NOTICE OF PRIVACY PRACTICES

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

If you have questions about this notice, please contact the Institute's
Privacy Officer, (805) 687-7444 ext. 2339.

This notice describes the practices of Rehabilitation Institute at Santa
Barbara (RISB) as related to the protection of the privacy of patient
information and that of:

• Any healthcare professional authorized to enter information into your
  medical record;
• All departments and units of the Institute;
• Any member of a volunteer group permitted to help while you are in the Institute; and
• All employees, staff and other Institute personnel.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Institute. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all medical information of your care maintained by the Institute, whether created by the Institute personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information maintained in the doctor's office or clinic.

This notice tells you, by giving you examples, about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information about you.

The Institute is required by law to:

• maintain the privacy of medical information that identifies you (with certain exceptions);
• give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• follow the terms of the notice that is currently in effect.

HOW RISB MAY DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe ways that we may use and disclose information. For each category of uses or disclosures we will explain what we mean and try to give some examples, although not every use or disclosure in a category may be listed.

TREATMENT

We may use medical information about you to provide you with medical treatment or services. We may disclose information about you to doctors, nurses, technicians, medical students, or other Institute personnel who are involved in taking care of you at the Institute. For example, a doctor treating your broken leg may need to know if you have diabetes because it may slow down the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that appropriate meals are planned. Several departments at the Institute may share information about you in order to coordinate your care such as prescriptions, lab work and x-rays. We may disclose medical information about you to people outside the Institute who may be involved in your medical care after you leave the Institute, such as a skilled nursing facility or home health agency.

PAYMENT

We may use and disclose medical information about you so that the treatment or services you receive at the Institute may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received so that they will reimburse you or pay the Institute. We may also tell your health plan about treatment you are going to receive to obtain prior approval or to determine whether your plan covers such treatment.

OPERATIONS OF THE INSTITUTE

We may use and disclose medical information about you to operate the Institute to the benefit of our patients. These uses and disclosures are necessary to run the Institute and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services to evaluate the performance of the staff caring for you. We may combine medical information about many Institute patients to decide what additional services we should offer, what services are not necessary and whether certain treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other Institute staff for review and learning purposes. We may combine the medical information we have with medical information from other hospitals or clinics to compare our outcomes and determine where we can make improvements in care and services. We may remove information that identifies you from this set of medical information so that others may use it to study healthcare delivery without knowing who the specific patients are.

BUSINESS ASSOCIATES

Certain business and other support functions of the Institute may be performed by our business associates. We may use or disclose your medical information to our business associates, who have agreed to safeguard your medical information just as we do, such as attorneys, accountants, and consultants who help us with our operations.

APPOINTMENT REMINDERS

We may use and disclose information to contact you as a reminder that you have an appointment or treatment or medical care at the Institute.

TREATMENT ALTERNATIVES

We may use or disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

HEALTH-RELATED PRODUCTS AND SERVICES

We may use and disclose medical information to tell you about our health-related products and services that you may benefit you as part of your continuing health care.

FUNDRAISING ACTIVITES

We may use medical information about you to contact you in an effort to solicit donations for the Institute and its programs. We may disclose general medical information to the Fund Development Department, related to the Institute, so that the foundation may contact you in raising money. We only release contact information, such as your name, address and phone number and any dates you received treatment at the Institute. If you do not want the Institute to contact you for fundraising efforts, please notify the Vice President of Fund Development in writing.

INSTITUTE DIRECTORY

We may include certain limited information about you in certain Institute patient listings while you are a patient. This information may include your name, room location, your general condition (e.g., fair, stable, etc.) and your religious affiliation, and may be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This information is released so your family, friends and clergy can visit you in the hospital and generally know how you are doing. If you object, we will not include your information in the directory or limit disclosures from the directory.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE

Unless there is a specific request, written or oral, from you to the contrary, we may: (i) share limited information about you to a friend or family member who is involved in your medical care; (ii) give limited information to someone who helps pay for your care; (iii) tell your family or friends about your condition and that you are in the Institute; and (iv) disclose certain limited medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

MEDICAL INFORMATION ABOUT MINOR CHILDREN

Parents may generally obtain medical information about their minor children. In some limited circumstances, however, we may be permitted or even required to deny parental access to a minor's medical information, such as when a minor may legally consent to health care services without parental consent.

