Notice of Privacy Practices
University of California Los Angeles (UCLA)
Effective Date: September 23, 2013
English | Spanish
This notice describes how health information about you
may be used and disclosed and how you can get access to this
Please review it carefully.
On this page you will find:
UCLA Health System
UCLA Health System is one of the health care components of the
University of California. The University of California health
care components consist of the UC medical centers, the UC medical
groups, clinics and physician offices, the UC schools of medicine
and other UC health professions schools engaged in clinical care,
the student health service areas on some campuses, employee
health units on some campuses, and the administrative and
operational units that are part of the health care components of
the University of California.
Our pledge regarding your health
UCLA Health System is committed to protecting medical, mental
health and personal information about you ("Health Information").
We are required by law to maintain the privacy of your Health
Information, provide you information about our legal duties and
privacy practices, inform you of your rights and the ways in
which we may use Health Information and disclose it to other
entities and persons.
How we may use and
disclose health information about you
The following sections describe different ways that we may use
and disclose your Health Information. Some information, such as
certain drug and alcohol information, HIV information, genetic
information and mental health information is entitled to special
restrictions related to its use and disclosure. Not every use or
disclosure will be listed. All of the ways we are permitted to
use and disclose information, however, will fall within one of
the following categories. Other uses and disclosures not
described in this Notice will be made only if we have your
For Treatment. We may use Health Information
about you to provide you with medical and mental health treatment
or services. We may disclose Health Information about you to
doctors, nurses, technicians, students, or other health system
personnel who are involved in taking care of you in the health
system. For example, a doctor treating you for a broken leg may
need to know if you have diabetes because diabetes may slow the
healing process. A doctor treating you for a mental condition may
need to know what medications you are currently taking, because
the medications may affect what other medications may be
prescribed to you. We may also share Health Information about you
with other non- UCLA Health System providers. The disclosure of
your Health Information to non-UCLA Health System providers may
be done electronically through a health information exchange that
allows providers involved in your care to access some of your
UCLA Health System records to coordinate services for you.
For Payment. We may use and disclose Health
Information about you so that the treatment and services you
receive at UCLA Health System or from other entities, such as an
ambulance company, 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 information to your health plan about surgery or
therapy you received at UCLA Health System so your health plan
will pay us or reimburse you for the surgery or therapy. We may
also tell your health plan about a proposed treatment to
determine whether your plan will pay for the treatment.
For Health Care Operations. We may use and
disclose Health Information about you for our business
operations. For example, your Health Information may be used to
review the quality and safety of our services, or for business
planning, management and administrative services. We may contact
you about alternative treatment options for you or about other
benefits or services we provide. We may also use and disclose
your health information to an outside company that performs
services for us such as accreditation, legal, computer or
auditing services. These outside companies are called "business
associates" and are required by law to keep your Health
Information confidential. We may also disclose information to
doctors, nurses, technicians, medical and other students, and
other health system personnel for performance improvement and
Appointment Reminders. We may contact you to
remind you that you have an appointment at UCLA Health System.
Fundraising Activities. We may contact you to
provide information about UCLA Health System sponsored
activities, including fundraising programs and events. We may use
contact information, such as your name, address and phone number,
date of birth, physician name, the outcome of your care,
department where you received services and the dates you received
treatment or services at UCLA Health System. You may opt-out of
receiving fundraising information for the UCLA Health System by
contacting us at 1-855-364-6945 or by email at OptOutUCLAHSD@Support.ucla.edu.
Hospital Directory. If you are hospitalized, we
may include certain limited information about you in the hospital
directory. This is so your family, friends and clergy can visit
you in the hospital and generally know how you are doing. This
information may include your name, location in the hospital, your
general condition (e.g., fair, stable, etc.) and your religious
affiliation. The directory information, except for your religious
affiliation, may also be released to people who ask for you by
name. Your religious affiliation may be given to members of the
clergy, such as ministers or rabbis, even if they don't ask for
you by name. You have the opportunity to limit the release of
directory information by telling UCLA Health System at the time
of your hospitalization.
Our disclosure of this information about you if you are
hospitalized in a psychiatric hospital will be more limited.
Individuals Involved in Your Care or Payment for Your
Care. We may release medical information to anyone
involved in your medical care, e.g., a friend, family member,
personal representative, or any individual you identify. We may
also give information to someone who helps pay for your care. We
may also tell your family or friends about your general condition
and that you are in the hospital.
Disaster Relief Efforts. We may disclose Health
Information about you to an entity assisting in a disaster relief
effort so that others can be notified about your condition,
status and location.
Research. The University of California is a
research institution. We may disclose Health Information about
you for research purposes, subject to the confidentiality
provisions of state and federal law. All research projects
involving patients or the information about living patients
conducted by the University of California must be approved
through a special review process to protect patient safety,
welfare and confidentiality.
