JBA Institute Notice of Privacy Practices 

I. 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.

 

II. JBA INSTITUTE (JBA) HAS A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED
HEALTH INFORMATION (PHI)

 

JBA is legally required to protect the privacy of your PHI, which includes information that can be used to
identify you that JBA created or received about your past, present, or future health or condition, the
provision of health care to you, or the payment of this health care. JBA must provide you with this Notice
about privacy practices, and such Notice must explain how, when, and why JBA will “use” and “disclose”
your PHI. A “use” of PHI occurs when JBA shares, examines, utilizes, applies, or analyzes such
information within the practice; PHI is “disclosed” when it is released, transferred, has been given to, or is
otherwise divulged to a third party outside of JBA’s practice. With some exceptions, JBA may not use or
disclose any more of your PHI than is necessary to accomplish the purpose for which the use or disclosure
is made. And, JBA Institute is legally required to follow the privacy practices described in this Notice.
 

However, JBA reserves the right to change the terms of this Notice and the privacy policies at any time.
Any changes will apply to PHI on file with JBA already. Before JBA makes any important changes to the
agency’s policies, this Notice will be promptly changed and a new copy will be posted on JBA’s website.
You can also request a copy of this Notice from JBA Institute, or you can view a copy of it on the website,
which is located at www.JBAInstitute.com.
 

III. HOW JBA MAY USE AND DISCLOSE YOUR PHI.

JBA will use and disclose your PHI for many different reasons. For some of these uses or disclosures, JBA
will need your prior written authorization; for others, however, we do not. Listed below are the different
categories of uses and disclosures along with some examples of each category.


A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Do Not Require
Your Prior Written Consent. JBA can use and disclose your PHI without your consent for the following
reasons:


1. For Treatment. JBA can use your PHI within the practice to provide you with mental health treatment
and behavioral health treatment (i.e., ABA), including discussing or sharing your PHI with JBA staff. JBA
can disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers
who provide you with health care services or are involved in your care. For example, if a psychiatrist is
treating you, JBA can disclose your PHI to your psychiatrist to coordinate your care.
 

2. To Obtain Payment for Treatment. JBA can use and disclose your PHI to bill and collect payment for
the treatment and services provided by JBA to you. For example, JBA might send your PHI to your
insurance company or health plan to get paid for the health care services that JBA has provided to you. JBA
may also provide your PHI to business associates, such as billing companies, claims processing companies,
and others that process the agency’s health care claims.


3. For Health Care Operations. JBA can use and disclose your PHI to operate the agency. For example,
JBA might use your PHI to evaluate the quality of health care services that you received or to evaluate the
performance of the health care professionals who provided such services to you. JBA may also provide
your PHI to the agency’s accountant, attorney, consultants, or others to further JBA’s health care
operations.


4. Patient Incapacitation or Emergency. JBA may also disclose your PHI to others without your consent
if you are incapacitated or if an emergency exists. For example, your consent isn't required if you need
emergency treatment, as long as an attempt to obtain your consent after treatment is rendered, or if an
attempt to get your consent is made but you are unable to communicate with JBA staff directly (for
example, if you are unconscious or in severe pain), and JBA staff felt that you would consent to such
treatment if you were able to do so.
 

B. Certain Other Uses and Disclosures Also Do Not Require Your Consent or Authorization. JBA can
use and disclose your PHI without your consent or authorization for the following reasons:


1. When federal, state, or local laws require disclosure. For example, JBA may have to make a disclosure
to applicable governmental officials when a law requires JBA to report information to government agencies
and law enforcement personnel about victims of abuse or neglect pertaining to children, dependent adults,
and/or elders.


2. When judicial or administrative proceedings require disclosure. For example, if you are involved in a
lawsuit or a claim for workers’ compensation benefits, JBA may have to use or disclose your PHI in
response to a court or administrative order. JBA may also have to use or disclose your PHI in response to a
subpoena.


3. When law enforcement requires disclosure. For example, JBA may have to use or disclose your PHI in
response to a search warrant.


4. When public health activities require disclosure. For example, JBA may have to use or disclose your PHI
to report to a government official an adverse reaction that you have to a medication.


5. When health oversight activities require disclosure. For example, JBA may have to provide information
to assist the government in conducting an investigation or inspection of a health care provider or
organization.


6. To avert a serious threat to health or safety. For example, JBA may have to use or disclose your PHI to
avert a serious threat to the health or safety of others. However, any such disclosures will only be made to
someone able to prevent the threatened harm from occurring.


7. For specialized government functions. If you are in the military, JBA may have to use or disclose your
PHI for national security purposes, including protecting the President of the United States or conducting
intelligence operations.
 

8. To remind you about appointments and to inform you of health-related benefits or services. For example,
JBA may have to use or disclose your PHI to remind you about your appointments, or to give you
information about treatment alternatives, other health care services, or other health care benefits that may
be of interest to you.
 

C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.