RESEARCH

Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients 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 purposed research project and its use of information; to balance the research needs with patients' need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may, however, disclose medical information about you to people preparing to conduct a research project; for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the Institute. We will always ask whether the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the Institute.

LEGAL REQUIREMENT

We will disclose medical information about you when required to do so by federal, state or local law.

SERIOUS THREAT TO HEALTH OR SAFETY

We may use and disclose medical information about you when necessary to prevent serious threat to your health and the safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat.

ORGAN AND TISSUE DONATION

We may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

MILITARY AND VETERANS

If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release information about foreign military personnel to the appropriate foreign military authority.

WORKERS COMPENSATION

We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

PUBLIC HEALTH RISKS

We may disclose medical information about you 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 abuse or neglect of children, elders and dependent adults;
• to report reactions to medications or problems with products;
• to notify people of recalls of 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 patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required by law.
  

HEALTH OVERSIGHT ACTIVITIES

We may disclose medical information 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.

LAWSUITS AND DISPUTES

If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may disclose medical information about you in response to a subpoena, discovery request, or lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include a written notice to you) or to obtain an order protecting the information request. We may also use or disclose medical information as necessary, for example, to defend the Institute in a legal dispute.

LAW ENFORCEMENT

We may release medical information if asked to do so by law enforcement official:

• in response to a court order, subpoena, 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 able to obtain the persons agreement;
• about a death we believe may be the result of criminal conduct;
• about criminal conduct at the hospital; 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.
  

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS

We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine cause of death. We may also release medical information about patients of the Institute to funeral directors as necessary to carry out their duties.

NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES

We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS

We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

INMATES

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with care; (2) to protect health and safety of others; or (3) for the safety and security of the correctional institution.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

RIGHT TO INSPECT AND COPY

You have the right to inspect and copy medical information used to make decisions about your care. Usually, this includes medical and billing records, but may not include mental health information.

To inspect and copy medical information used to make decisions about you, a request must be submitted in writing to the Department of Medical Information Management. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, we will tell you in writing why the request was denied and explain how to have the denial reviewed, if applicable, and how to complain.

RIGHT TO AMEND

If you believe that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request the amendment for as long as the information is kept by the Institute.

To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request.

We may deny your request for 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 to amend information that:

• Was not created by the Institute, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the medical information kept by or for the Institute;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

If we deny your request for amendment, we will tell you in writing why the request was denied and explain how to submit a statement of disagreement and how to complain. Even if we deny your request for amendment, you have the right to submit a brief written addendum. If you clearly indicate in writing that you want the addendum to be part of the medical record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

RIGHT TO AN ACCOUNTING OF DISCLOSURES

You have the right to request an "accounting of disclosures." This is a list of disclosures we have made of medical information about you other than our own uses for treatment, payment and health care operations, (as those functions are described above) and with other exceptions pursuant to the law.
To request a list or accounting of disclosures, you must submit a request in writing to the Department of Medical Information Management.

Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. 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 list we may charge you for the cost of providing the list. We will inform you of the cost involved and you may choose to withdraw your request at that time before any costs are incurred.

RIGHT TO REQUEST RESTRICTIONS

You have the right to request a restriction or limitation on the medical information we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you could ask that we not use or disclose information about a certain medical procedure.
We do not have to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

RIGHT TO REQEST CONFIDENTIAL COMMUNICATIONS

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 Institute's Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

RIGHT TO A PAPER COPY OF THIS NOTICE

You have the right to a paper copy of this notice. You may ask that we give you this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.

You may obtain a copy of this notice on our website at www.risb.org.

To obtain a paper copy, please contact the Institute's Privacy Officer.

CHANGES TO THE NOTICE

We reserve the right to change this notice. We reserve the right to make the revised notice effective for medical information 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 Institute. The posted notice will contain on the top of the first page in the right-hand corner, the effective date. In addition, we will provide a copy of the current notice each time you are admitted to the Institute.