LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 501.01 Client's Right to Access Protected Health Information and Confidential Data
 
Policy Category:  Administrative
Distribution Level:  Directly Operated
Responsible Party:  Quality Assurance

Approved by Curley L. Bonds, MD, Chief Medical Officer, on Oct 20, 2020 
I.  PURPOSE
 
To ensure Los Angeles County Department of Mental Health (DMH/Department) clients, or their personal representatives, have the right to access Protected Health Information (PHI) and Confidential Data contained within their mental health record.
 
II.  DEFINITIONS
 
Access: Inspect and copy or arrange for copying PHI and confidential data maintained by DMH or DMH's business associates.

Confidential Data: Information that is sensitive, proprietary, or personal to which access must be restricted and whose unauthorized disclosure could be harmful to a person, process, or an organization.

Consenting Minor: (FAM § 6924) A minor, 12 years of age or older, who may consent to outpatient mental health treatment/counseling or residential shelter services, if the following requirements are satisfied:
  • The minor, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient mental health treatment/counseling or residential shelter services; and
  • The following are met:
    • The minor presents a danger of serious physical or mental harm to self or others without the mental health treatment/counseling or residential shelter services; or,
    • The minor is the alleged victim of incest or child abuse.
Emancipated Minor: (FAM § 7122) A person under the age of 18 is an emancipated minor if any of the following conditions are satisfied:
  • The person has entered into a valid marriage, whether or not the marriage has been dissolved;
  • The person is on active duty with the armed forces of the United States; or,
  • The person has received a declaration of emancipation.
Health Insurance Portability and Accountability Act (HIPAA): United States law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers.

Mental Health Record: A patient record stored in any form or medium (e.g., electronic or paper) relating to mental health evaluation or treatment.

 
Minor: An individual who is under 18 years of age. The period of minority is calculated from the first minute of the day on which the individual is born to the same minute of the corresponding day completing the period of minority.

Particularly Sensitive Health Information: Highly confidential PHI including, but not limited to, mental health, substance abuse, genetics, and sexually transmitted disease information, including HIV/AIDS.

Personal Representative: The legal guardian or conservator of an adult client; the parent or legal guardian of a minor client; or the executor or administrator of the deceased's estate.

Protected Health Information (PHI): Individually identifiable information relating to the past, present, or future physical or mental health condition of an individual; the provision of health care to an individual; or the past, present, or future payment for health care provided to an individual.


Outside Documentation: Records or documentation that originated from other agencies or providers and were used to provide treatment or make clinical decisions for DMH clients automatically become part of the clinical record or designated record set.


 
III.  POLICY
 
A client has the right to access his/her PHI and confidential data in all but a limited number of circumstances, which include information compiled in anticipation of or used in a civil, criminal, or administrative action or proceeding.
 
Any current or former adult client, minor client authorized by law to consent to treatment, and/or client's legally authorized personal representative has the right to inspect and receive copies of his/her PHI and confidential data contained in his/her mental health record upon presenting the treatment provider with a signed Request for Access to Health Information form.
If a minor client is legally authorized to consent to treatment, only the minor client may sign the Request for Access to Health Information form.
 
If a personal representative makes a request for access on behalf of the client, he/she must provide appropriate legal identification as outlined in DMH Policy 500.06. 
 
If DMH does not maintain the PHI and confidential data that are the subject of the client's request and knows where the requested information is maintained, DMH staff must inform the client where to submit the request.
 
Client, or client's representative, is prohibited from using any personal recording devices including, but not limited to, watches, video, audio devices, camera, etc.
 
IV.  PROCEDURES
 
Procedures - Client's Right to Access Protected Health Information and Confidential Data
 
V.  AUTHORITIES
 
VI.  ATTACHMENTS