In addition to disclosing Health Information for research,
researchers may contact patients regarding their interest in
participating in certain research studies. Researchers may only
contact you if they have been given approval to do so by the
special review process. You will only become a part of one of
these research projects if you agree to do so and sign a specific
permission form called an Authorization. When approved through a
special review process, other studies may be performed using your
Health Information without requiring your authorization. These
studies will not affect your treatment or welfare, and your
Health Information will continue to be protected.
As Required By Law. We will disclose Health
Information about you when required to do so by federal or state
To Prevent a Serious Threat to Health or Safety.
We may use and disclose Health Information about you when
necessary to prevent or lessen a serious and imminent threat to
your health and safety or the health and safety of the public or
another person. Any disclosure would be to someone able to help
stop or reduce the threat.
Organ and Tissue Donation. If you are an organ
donor, we may release your Health Information to organizations
that obtain, bank or transplant organs, eyes or tissue, as
necessary to facilitate organ or tissue donation and
Military and Veterans. If you are or were a
member of the armed forces, we may release Health Information
about you to military command authorities as authorized or
required by law.
Workers' Compensation. We may use or disclose
Health Information about you for Workers' Compensation or similar
programs as authorized or required by law. These programs provide
benefits for work-related injuries or illness.
Public Health Disclosures. We may disclose
Health Information about you for public health activities such
- preventing or controlling disease (such as cancer and
tuberculosis), injury or disability;
- reporting vital events such as births and deaths;
- reporting child abuse or neglect;
- reporting adverse events or surveillance related to food,
medications or defects or problems with products;
- notifying persons of recalls, repairs or replacements of
products they may be using;
- notifying a person who may have been exposed to a disease or
may be at risk of contracting or spreading a disease or
Abuse and Neglect Reporting. We may disclose
your Health Information to a government authority that is
permitted by law to receive reports of abuse, neglect or domestic
Health Oversight Activities. We may disclose
Health Information to governmental, licensing, auditing, and
accrediting agencies as authorized or required by law.
Lawsuits and Other Legal Proceedings. We may
disclose Health Information to courts, attorneys and court
employees in the course of conservatorship, writs and certain
other judicial or administrative proceedings. We may also
disclose Health Information about you in response to a court or
administrative order, or in response to a subpoena, discovery
request, warrant, or other lawful process.
Law Enforcement. If asked to do so by law
enforcement, and as authorized or required by law, we may release
- To identify or locate a suspect, fugitive, material witness,
certain escapees, or missing person;
- About a suspected victim of a crime if, under certain limited
circumstances, we are unable to obtain the person's agreement;
- About a death suspected to be the result of criminal conduct;
- About criminal conduct at UCLA Health System; and
- 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.
Coroners, Medical Examiners and Funeral
Directors. We may disclose medical information to a
coroner or medical examiner. This may be necessary, for example,
to identify a deceased person or determine cause of death. We may
also disclose medical information about patients of UCLA Health
System to funeral directors as necessary to carry out their
National Security and Intelligence Activities.
As required by law, we may disclose Health Information about you
to authorized federal officials for intelligence,
counterintelligence, and other national security activities.
Protective Services for the President and
Others. As required by law, we may disclose Health
Information about you to authorized federal officials so they may
conduct special investigations or provide protection to the
President, other authorized persons or foreign heads of state.
Inmates. If you are an inmate of a correctional
institution or under the custody of law enforcement officials, we
may release Health Information about you to the correctional
institution as authorized or required by law.
Psychotherapy Notes. Psychotherapy notes means
notes recorded (in any medium) by a health care provider who is a
mental health professional documenting or analyzing the contents
of conversation during a private counseling session or a group,
joint, or family counseling session and that are separated from
the rest of the individual's medical record.
Psychotherapy notes have additional protections under federal law
and most uses or disclosures of psychotherapy require your
Marketing or Sale of Health Information. Most
uses and disclosures of your Health Information for marketing
purposes or any sale of your Health Information would require
your written authorization.
Other uses and disclosures of
Other uses and disclosures of Health Information not covered by
this Notice will be made only with your written authorization. If
you authorize us to use or disclose your Health Information, you
may revoke that authorization, in writing, at any time. However,
the revocation will not be effective for information that we have
already used and disclosed in reliance on the authorization.
Your rights regarding
your health information
Your Health Information is the property of UCLA Health
System. You have the following rights regarding the Health
Information we maintain about you:
Right to Inspect and Copy. With certain
exceptions, you have the right to inspect and/or receive a copy
of your Health Information. If we have the information in
electronic format then you have the right to get your Health
Information in electronic format if it is possible for us to do
so. If not we will work with you to agree on a way for you to get
the information electronically or as a paper copy.
