Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 1 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
San Mateo County Health System
Behavioral Health and Recovery Services
NOTICE OF PRIVACY PRACTICES
SUMMARY
Updated 12/28/2021
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 any questions about this notice, please contact the Office of
Consumer and Family Affairs at 1-800-388-5189.
Behavioral Health and Recovery Services values your privacy and will protect
behavioral health information about you or your child.
The complete Notice of Privacy Practices tells you in detail about how we
safeguard your behavioral health information to make sure only the minimum
amount of information is used or disclosed to individuals with a legal right to
access or read your behavioral health information. PLEASE REVIEW IT
CAREFULLY.
“Use” means the sharing and using of information by behavioral health staff.
“Disclosure” is the release of information by us to others outside of Behavioral
Health Services.
“Authorization” is you giving us written permission to release your information
to you or to other persons.
“SUDS” substance use disorder treatment and “AOD” alcohol and other drugs
treatment are used interchangeably in San Mateo County.
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 2 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
We invite you to go to one of the links below to help you understand your
rights and what specific services are provided by BHRS, including:
• Guide to Medi-Cal Services
• Consumer Rights and Problem Resolution Brochure
• List of BHRS Providers
For Mental Health Services:
https://www.smchealth.org/new-client-information-english
For Substance Use Services:
English:
https://www.smchealth.org/sites/main/files/file-
attachments/dmc-ods_member_handbook_072018.pdf
Spanish: https://www.smchealth.org/sites/main/files/file-
attachments/dmc-ods-member-handbook-spanish.pdf
By law, you have the legal right to:
• Be given this written notice explaining how Behavioral Health and
Recovery Services will use and disclose your information.
• See your records and get a copy of them, with a few exceptions.
• Ask to correct or add information to your behavioral health records.
• Find out, in writing, where we disclosed your health information.
• Authorize the release of your own health information; Behavioral Health
may release information needed for mental health treatment, mental
health payment or our own business operations without your
authorization, in many cases. SUDS treatment requires your
authorization to release your information for treatment and for payment,
in most cases.
The Notice will tell you:
• How to ask Behavioral Health and Recovery Services about seeing
your chart, getting a copy, making changes or releasing your
information.
• How we will respond to any of your requests.
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 3 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
• How to make a complaint about the use or disclosure of your Protected
Health Information. It will tell you that you may complain to Behavioral
Health and that you may also complain to the Secretary of Health and
Human Services.
San Mateo Behavioral Health and Recovery Services pledges that we will
follow this Notice. It will be posted at all Behavioral Health sites, and if any
part of it changes, new notices will be available.
If you have any questions about your privacy rights, please contact:
Office of Consumer and Family Affairs at 1-800-388-5189
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices of San Mateo County Behavioral Health
and Recovery Services and that of:
• Any health care professional authorized to provide treatment and to
enter information into your behavioral health record.
• All teams and services of San Mateo County Behavioral Health and
Recovery Services.
• Any volunteer or student who provides services to you.
• All employees, contract staff and other behavioral health personnel.
All Behavioral Health and Recovery Services’ providers, teams and clinics
follow the terms of this notice. In addition, these providers, teams and clinics
may share behavioral health information with each other for treatment,
payment or medical operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that behavioral health information about you is personal. We
are committed to protecting behavioral health information about you. We
create a record of the care and services you receive from San Mateo County
Behavioral Health and Recovery Services. We need this record to provide
you with quality care and to comply with certain legal requirements. This
notice applies to all of the records of your care generated by County
Behavioral Health and Recovery Services, whether made by your personal
therapist, doctor, treatment team or other personnel. In addition, for services
provided at County Medical Clinics or at San Mateo County Health Center,
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 4 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
there may be other policies or notices regarding the use and disclosure of
your medical information created in those locations.
This notice will tell you about the ways in which we may use and disclose
behavioral health information about you. We also describe your rights and
certain obligations we have regarding the use and disclosure of behavioral
health information.
We are required by law to:
• Make sure that behavioral health information that identifies you is kept
private.
• Give you this notice of our legal duties and privacy practices with
respect to behavioral health information about you.
• Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT
YOU
The following categories describe different ways that we use and disclose
behavioral health information. For each category of uses or disclosures we
will explain what we mean and try to give some examples. Not every use or
disclosure in a category will be listed. However, all the ways we are permitted
to use and disclose information will fall within one of the following categories.