1. Disclosures to Family, Friends, or Others. JBA may provide your PHI to a family member, friend, or
other person that you indicate is involved in your care or the payment for your health care, unless you
object in whole or in part. The opportunity to consent may be obtained retroactively in emergency
situations.


D. Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not
described in sections III A, B, and C above, JBA will need your written authorization before using or
disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later
revoke such authorization in writing to stop any future uses and disclosures (to the extent that JBA hasn't
taken any action in reliance on such authorization) of your PHI by JBA.


IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

 

You have the following rights with respect to your PHI:
 

A. The Right to Request Restrictions on JBA Uses and Disclosures. You have the right to request
restrictions or limitations on JBA uses or disclosures of your PHI to carry out a treatment, payment, or
health care operations. You also have the right to request that JBA restrict or limit disclosures of your PHI
to family members or friends or others involved in your care or who are financially responsible for your
care. Please submit such requests to JBA in writing. JBA will consider your requests, but JBA is not legally
required to accept them. If JBA does accept your requests, we will put them in writing and will abide by
them, except in emergency situations. However, be advised, that you may not limit the uses and disclosures
that JBA is legally required to make.


B. The Right to Choose How I Send PHI to You. You have the right to request that JBA send
confidential information to you to at an alternate address (for example, sending information to your work
address rather than your home address) or by alternate means (for example, e-mail instead of regular mail).
JBA must agree to your request so long as it is reasonable and you specify how or where you wish to be
contacted, and, when appropriate, you provide JBA with information as to how payment for such alternate
communications will be handled. JBA may not require an explanation from you as to the basis of your
request as a condition of providing communications on a confidential basis.


C. The Right to Inspect and Receive a Copy of Your PHI. In most cases, you have the right to inspect
and receive a copy of the PHI that JBA maintains, but you must make the request to inspect and receive a
copy of such information in writing. JBA will respond to your request within 30 days of receiving your
written request. In certain situations, JBA may deny your request. If this occurs, JBA will tell you, in
writing, reasons for the denial and explain your right to have the denial reviewed.


If you request copies of your PHI, JBA will charge you not more than $.25 for each page. Instead of
providing the PHI you requested, JBA may provide you with a summary or explanation of the PHI as long
as you agree to that and to the cost in advance.


D. The Right to Receive a List of the Disclosures JBA Has Made. You have the right to receive a list of
instances, (i.e., an Accounting of Disclosures), in which JBA has disclosed your PHI. The list will not
include disclosures made for treatment, payment, or health care operations; disclosures made to you;
disclosures you authorized; disclosures incident to a use or disclosure permitted or required by the federal
privacy rule; disclosures made for national security or intelligence; disclosures made to correctional
institutions or law enforcement personnel; or, disclosures made before April 14, 2003.


JBA will respond to your request for an Accounting of Disclosures within 60 days of receiving such
request. The list compiled by JBA will include disclosures made since start of treatment with JBA Institute
or in the last six years (whichever is sooner) unless you request a shorter time. The list will include the date
the disclosure was made, to whom the PHI was disclosed (including their address, if known), a description
of the information disclosed, and the reason for the disclosure. JBA will provide the list to you at no
charge, but if you make more than one request in the same year, JBA may charge you a reasonable, cost-
based fee for each additional request.

 

E. The Right to Amend Your PHI. If you believe that there is a mistake in your PHI or that a piece of
important information is missing, you have the right to request that JBA correct the existing information or
add the missing information. You must provide the request and your reason for the request in writing. JBA
will respond within 60 days of receiving your request to correct or update your PHI. JBA may deny your
request in writing if the PHI is (i) correct and complete, (ii) not created by JBA, (iii) not allowed to be
disclosed, or (iv) not part of JBA records. JBA’s written denial will state the reasons for the denial and
explain your right to file a written statement of disagreement with the denial. If you don't file one, you have
the right to request that your request and JBA’s denial be attached to all future disclosures of your PHI. If
JBA approves your request, we will make the change to your PHI, tell you that change was made, and tell
others that need to know about the change to your PHI.


F. The Right to Receive a Paper Copy of this Notice. You have the right to receive a paper copy of this
notice even if you have agreed to receive it via e-mail.
 

V. HOW TO COMPLAIN ABOUT JBA’S PRIVACY PRACTICES


If you feel that JBA may have violated your privacy rights, or if you disagree with a decision made about
access to your PHI, you may file a complaint with the person listed in Section Vl below. You also may
send a written complaint to the Secretary of the Department of Health and Human Services at 200
Independence Avenue S.W., Washington, D.C. 20201. JBA will take no retaliatory action against you if
you file a complaint about JBA’s privacy practices.


VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN
ABOUT MY PRIVACY PRACTICES

 

If you have any questions about this notice or any complaints about JBA’s privacy practices, or would like
to know how to file a complaint with the Secretary of the Department of Health and Human Services,
please send your correspondence either by mail to the Privacy Officer of JBA Institute at 65 Enterprise, Aliso Viejo, CA, 92656; or by fax at (866) 522-4149.

 

VlI. EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on September 30, 2011.