To inspect and/or to receive a copy of your Health Information,
you must submit your request in writing to UCLA Health System,
Health Information Management Services, 10833 Le Conte Avenue,
CHS BH921, Los Angeles CA 90095-7305. If you request a copy of
the information, there is a fee for these services.
We may deny your request to inspect and/or to receive a copy in
certain limited circumstances. If you are denied access to Health
Information, in most cases, you may have the denial reviewed.
Another licensed health care professional chosen by UCLA Health
System 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 Request an Amendment or Addendum. If
you feel that Health Information we have about you is incorrect
or incomplete, you may ask us to amend the information or add an
addendum (addition to the record). You have the right to request
an amendment or addendum for as long as the information is kept
by or for UCLA Health System.
Amendment. To request an amendment, your request
must be made in writing and submitted to the UCLA Health System,
Health Information Management Services, 10833 Le Conte Avenue,
CHS BH921, Los Angeles CA 90095-7305. You must be specific about
the information that you believe to be incorrect or incomplete
and you must provide a reason that support the request.
We may deny your request for an amendment if it is not in
writing, we cannot determine from the request the information you
are asking to be changed or corrected or your request does not
include a reason to support the change or addition. In addition,
we may deny your request if you ask us to amend information that:
- Was not created by UCLA Health System
- Is not part of the Health Information kept by or for UCLA
- Is not part of the information which you would be permitted
to inspect and copy; or
- UCLA Health System believes to be accurate and complete.
Addendum. To submit an addendum, the addendum
must be made in writing and submitted to the UCLA Health System,
Health Information Management Services, 10833 Le Conte Avenue,
CHS BH921, Los Angeles CA 90095-7305. An addendum must not be
longer than 250 words per alleged incomplete or incorrect item in
Right to an Accounting of Disclosures. You have
the right to receive a list of certain disclosures we have made
of your Health Information.
To request this accounting of disclosures, you must submit your
request in writing to UCLA Health System, Health Information
Management Services, 10833 Le Conte Avenue, CHS BH921, Los
Angeles CA 90095-7305. Your request must state a time period that
may not be longer than the six previous years. You are entitled
to one accounting within any 12-month period at no cost. If you
request a second accounting within that 12-month period, there
will be a charge for the cost of compiling the accounting. 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
Right to Request Restrictions. You have the
right to request a restriction or limitation on the 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 Health Information we disclose about you to someone
who is involved in your care or the payment for your care, such
as a family member or friend.
To request a restriction, you must make your request in writing
to the UCLA Health System, Health Information Management
Services, 10833 Le Conte Avenue, CHS BH921, Los Angeles CA
90095-7305. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our
use, disclosure or both; and (3) to whom you want the limits to
apply, for example, only to you and your spouse. We are not
required to agree to your request except in the limited
circumstance described below. If we do agree, our agreement must
be in writing, and we will comply with your request unless the
information is needed to provide you emergency care.
We are required to agree to a request not to share your
information with your health plan if the following conditions are
1. We are not otherwise required by law to share the information
2. The information would be shared with your insurance company
for payment purposes;
3. You pay the entire amount due for the health care item or
service out of your own pocket or someone else pays the entire
amount for you.
Right to Request Confidential Communications.
You have the right to request that we communicate with you about
your Health Information in a certain way or at a certain
location. For example, you may ask that we contact you only at
home or only by mail.
To request confidential medical communications, you must make
your request in writing to the UCLA Health System, Health
Information Management Services, 10833 Le Conte Avenue, CHS
BH921, Los Angeles CA 90095-7305. 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.
Copies of this Notice are available throughout UCLA Health
System, or you may obtain a copy at our website, http://www.uclahealth.org.
Right to be Notified of a Breach. You have the right to be
notified if we or one of our Business Associates discovers a
breach of unsecured Health information about you.
Changes to UCLA Health
System's privary practices and this notice
We reserve the right to change UCLA Health System's privacy
practices and this Notice. We reserve the right to make the
revised or changed Notice effective for 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 throughout
UCLA Health System. In addition, at any time you may request a
copy of the current Notice in effect.
Questions or complaints
If you have any questions about this Notice, please contact the
Office of Compliance Services - Privacy, 924 Westwood Boulevard,
Suite 520, Los Angeles CA, 90024-2929 or (310) 794-8638.
If you believe your privacy rights have been violated, you may
file a complaint with UCLA Health System or with the Secretary of
the Department of Health and Human Services, Office for Civil
Rights. To file a written complaint with UCLA Health System
contact: Office of Compliance Services - Privacy, 924 Westwood
Boulevard, Suite 520, Los Angeles CA, 90024-2929. You will not be
penalized for filing a complaint.
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Page last modified: Sept. 2013