This Notice of Privacy Practices (the “Notice”) describes Lightfully (the “Lightfully”) practices and those of Lightfully employees, staff, volunteers, and other personnel who are involved in your care. Lightfully and these individuals will follow the terms of this Notice and may use or disclose medical information about you to carry out treatment, payment or health care operations, or for other purposes as permitted or required by law. This Notice describes your rights to access and control medical information about you, including information that may identify you and that relates to your past, present, or future physical, medical, or mental condition and medical care and related health care services.

 

 

Lightfully understands that medical information about you and your health is personal. Lightfully is committed to protecting medical information about you. To provide you with quality care and to comply with certain state and federal legal requirements, Lightfully creates a record of the services you receive at Lightfully. This Notice applies to all of the records of your care generated by Lightfully. This Notice will tell you about the ways in which Lightfully may use and disclose medical information about you. It also describes your rights and certain obligations Lightfully has regarding the use and disclosure of medical information. Lightfully is required by law to: (1) make sure that medical information that identifies you is kept private; (2) give you this Notice of its legal duties and privacy practices concerning medical information about you; (3) follow the terms of the Notice that are currently in effect, and (4) notify you in case there is an unauthorized use or disclosure of your unsecured medical information.

 

 

Federal and state laws both have rules and regulations regarding the protection of your health information. When state law and federal law differ, federal law requires that providers comply with the federal or state law that provides clients with greater protection.

 

 

The following categories describe different ways that Lightfully may use or disclose protected medical information. For each category of uses and disclosures, Lightfully will explain what is meant and may give some examples. Not every use or disclosure in a category will be listed. However, all of the ways Lightfully is permitted to use and disclose information will fall within

one of the categories. Some information such as psychotherapy notes, certain drug and alcohol information, HIV, or mental health information is entitled to special restrictions.

 

For Treatment. Lightfully may use clinical information about you to provide you with treatment and to coordinate or manage your treatment and any related services. We may disclose information about you to Lightfully staff or other providers involved in your treatment. We may also disclose your clinical information to family members or other individuals involved in your continuing medical care after you leave Lightfully. For example, Lightfully may share your protected health information between or among Lightfully personnel to assist your health care providers in treating you.

 

For Payment. Lightfully may use and disclose medical information about you so that Lightfully can get paid for the treatment and services you receive at Lightfully. For example, Lightfully may need to give information to your health plan or to the Medi-Cal or Medicare program about treatment you receive at Lightfully so that they will pay Lightfully or reimburse you for your care. Lightfully may also tell your health plan about a proposed treatment to determine whether your plan will cover the treatment.

 

For Health Care Operations. Lightfully may use and disclose medical information about you to carry out activities that are necessary for Lightfully operations. These uses or disclosures are made for quality of care, compliance activities, administrative purposes, contractual obligations, grievances, or lawsuits. For example, Lightfully may use medical information to review treatment and services provided at Lightfully or to evaluate the performance of its staff and contractors in caring for you.

 

To Individuals or Family Members Involved in Your Health Care. Unless you object, Lightfully may disclose medical information about you to a member of your family, a relative, close friend, or any other person that you identify who is involved in your care. Lightfully may also tell your family or friends, personal representative, or any other person who is responsible for your care, of your location, general condition, or death, unless you object.

 

For Appointment Reminders. Lightfully reserves the right to contact you, in a manner permitted by law, with appointment reminders or information about treatment alternatives and other health-related benefits that may be appropriate for you.

 

Emergencies. Lightfully may disclose medical information about you to a public or private entity assisting in disaster relief so that your family can be notified about your condition, status, or location. You may object to this disclosure with a written request. However, if you

are not available or are unable to agree or object, or in some emergency circumstances, Lightfully will use its professional judgment to decide whether this disclosure is in your best interest.

 

As Required by Law. Lightfully will disclose your health information when required to do so by federal, state, or local law.

 

Workers’ Compensation. Lightfully may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

 

For Public Health Activities. Lightfully may disclose medical information about you for public health activities. These purposes generally include the following: (1) To prevent or control disease, injury, or disability; (2) to report deaths; (3) to report abuse or neglect of children, elders, and dependent adults; (4) to report reactions to medications or problems with products; (5) to notify people of recalls of products they may be using; and (6) to notify a person who may have been exposed to a disease or who may be at risk for contracting or spreading a disease or condition.

 

For Health Oversight Activities. Lightfully may disclose medical information about you to a health oversight agency for activities authorized by law.