For MENTAL HEALTH Treatment: We may use medical information
about you to provide you with behavioral health treatment or services.
We may disclose behavioral health information about you to your
doctors, nurses, other therapists, case managers, students, or other
behavioral health personnel who are involved in taking care of you. We
may also disclose information about your treatment to other medical
professionals caring for you. For example, a doctor treating you for
diabetes may need to know what medications your psychiatrist has
prescribed to be sure they work together. In addition, your case
manager may need to know if you have diabetes so that we can help
you with an appropriate diet. Different behavioral health teams also may
share medical information about you in order to coordinate the different
things you need, such as prescriptions, lab work, referrals and case
management. We also may disclose behavioral health information
about you to people outside the County system who may be involved in
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 5 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
your behavioral health or medical care, such as your other case
managers or, with your consent, family members, clergy or others who
may be providing services that are part of your care.
For MENTAL HEALTH Payment: We may use and disclose
behavioral health information about you so that the treatment and
services you receive from San Mateo County Behavioral Health and
Recovery Services may be billed to 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 therapy you received at a
behavioral health clinic so your health plan will pay us or reimburse you
for these 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, BOTH SUDS AND MENTAL HEALTH:
We may use and disclose behavioral health information about you for
Behavioral Health and Recovery Service’s operations. These uses and
disclosures are necessary to run our system and make sure that all of
our clients receive quality care. For example, we may use medical
information to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also combine
medical information about many behavioral health clients to decide
what additional services Behavioral Health and Recovery Services
should offer, what services are not needed, and whether certain new
treatments are effective. We may also disclose information to doctors,
nurses, therapists, students, and other behavioral health personnel for
review and learning purposes. We may also combine the behavioral
health information we have with behavioral health information from
other counties to compare 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 from this set of medical information so
others may use it to study health care and health care delivery without
learning who the specific clients are.
Appointment Reminders, BOTH SUDS AND MENTAL HEALTH: We
may use and disclose medical information to contact you as a reminder
that you have an appointment for assessment or treatment at
Behavioral Health and Recovery Services.
Email and Text, BOTH SUDS AND MENTAL HEALTH: If you provide
BHRS with your email address and/or cell phone number, we may
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 6 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
email or text you information about your services, send you resources,
or reminders. There is a level of risk involved in emailing or texting
confidential information. Please talk with your provider about potential
risks and benefits to emailing or texting.
Health-Related Benefits and Services, BOTH SUDS AND MENTAL
HEALTH: We may use and disclose behavioral health information 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, BOTH
SUDS AND MENTAL HEALTH: We may release behavioral health
information about you, with your consent, to a friend or family member
who is involved in your medical care. We may also give information to
someone who helps pay for your care, in many cases. If you are
admitted into a hospital, we may release medical information to a family
member or others involved in your care so that they can know where
you are. In addition, we may disclose 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.
Audits, BOTH SUDS AND MENTAL HEALTH: We may use and
disclose behavioral health information about you to auditors and
evaluators.
Research, BOTH SUDS AND MENTAL HEALTH: Under certain
circumstances, we may use and disclose behavioral health information
about you 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 medical information, trying to balance the research needs with
clients’ need for privacy of their behavioral health information. Before
we use or disclose behavioral health 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 clients with specific behavioral health needs, so long as
the information they review does not leave Behavioral Health and
Recovery Services. We will almost always ask for your specific
permission if the researcher will have access to your name, address or
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 7 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
other information that reveals who you are, or will be involved in your
care.
As Required by Law, BOTH SUDS AND MENTAL HEALTH: We will
disclose behavioral health information about you when required to do
so by federal, state, or local law, for example:
o To report suspected child or elder abuse or neglect; and
o To report a crime or a threat to commit a crime on program
premises or against program personnel.
To Avert a Serious Threat to Health or Safety, BOTH SUDS AND
MENTAL HEALTH: We may use and disclose behavioral health
information about you when necessary to prevent a serious threat to
your 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. We may use and disclose behavioral health
information about you in a medical emergency.
QSO, BOTH SUDS AND MENTAL HEALTH: BHRS may disclose
your information to a qualified service organizations or business
associates who provide services to the program’s treatment, payment,
or health care operations.
OTHER SPECIAL CATEGORIES OF INFORMATION, BOTH SUDS
AND MENTAL HEALTH: Special legal requirements may apply to the
use or disclosure of certain categories of information e.g., tests for the
human immunodeficiency virus (HIV) or treatment and services for
alcohol and drug use. In addition, somewhat different rules may apply
to the use and disclosure of medical information related to any general
medical (non-mental health) care you receive.
