner in which substantive functions such as research, treatment, and evaluation are carried out. They are intended to ensure that a patient receiving treatment for a substance use disorder in a part 2 program is not made more vulnerable by reason of the availability of their patient record than an individual with a substance use disorder who does not seek treatment.

(3) Because there is a criminal penalty for violating the regulations, they are to be construed strictly in favor of the potential violator in the same manner as a criminal statute (see M. Kraus & Brothers v. United States, 327 U.S. 614, 621-22, 66 S. Ct. 705, 707-08 (1946)).

ETHICS AND COMPLIANCE

Placer County System of Care is firmly committed to full compliance with all federal and state laws, regulations, rules and guidelines that apply to SOC’s operations and services. At the core of this commitment are the employees of the MHP, and the manner in which they conduct themselves. To ensure that its employees share SOC’s commitment, SOC has established a Compliance Program Code of Conduct. Employees will be expected to read, understand, and follows our Code of Ethics which include the following guide for our professional behavior:

• Be professional and courteous,
• Keep all information confidential,
• Do not favor or advantage any person beyond what is available for every other person in similar circumstances,
• Uphold and adhere to all federal, state, and local laws and regulations,
• Report corruption without fear of retaliation, and
• Maintain the highest ideals of honor and integrity.

Your right to access your health information:

• You have the right to request access, look at or obtain a paper or electronic copy of information about yourself that is in the Placer County Adult System of Care health record.
• You have the right to inspect your records within five (5) working days, and to be provided a copy withing 30 days of signed request.
• You may be charged a fee, if you have accessed the same information withing the past year.
• Your request may be denied if professionals involved in your case believe that access to your information could be harmful to you or others.
• You request may be denied if your health information was given to Placer County by someone other than a health care provider, under the promise of confidentiality.
• The review must decide, within a reasonable time, whether to approve or deny your request. You will receive an answer in writing. The answer will include the reason for the decision.

To obtain a copy of your health records for personal use, please download, print, and complete the HIPAA07/HIPAA08 form.

HIPAA 07 Patient Access to Health Records Request (PDF)
HIPAA 07 Condado de Placer Solicitud de Acceso a Regitros de Salud (PDF)

If you would like to request to have records sent to another facility/person or authorize the verbal release of information for up to one (1) year from sign date, please download, print, and complete the HIPAA05/HIPAA06 form below:

Authorization for Release of Information HIPAA 05 (PDF)
Autorización para la Divulgación de Información HIPAA 06 (PDF)

If you would like to revoke an authorization that was previously requested on form HIPAA05/HIPAA06, please download, print, and complete the Client Authorization Revocation form below. The revocation will be active upon receipt at our office for processing. Incomplete forms may delay processing.

Client Authorization Revocation (PDF)

Client Authorization Revocation - Spanish (PDF)

Completed forms may be presented to the clinic where you are currently being seen. If you are not currently being seen, the request can be sent to the Medical Records Department at:

Placer County Adult System of Care (Adult Mental Health Records)
Attn: Medical Records
101 Cirby Hills Drive
Roseville, CA 95678
Email forms to [email protected]

Placer County Adult System of Care (Adult Substance Use Records)
Attn: Substance Use Medical Records
101 Cirby Hills Drive
Roseville, CA 95678

Placer County Children System of Care (Childrens Records)
1-530-889-6700

REQUEST CHILD WELFARE SERVICES (CWS) RECORDS 

APPEAL GRIEVANCE FORM 

• Placer County Appeal Grievance - English (Online) 
• Placer County Appeal Grievance - English (PDF)
• El Condado de Placer Apelar/Agravio – Español (Online)
• El Condado de Placer Apelar/Agravio – Español (PDF)

SOC PROVIDER FORMS 

• Beneficiary Protection English and Spanish 2018 Update (ZIP) - Required Provider Posting Materials for Beneficiary Protection in English and Spanish (Revised May 2018)
• "Mental Health Holds in the Emergency Department" - A Video