Children's Recovery Center of Northern California
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Creating Big Miracles for Life's Little People


Children’s Recovery Center

3777 South Bascom Avenue, Campbell, CA  95008




At Children’s Recovery Center we are committed to treating and using protected health information (PHI) about your child responsibly. This Notice of Privacy Practices describes the protected health information (PHI) we collect and how and when we use or disclose that information. It also describes your rights as they relate to your child’s protected health information. PHI may include your child’s health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, plans for care or treatment, billing activity and similar types of health-related information. It may be in the form of written or electronic records or spoken words.

 Understanding Your Child’s Medical Record

Each time your child receives care at Children’s Recovery Center, a record of his or her stay is made. This information is often referred to as your child’s medical record and serves as a:

         Basis for planning care and treatment

         Means of communication among the many health professionals who contribute to your child’s care

         Legal document describing the care received

         Means by which you or a third party payer can verify that services billed were actually provided

         A tool in educating health professionals

         A source of data for medical research

         A source of information for public health officials charged with improving the health of this state and the nation

         A source of data for planning and marketing

         A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your child’s record and how his or her PHI is used helps you to ensure its accuracy, better understand who, what, when, where and why others may access your child’s health information, and make more informed decisions when authorizing disclosures to others.

Your Health Information Rights

You have the following rights regarding Health Information we maintain about your child:

         In general, you have the right to inspect and receive a copy of your child’s health records in designated record sets, such as the medical record or billing records. We may charge you a fee for the copies.

         If you believe there is a mistake or important omission in your child’s health record, you may request a correction or addition.

         You may obtain from us a list of our disclosures of your child’s PHI as provided by federal law

         You may request that we communicate health information about your minor child to you at an alternative location (for example, to a work address) or by different means (for example, by fax instead of telephone).

         You may request a restriction on certain uses and disclosures of your child’s PHI as provided by federal law.

         You have the right to be notified upon a breach of any of your child’s unsecured PHI.

         If you paid out-of-pocket in full for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be communicated to your health plan.

         You have the right to receive a paper copy of the Notice of Privacy Practices upon request.

Our Responsibilities

Children’s Recovery Center is required to:

         Maintain the privacy of your child’s PHI

         Provide you with this Notice as to our legal duties and privacy practices with respect to the information we collect and maintain about your child.

         Abide by the terms of this notice.

         Notify you if we are unable to agree to a requested restriction.

         Accommodate reasonable requests you may have to communicate PHI by alternative means or at alternative locations.

 How We May Use or Disclose Your Child’s Protected Health Information

For Treatment.  For example, information obtained by a nurse, physician, or other member of your child’s health care team will be recorded in your child’s record and used to determine the course of treatment that should work best for him or her. Your child’s physician will document in the record his or her expectations of the members of your child’s health care team. Members of the team will then record the actions they took and their observations. In that way, the physician will know how your child is responding to treatment. We will also provide your child’s physician or subsequent health care providers with copies of various reports that should assist him or her in your child’s treatment. This is to include all health care providers in our practice and those assisting in coverage of our practice.

For Payment. For example, a bill may be sent to an insurance company The information on or accompanying the bill may include information that identifies your child, as well as his or her diagnoses, procedures, and supplies used.

For Health Care Operations. For example, members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your child’s health record to assess the care and outcomes in your child’s case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.

Business Associates. There are some services provided in our organization through contracts with business associates. Examples include radiology and laboratory tests and transcription services. When these services are contracted, we will disclose your child’s PHI to our business associates so that they can perform the job we’ve asked them to do. To protect your child’s privacy, however, we require the business associate to appropriately safeguard your child’s PHI.

Directory. Unless you notify us that you object, we will use your child’s name, location within the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you or your child by name.

Communication with family. Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, PHI relevant to that person’s involvement in your child’s care or payment related to your child’s care.

Research. We may disclose PHI to researchers when their research proposal has been approved by an Institutional Review Board (IRB) under federal law.

Funeral directors and county coroner. We may disclose PHI to funeral directors and the county coroner’s office, consistent with applicable law, to carry out their duties.

Organ procurement organizations. Consistent with applicable law, we may disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Fund raising. We may contact you as part of a fund-raising effort. Please notify us if you do not wish to be contacted during fund raising campaigns.

Food and Drug Administration (FDA). We may disclose to the FDA PHI relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Health oversight. As a health care provider we are subject to oversight conducted by federal and state agencies. These agencies may conduct audits of our operations and activities and in that process they may review PHI.

Workers compensation. We may disclose PHI to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health. As required by law, we may disclose PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Required by law. In some circumstances federal or state law requires that we disclose PHI to others. For example, the secretary of the Department of Health and Human Services may review our compliance efforts, which may include seeing protected health information.

Law enforcement. In some circumstances we will disclose PHI to law enforcement officials, for example, to respond to a search warrant or to report a crime on our premises.

Lawsuits and other legal disputes. We may use and disclose PHI to respond to a court or administrative order, subpoena, or to defend a lawsuit or arbitration.

Abuse and neglect. By law we will disclose PHI to the appropriate authority to report suspected child abuse or neglect or to identify suspected victims of abuse, neglect, or domestic violence.

Serious threat to health or safety. We may use and disclose PHI is we believe it is necessary to avoid a serious threat to your health or safety or to someone else’s.

All Other Uses and Disclosures Require Your Written Authorization

Except as described above in this Notice, we will not use or disclose your child’s protected health information without your written authorization. The following uses and disclosures of your child’s PHI will be made only with your written authorization:

         Uses and disclosures of PHI for marketing purposes

         Disclosures that constitute a sale of your child’s PHI

         Any disclosure of psychotherapy notes

When your authorization is required and you have authorized us to use or disclose your child’s PHI, you may revoke that authorization by notifying us in writing at any time. The revocation will not apply to any authorized use or disclosure of your child’s PHI that took place before we received your revocation.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact our Social Work Office at 408-558-3642. If you believe your child’s privacy rights have been violated, you can file a complaint with our Social Worker or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either our Social worker or the Office for Civil Rights.

Changes to This Notice

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will promptly revise this Notice and provide a new Notice on our web site at

Effective Date:  This Notice is effective 9/23/13