Other disclosures not listed above will be made only with the patient’s
consent/authorization unless there is a legal exception.
SUBSTANCE USE INFORMATION
The San Mateo BHRS Substance Use Treatment Team is comprised of
multiple programs within in our Electronic Medical Record. However, it is
considered one large SUDS treatment team that may share your information
as needed during your care.
Although the federal Privacy Rule does not make a distinction between
medical and substance use information, other federal statutes and California
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 8 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
state laws do provide statutory restrictions for the release of information
developed or obtained in the course of providing substance use treatment in
federally-funded substance use programs. Substance use information
obtained during general medical/ or mental health treatment is not subject to
these provisions. Therefore, substance use information may be shared
among Behavioral Health providers and to its contracted providers without
authorization of the patient for patient care purposes. For example, substance
use information may be shared from the General Medical Clinic to Behavioral
Health Mental Health Services or to a substance use treatment program.
However, the substance use treatment program must obtain the patient’s
authorization to share information back to the General Medical Clinic or
Behavioral Health Mental Health Services. All other uses and disclosures
require specific substance use authorization from the patient. Information
pertaining to substance use treatment is subject to special protection under
Federal Statute 42 U.S.C. Section 290dd-2 and under federal regulations
found in the "Confidentiality of Alcohol and Drug Abuse Patient Records," 42
C.F.R. part 2. Additionally, California Health and Safety Code Section 11977
provides special protections to information of certain drug use programs. The
Petris and Alan Short (LPS) Act may also apply if the patient receives
services such as involuntary evaluation and treatment because the patient is
gravely disabled or dangerous to self or others as a result of use of alcohol,
narcotics, or other dangerous drugs. These federal and state statutes require
written authorization for disclosure of substance use information in certain
circumstances and other special protections for substance use information. In
these situations, the state law must be followed.
SPECIAL SITUATIONS
Military and Veterans. If you are a member of the armed forces, we
may release behavioral health information about you as required by
military command authorities.
Workers’ Compensation. We may release behavioral health
information about you for Workers’ Compensation or similar programs.
These programs provide benefits for work-related injuries or illness.
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 9 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
Public Health Risks. We may disclose behavioral health information
about you for public health activities. These activities generally include
the following:
o To prevent or control disease, injury or disability.
o To report births and deaths.
o To report the abuse or neglect of children, elders and dependent
adults.
o To report reactions to medications or problems with products.
o To notify people of recalls of products they may be using.
o 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.
Health Oversight Activities. We may disclose behavioral health
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 a dispute,
we may disclose behavioral health information about you in response to
a court or administrative order. We may also disclose behavioral health
information about you in response to a subpoena, discovery request, or
other lawful process to someone else involved in the dispute, but only if
efforts have been made to tell you about the request (which may
include written notice to you) or to obtain an order protecting the
information requested.
Law Enforcement. We may release behavioral health information if
asked to do so by a law enforcement official:
o In response to a court order, warrant, summons or similar
process.
o To identify or locate a suspect, fugitive, material witness, or
missing person.
o About the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement.
o About a death we believe may be the result of criminal conduct.
o About criminal conduct at behavioral health locations.
o 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.
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 10 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
Coroners, Medical Examiners and Funeral Directors. We may
release behavioral health information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death.
National Security and Intelligence Activities. We may release
behavioral health 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 behavioral health
information about you to the correctional institution or law enforcement
official. This release would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or the health
and safety of others; or (3) the safety and security of the correctional
institution.
HIE. Your information will be shared in the SMC Connected Care
Health Information Exchange (HIE) database. The HIE allows your
current San Mateo County providers access to important information to
improve your care, such as your current medications and diagnosis.
