LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 500.01 Use and Disclosure of Protected Health Information Requiring Authorization
 
  PROCEDURES
  1. Authorization language shall be as provided in the Los Angeles County Department of Mental Health (DMH) Authorization for Use or Disclosure of Protected Health Information (MH 602) form.
  2. Required Elements:
    1. To be valid, an authorization shall contain the elements listed below:
      1. Description of Protected Health Information (PHI): Such as assessment, progress notes, medications, psychological test results, treatment plan, etc.
      2. Identity of Disclosing Party: The name or other specific identification of the person(s) or class of persons authorized to disclose the PHI.
      3. Identity of Recipient: The name or other specific identification of the person(s) or class of persons authorized to use/receive the PHI.
      4. Purpose of Use or Disclosure: A description of each purpose of the requested use or disclosure, including limitation on the recipient’s use of the PHI.
      5. Expiration Date: A specific end date, not to exceed one (1) year, for the permission granted by the authorization after which DMH is no longer authorized to disclose the PHI.  
      6. Authorization as a Condition: The authorization shall state that DMH cannot condition treatment, payment, enrollment in the health plan, or eligibility for benefits on obtaining a signed authorization, except as stated in DMH Policy 500.05.
      7. Redisclose: The authorization shall state that the PHI disclosed to the indicated party can not be further shared, transferred, disclosed, or used with a third party. A new authorization signed and dated by the client shall be created.
      8. Copy: A copy of the signed authorization shall be scanned into the client's electronic medical record and a hard copy given to the client or client's representative upon request.
    2. Client's Right to Revoke
      1. The revocation shall be in writing. The client may: 
        1. Use the Revocation section on the authorization form; or
        2. Write their own revocation.
      2. Include any exceptions that apply to the revocation. 
      3. Signature: The client shall sign and date the revocation in order for it to be valid.
  3. Defective Authorizations:
    1. An authorization is not valid, or is no longer valid, and shall not be relied upon to use or disclose PHI, if:
      1. The expiration date has passed;
      2. Any required element for a valid authorization is missing;
      3. DMH has received a written revocation of the authorization; or
      4. DMH knows that important information in the authorization is false.
  4. Authorization for Marketing
    1. DMH shall obtain a signed Authorization for Use or Disclosure of PHI (MH 602) form for any use or disclosure of PHI for marketing, except:
      1. Face-to-face communications to the client by DMH; or
      2. A gift to the client from DMH of nominal value (e.g., a pen with a DMH logo).
    2. If the marketing involves direct or indirect remuneration to DMH from a third party, the authorization shall state that such remuneration is involved.
  5. Authorization for Research
    1. Authorizations for research shall be in accordance with DMH Policy 500.05.