 

Lightfully Directory. Lightfully may list your name, location, general description of your condition (excluding medical information), and your religious affiliation in Lightfully’s Directory of clients, for internal use only.

 

 

For Lawsuits and Disputes. Lightfully may disclose medical information about you in response to a court or administrative order, subpoena, discovery request, or other lawful process.

 

Disclosure to Law Enforcement. If asked to do so by law enforcement and as authorized or required by law, Lightfully may release medical information: (1) to identify or locate a suspect, fugitive, material witness, or missing person; (2) about a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (3) about a death suspected to be the result of criminal conduct; (4) about criminal conduct at Lightfully; and (5) in case of a medical emergency, to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

 

Decedents. Lightfully may release medical information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. Lightfully may also release medical information about you to funeral directors. Lightfully may also release information to any individual known to Lightfully as a family member, close friend of the family, or any other person identified, who was involved in your care or the payment for your care prior to your death, unless you indicate otherwise. Your medical information may be used or disclosed to others without your authorization after fifty (50) years from the date of your death.

 

For Specialized Government Functions. Lightfully may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities.

 

Information About Inmates/Individuals in Custody. If you are an inmate or under the custody of a law enforcement official, Lightfully may release medical information about you to the correctional institution or law enforcement official responsible for you as authorized or required by law.

 

Disclosure For Threats to Health and Safety. In certain circumstances, Lightfully may be required to disclose medical information to avert a serious threat to your health and safety or the health and safety of another person as required by law enforcement. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.

 

 

Psychotherapy Notes. Lightfully will not release any psychotherapy notes without a specific authorization from you that allows Lightfully to release the notes.

 

Marketing. Lightfully will not release your medical information for marketing purposes without authorization from you.

 

Sale of Medical Information. Lightfully will not sell your medical information without authorization from you.

 

HIV/AIDS Test Results. Lightfully will not disclose the results of an HIV/AIDS test unless you give Lightfully specific written authorization. Lightfully may disclose HIV/AIDS test results without your specific authorization as required by state or federal reporting laws.

 

 

You have the following rights regarding your medical information. To exercise these rights, you must contact The Privacy Officer at Lightfully. You may be asked to submit a written request. The Privacy Officer may be contacted using the following information:

Attn: Privacy Officer

3435 E. Thousand Oaks Blvd

Thousand Oaks, CA 91362

Phone: (669) 721-0872

Fax: 669-721-0872

Email: compliancehotline@lightfully.com

 

Right to Inspect and Copy. With certain exceptions, you have the right to inspect and receive copies of your medical information.

 

Amendment. If you feel that medical information about you is incorrect or incomplete, you may ask Lightfully to amend the information.

 

Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures that we may have made of your medical information.

 

Right to Request Restrictions. You have the right to request a restriction or limitation on medical information that Lightfully uses or discloses about you for treatment, payment, or health care operations, and to request a limit on the medical information that Lightfully may disclose to family members or friends involved in your care.

 

Request Confidential Communications. You have the right to request that Lightfully communicate with you about matters related to your treatment in a specific way or at a specific location.

 

Receive a Copy. You have the right to obtain a copy of this notice.

 

 

Lightfully reserves the right to change the terms of this Notice at any time. Lightfully reserves the right to make the revised or changed notice effective for medical information Lightfully already has about you as well as any information Lightfully receives in the future. Lightfully will post a copy of the current Notice. The Notice will contain an effective date.

 

 

If you have any questions or believe that your privacy rights have been violated, you may contact Lightfully’s Privacy Officer in person or mail a written summary of your concern to the address listed above.

 

You may also file a complaint with the Department of Health and Human Services as follows:

 

Michael Leoz, Regional Manager

Office for Civil Rights

U.S. Department of Health and Human Services

90 7th Street, Suite 4-100

San Francisco, CA 94103

Customer Response Center: (800) 368-1019

Fax: (202) 619-3818

TDD: (800) 537-7697

Email: OCRPrivacy@hhs.gov

 

You will not be penalized or retaliated against for filing a complaint.

 

 

Other uses and disclosures of medical information not covered by this Notice or the laws that apply to use will be made only with your written permission. If you provide Lightfully with permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission Lightfully will stop any further use or disclosure of your medical information for the purposes covered by your written authorization, except if Lightfully has already acted in reliance on your permission. You understand that Lightfully is unable to take back any disclosure Lightfully has already made with your permission and that Lightfully is required to retain its records of the care that Lightfully provided for you.