You may opt-out of the HIE. SUDS information will only be available to
other provides from the HIE in the case of an emergency, which is
consider a “break the glass” situation allowing them to see your
information due to your health emergency. Please note that opting out
only means your information will not be included in the SMC Connected
Care HIE database. Providers may still have access to your San Mateo
County medical records, as appropriate.
o This is the Opt-Out Form:
https://www.smchealth.org/sites/main/files/smc_connected_care_
opt_out_form_2.pdf
YOUR RIGHTS REGARDING YOUR BEHAVIORAL HEALTH
INFORMATION
You have the following rights regarding behavioral health information we
maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy
behavioral health information that may be used to make decisions
about your care. Usually, this includes behavioral health
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 11 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
therapy/services information and billing records, but certain behavioral
health information may not be included. To inspect and copy behavioral
health information that may be used to make decisions about you, you
must submit your request in writing to the clinic where you are receiving
treatment, OR to San Mateo County Behavioral Health and Recovery
Services, 1950 Alameda de las Pulgas, San Mateo, CA 94403. 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 behavioral health
information, you may request that the denial be reviewed. Another
licensed health care professional chosen by us will review your request
and the denial. The person conducting the review will not be the person
who denied your request. We will comply with the outcome of the
review.
Right to Amend. If you feel that any behavioral health information we
have about you is incorrect or incomplete, you may ask us to amend
the information. You have the right to request an amendment for as
long as the information is kept by or is for Behavioral Health and
Recovery Services.
To request an amendment, your request must be made in writing and
submitted to the clinic where you are/were treated, OR to San Mateo
County Behavioral Health and Recovery Services, 1950 Alameda de
las Pulgas, San Mateo, CA 94403. In addition, you must provide a
reason that supports your request.
We may 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:
o Was not created by us, unless the person or entity that created
the information is no longer available to make the amendment.
o Is not part of the behavioral health information kept by or for
Behavioral Health and Recovery Services.
o Is not part of the information which you would be permitted to
inspect and copy.
o Is accurate and complete.
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 12 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
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 behavioral health information about you other than those
you authorized or those made for our own uses for treatment, payment
and health care operations. These functions are described above.
To request this list of accounting of disclosures, you must submit your
request in writing to the clinic where you are receiving treatment, OR to
San Mateo County Behavioral Health and Recovery Services, 1950
Alameda de las Pulgas, San Mateo, CA 94403. Your request must state
a time period. Your request should indicate in what form you want the
list (for example, on paper or 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.
Right to Request Restrictions. You have the right to request a
restriction or limitation on the behavioral health information we use or
disclose about you for treatment, payment or health care operations.
You also have the right to request a limit on the behavioral health
information we disclose about you to someone who is involved in your
care or the payment for your care, like a family member or friend. For
example, you could ask that we not use or disclose information about a
surgery you had.
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 with emergency treatment.
To request restrictions, you must make your request in writing to the
clinic where you are receiving treatment, OR to San Mateo County
Behavioral Health and Recovery Services, 1950 Alameda de las
Pulgas, San Mateo, CA 94403. In your request, you must tell us (1)
what information you want to limit; and (2) to whom you want the limits
to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right
to request that we communicate with you about behavioral health
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 13 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
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 clinic where you are receiving treatment, OR to San
Mateo County Behavioral Health and Recovery Services, 1950
Alameda de las Pulgas, San Mateo, CA 94403. 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 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.
You may obtain a copy of this notice at our website,
https://www.smchealth.org/new-client-information-english
To obtain a paper copy of this notice, you may ask for one at the clinic where
you are receiving treatment, OR to San Mateo County Behavioral Health and
Recovery Services, 1950 Alameda de las Pulgas, San Mateo, CA 94403.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the
revised or changed notice effective for behavioral health 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 at all behavioral health clinics. The
notice will contain, on the first page in the top right-hand corner, the effective
date. If the notice has changed, you will be notified and offered a revised
copy at your next behavioral health visit.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint
with Behavioral Health and Recovery Services or with the Secretary of the
Department of Health and Human Services. To file a complaint with San
Mateo County Behavioral Health and Recovery Services, contact the Office
of Consumer and Family Affairs at 1-800-388-5189. Complaints may be
submitted verbally or in writing. Complaints regarding violations of privacy will
Confidential Patient Information:
See California Welfare and
Institutions Code Section 5328
CFR 42, PART 2
www.smchealth.org/bhrs-documents Page 14 of 14
03-02 Notice of Privacy Practices Attachment A – English, Updated 12/28/2021
be reported by Behavioral Health and Recovery Services to the County
Privacy Officer.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of behavioral health information not covered by
this notice or the laws that apply to us will be made only with your written
permission. If you provide us permission to disclose behavioral health
information about you, you may revoke that permission, in writing, at any
time. If you revoke your permission, we will no longer disclose medical
information about you for the reasons covered by your written authorization.
You understand that we are not able 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.
