HIPAA Notice of Privacy Practices

(Revised September 23, 2013)


  1. Who We Are


This Notice describes the privacy practices of The Whole Child and other facility personnel. It applies to services furnished to you and/or a family member as a Client/Consumer of The Whole Child.

  1. Privacy Obligations

During your and/or your child’s enrollment, The Whole Child creates a record of the care and services received. We need this record to provide you and/or your child with quality treatment and to comply with certain legal and payment requirements. We refer to this information as “Protected Health Information” or “PHI”. The Whole Child is committed to protecting the confidentiality of this information and advising you about the ways in which we may use and disclose your Protected Health Information (PHI).

This notice will tell you about the ways in which we may use and disclose your PHI. We also describe your rights and certain obligations that we have regarding the use and disclosure of PHI. We are required by law to:

  • make sure that PHI that identifies you is kept private;
  • give you this notice of our legal duties and privacy practices concerning your

PHI; and

  • follow the terms of the notice that is currently in effect.
  • Use and Disclosure of Protected Health Information (PHI)

The Whole Child 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 uses and disclosures, with some examples.

  1. Permissable Uses and Disclosures Without Your Written Authorization
  • For Treatment We may use PHI about you to provide you and/or your child with medical treatment or services. We may disclose PHI about you and/or your child to doctors, nurses, technicians, nursing and medical students, or medical personnel who are involved in taking care of you and/or your child. For example, a doctor treating you for a chemical imbalance may need to know if you and/or your child have problems with your heart because some medications may affect blood pressure. We may share your and/or your child’s PHI for treatment in order to coordinate varying medical needs, such as prescriptions, blood pressure checks and lab tests, and to determine a correct diagnosis.
  • For Payment We may use and disclose PHI about you and/or your child so that the treatment and services received at The Whole Child may be billed and payment may be collected from you or on your behalf from an insurance company or a third party. For example, we may need to give your health plan information about testing that you received at our facilities so your health plan will pay us or reimburse you for those services. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
  • For Health Care Operations We may use and disclose PHI about you and/or your child for our health care operations. These uses and disclosures are necessary to run our organization and make sure that all of our Clients/Consumers receive quality care. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you and/or your child. We may also gather PHI about clients to decide what additional services our facilities should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, nursing and medical students, and other personnel for review and learning purposes. We may also compare the PHI we have with PHI from other organizations and providers to determine how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you and/or your child from this set of PHI so others may use it to study health care and health care delivery without learning the identity of any clients. We may also disclose PHI to our Privacy Officer in order to resolve any complaints you may have and ensure that your issues/complaints are addressed.
  • Other Disclosure If you are not present, or the opportunity to agree or object to a use or disclosure cannot be obtained because of you or your child’s incapacity or an emergency circumstance, The Whole Child staff may exercise his/her professional judgment to determine whether a disclosure is in you or your child’s best interest.
  1. Certain Other Uses and Disclosures that Do Not Require Your Consent


  • As Required By Law  We will disclose PHI about you and/or your child when required to do so by Federal, State or local law, such as laws that require us to report abuse.
  • Lawsuits and Dispute If you are involved in a lawsuit or a dispute, we may disclose PHI about you and/or your child in response to a court or administrative order. We may also disclose PHI about you and/or your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the privacy of the information requested
  • Law Enforcement We may release PHI if asked to do so by a law enforcement official: in response to a court order, court-issued subpoena, court- issued warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s authorization; about criminal conduct at The Whole Child; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  • For Your Own Information We may use and disclose PHI to tell you about your own health condition, such as your test results, to tell you about or recommend possible treatment options or alternatives, and to tell you about health-related benefits or services that may be of interest to you.
  • Individuals Involved in Your Care or Payment for Your Care We may disclose PHI about you and/or your child to a family member or other person you designate if you give us permission to do so. We may also tell certain family members about you and/or your child’s presence in our facility but only if the law permits us to do so. We may share PHI about you and/or your child when necessary for a claim for aid, insurance, or medical assistance to be made on your or your child’s behalf.
  • To Avert a Serious Threat to Health or Safety We may use and disclose PHI about you and/or your child when necessary to prevent a serious threat to you and/or your child’s health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
  • Abuse or Neglect We may disclose PHI about you and/or your child to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may also disclose your and/or your child’s PHI if we believe that you have been a victim of elder or dependent adult abuse or neglect provided the disclosure is authorized by law
  • Health Oversight Activities We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
  • Health Information Exchange (HIE) We, along with other health care providers in the Los Angeles area, participate in one or more health information exchanges. An HIE is a communitywide information system used by participating health care providers to share health information about you for treatment purposes. Should you and/or your child require treatment from a health care provider that participates in one of these exchanges who does not have your medical records or health information, that health care provider can use the system to gather your health information in order to treat you. For example he or she may be able to get laboratory or other tests that have already been performed or find out about the treatment that you have already received. We will include your PHI in this system.
  • For Research Under certain circumstances, we may use and disclose PHI about you and/or your child for research purposes. For example, a research project may involve comparing the health and recovery of all clients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of PHI, trying to balance the research needs with patients’ need for privacy of their PHI. Before we use or disclose PHI for research, the project will have been approved through this research approval process, but we may, disclose PHI about you to people preparing to conduct a research project, for example, to help them look for clients with specific medical needs. We will always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care.
  • Public Health Risks We may disclose PHI about you and/or your child when required for public health activities. These activities generally include the following: to prevent or control disease, injury or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of product recalls of the products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a client has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
  • For Appointment Reminders We may use and disclose PHI to contact you as a reminder that you and/or your child have an appointment at The Whole Child.
  • To Provide Breach Notification We may use and disclose your and/or your child’s PHI, if necessary, to tell you and regulatory authorities or agencies of unlawful or unauthorized access to your PHI. For example, if you and/or your child’s PHI is lost or stolen.
  • Workers’ Compensation We may release PHI about you for workers compensation or similar programs to comply with these and other similar legally established programs. These programs provide benefits for work-related injuries or illness.
  • National Security and Intelligence Activities We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities as required by law.
  • Protective Services for the President and Others We may disclose PHI about you to authorized federal or government law enforcement officials so they may provide protection to the President, other authorized or elected persons or foreign heads of state or to conduct special investigations.
  • Protection and Advocacy Services We may disclose PHI about you to the protection and advocacy agency established by law to investigate incidents of abuse and neglect and to otherwise protect the legal and civil rights of people with disabilities.
  • As Required By Law We may use and disclose your and/or your child’s PHI when required to do so by any other law not already referred to in the preceding categories.
  1. Uses and Disclosures Requiring Your Written Consent


