Page 59 - Privacy_Program

AUTHORIZATION FOR USE OR DISCLOSURE OF PHI [DP130B]
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Scope: Enterprise
Distribution: Executive Leadership Team; Director of Information Technology, Privacy and Data Security; Directors, Managers
and Supervisors; All Working Well Mental Health Services Employees and Others with Access to Protected Health Information
(includes Contractors, temporary employees and Interns)
Purpose: To provide participants an opportunity to determine how their health information may be used or disclosed and their
rights under the HIPAA privacy rule.
External Regulation or Standard: 45 C.F.R. §164.508 ‐ Uses and disclosures for which an authorization is required

Who is Responsible Statement Policy, Standard, or Procedure Statement
Number
Employees and DP130B.3 Except as stated in DP‐131 ‐ CONDITIONING SERVICES ON THE PROVISION OF AN
others with Access AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION the
to PHI organization will not condition treatment, payment, or enrollment on the
provision of an authorization.

Employees and others DP130B.4 The organization will obtain a signed authorization from all participants before
with Access to PHI using or disclosing their Protected Health Information (PHI), unless the use or
disclosure is required, or otherwise permitted without an authorization (see DP‐
162 through DP‐166).
Employees and others DP130B.5 Prior to all marketing communications to participants with PHI, the
with Access to PHI organization will obtain authorization from participants who would receive
such communications, except if:
DP130B.5a (a) the communication is made face‐to‐face by an employee of the organization;
or
DP130B.5b (b) the communication is a promotional gift of nominal value provided by the
organization.
Employees and others DP130B.6 Prior to any use or disclosure of psychotherapy notes, including for treatment,
with Access to PHI payment or health care operations, the organization will obtain authorization
from the participant, except if the use or disclosure is for:
DP130B.6a (a) the treatment activities of the originator of the psychotherapy notes;

DP130B.6b (b) the organization’s own training programs in which mental health students,
trainees or practitioners practice, under supervision, their skills in counseling; or
DP130B.6c (c) the organization’s own defense in a legal action or other proceeding brought
by the individual.
Employees and others DP130B.7 The organization is not required to obtain authorization regarding PHI for
with Access to PHI thefollowing purposes:
DP130B.7a (a) uses and disclosures required by law;
DP130B. 7b (b) uses and disclosures for public health activities;
DP130B. 7c (c) disclosures about victims of abuse, neglect or domestic violence;
DP130B. 7d (d) uses and disclosures for health oversight activities;
DP130B. 7e (e) disclosures for judicial and administrative proceedings;
DP130B. 7f (f) disclosures for law enforcement purposes;
DP130B. 7g (g) disclosing protected health information about decedents;
DP130B. 7h (h) uses and disclosures for research purposes;
DP130B. 7i (i) uses and disclosures to avert a serious threat to health or safety;
DP130B. 7j (j) uses and disclosures for specialized government functions; and
DP130B. 7k (k) disclosures for workers’ compensation.

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