  • Disclosures to family, friends or others We may provide PHI to a family member, friend or other individual who you indicate is involved in your and/or your child’s care, or responsible for the payment of health care unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
  • Use or Disclosure with Your Authorization For any purpose other than the one’s described above, we only may use or disclose you and/or your child’s PHI when you grant us your written authorization on our authorization form. For example, you will need to execute an authorization form before The Whole Child can send PHI to an attorney representing the other party in litigation in which you are involved.
  • Marketing The Whole Child must obtain your written authorization prior to using your or your child’s PHI to send you any marketing materials. We can, however, provide you with marketing materials in a face-to-face encounter without obtaining your authorization. In addition, we may communicate with you about products or services relating to your treatment, case management, or care coordination, or alternative treatments, therapies, providers or care settings without your authorization.
  • Uses and Disclosures of Highly Confidential Information Federal and California law requires special privacy protections for certain highly confidential information about you and/or your child including the subset of your PHI that: 1) is maintained in psychotherapy notes; 2) is about mental health and developmental disabilities services; 3) is about alcohol and drug abuse prevention and treatment; 4) is about HIV/AIDS testing, diagnosis or treatment; 5) is about communicable disease (s); 6) is about genetic testing; 7) is about child abuse and neglect; 8) is about domestic and elder abuse or 9) is about sexual assault. In order for us to disclose your or your child’s confidential information for a purpose other than those permitted by law, we must obtain your written authorization.


  1. Your Rights Regarding Your Protected Health Information


  1. Right to Inspect and Copy You have the right to inspect and copy your and/or your child’s PHI that is used to make decisions about care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy PHI that may be used to make decisions about you and/or your child, you must submit your request in writing (“Request for Access to Medical Information”) to the Privacy Officer at The Whole Child. If you request a copy of the information, we will charge a fee in amount of $0.15 (15 cents) for each page. Additional fees may be added for the cost of postage or other supplies associated with your request. If your health information is available electronically, under certain circumstances, you may be able to obtain this information in an electronic format. The Whole Child does reserve the right to deny requests to inspect and copy PHI in certain limited circumstances. If you are denied access to PHI, you may request, in writing, that the denial be reviewed. At that time, another licensed health care professional chosen by The Whole Child will review your request and the denial. The person conducting the review will not be the person who previously denied your request. We will comply with the outcome of the review.
  2. Limitations to PHI inspection and copy for minors If you are a parent or legal guardian of a minor, certain portions of the minor’s mental health record will not be accessible to you; for example, records pertaining to mental health care services for which the minor can lawfully give consent and therefore which the minor has the right to inspect or obtain copies of the record; or the mental health care provider determines, in good faith, that access to the patient records requested by the representative would have a detrimental effect on the provider’s professional relationship with the minor patient or on the minor’s physical safety or psychological well-being.
  3. Right to Amend If you feel that PHI we have about you and/or your child is incorrect or incomplete, you may ask us to include additional information in your medical record. You have the right to request an amendment for as long as all of the information, both old and new, is kept by or for The Whole Child. To request an amendment, a request must be made in writing and submitted to the Privacy Officer at The Whole Child. In addition, you must provide a reason that supports your request. The Whole Child reserves the right to deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the PHI kept by The Whole Child; is not part of the information which you would be permitted to inspect and copy; or is believed to be accurate and complete.
  4. Right to an Accounting of Disclosures You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of PHI about you and/or your child, excluding disclosures for the purpose of treatment, payment or healthcare operations. To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer at The Whole Child. Your request must state a time period, which may not be more than six years prior to your request. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12- month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
  5. Right to Request Restrictions You have the right to request a restriction or limitation on the PHI we use or disclose about you and/or your child for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you and/or your child to someone who is involved in your care or the payment for your care, like a family member. We will do our best to honor your request; however, except when you fully pay out-of-pocket as explained below, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the Privacy Officer at The Whole Child. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
  6. Right To Restrict Disclosure of Information For Certain Services You have the right to restrict the disclosure of information regarding services for which you or someone else has paid in full or on an out-of-pocket basis (in other words you, don’t ask us to bill your health plan or health insurance company). If you or someone else has paid in full for a service, we must agree to your request and we will not share this information with your health plan without your written authorization, unless the law requires us to share your information.
  7. Right to Request Confidential Communication You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Privacy Officer at The Whole Child. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must tell us how or where you wish to be contacted. If you do not tell us how or where you wish to be contacted, we do not have to honor your request.
  8. Right to Choose How PHI is Provided to You You have the right to choose how PHI is made available to you. While the preferred method of providing PHI to you is face to face, you may also ask to have the PHI sent to you at your primary household residence; at an alternate address (for example, sending information to your work address rather than your home address), or by alternative method including email instead of regular mail. The Whole Child will be agreeable to honor your requests providing that the PHI (in the format you requested) can be given to you without undue inconvenience. The Whole Child may not require an explanation as to the basis of the request as a condition of providing communications on a confidential basis.
  9. Right to a Copy of This Notice You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, ask any of our office staff. You also have the right to obtain this notice by email.
  10. Right to Revoke An Authorization If you provide us permission to use or disclose PHI about you and/or your child, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose PHI about you and/or your child for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
  11. Amendments to Privacy Rule (2013) Amendments were made in 2013 to the Privacy Rules which adopt the proposal in the interim rule requiring The Whole Child to provide you a copy of PHI to any individual patient requesting it in electronic form. The electronic format must be provided to you if it is readily producible. The Office for Civil Rights (OCR) clarified that The Whole Child must provide you only with an electronic copy of PHI and not direct access to its electronic health record systems. The 2013 Amendments also give you the right to direct The Whole Child to transmit and electronic copy of PHI to an entity or person designated by you. Furthermore, the 2013 Amendments restrict the fees that The Whole Child may charge you for handling and reproduction of PHI, which must be reasonable, cost –based and identify separately the labor for copying PHI (if any). Finally, the 2013 Amendments modify the timeliness requirement for right of access, from up to 90 days currently permitted to 30 days, with a one-time extension of 30 additional days.


  1. Changes to This Notice
  • The Whole Child reserves the right to change the terms of this Notice. We reserve the right to make the revised or changed Notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the facility. The Notice will contain on the first page, in the top right-hand corner, the effective date. If we change our Notice, you may obtain a copy of the revised Notice by request one from the front office.
  1. Complaints


  • If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer at The Whole Child, Los Angeles County or the U.S. Department of Health & Human Services. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint. To file a complaint with us, or if you have comments or questions regarding our privacy practices, please contact: Caesar Moreno, LCSW, Privacy Officer (562) 692-0383, ext. 236.
  • To file a complaint with the Los Angeles County Department of Mental Health: Los Angeles County Department of Mental Health (LAC-DMH); Patients’ Rights Division, 550 South Vermont Avenue, Los Angeles, CA 90020, (213) 738-4949.
  • To file a complaint with the Federal Government: Region IX, Office for Civil Rights, U.S. Department of Health and Human Services, 90 7th Street, Suite 4-100, San Francisco, CA 94103, (415) 437-8310.
  • Notification of Breaches
  • In the case of a breach, The Whole Child is required to notify each affected individual whose unsecured PHI has been compromised. Even if such a breach was caused by a business associated, The Whole Child is ultimately responsible for providing the notification directly or via the business associate. If the breach involves more than 500 persons, the Office for Civil Rights must be notified in accordance with instructions posted on its website. The Whole Child bears the burden of proof to demonstrate that all notifications were given or that the impermissible use or disclosure of PHI did not constitute a breach and must maintain supporting documentation, including documentation pertaining to the risk assessment.
  • PHI After Death


  • Generally, PHI excludes any health information of a person who has been deceased for more than 50 years after the date of death. The Whole Child may disclose deceased individual’s PHI to non-family members, as well as family members, who were involved in the care or payment for healthcare of the decedent prior to death; however, the disclosure must be limited to PHI relevant to such care or payment and cannot be inconsistent with any prior expressed preference of the deceased individual.
  1. Privacy Officer
  • Any supplemental questions or specific requests as discussed in this document can be forwarded to The Whole Child Privacy Officer listed below:
  • Caesar Moreno, LCSW, Privacy Officer: 10155 Colima Road, Whittier California 90603. Phone: (562) 692-0383, ext. 236.   Fax: (562) 692-0380.