LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 501.07 Procedure Client Right to Request Restrictions
 
  PROCEDURES
  1. DMH shall permit a client to request to restrict use and disclosure of PHI for treatment, payment and health care operations purposes, and disclosure to those involved in the client’s care or payment for such client’s care and for notification purposes. The client may be asked to complete and submit the Client’s Request for Restriction of Use and Disclosure of Health Information form (Attachment I). If the client refuses or is unable to complete the form, DMH shall complete the form on behalf of the individual.
     
  2. DMH is not required to agree to the client’s request for restriction. At this time, all requests will be denied until DMH can better access how it will properly manage and support such requests.
     
  3. If a client submits a completed Client’s Request for Restriction of Use and Disclosure of Health Information form, DMH will sign the bottom of the last page and inform the client that it will not be able to support at this time.
     
  4. DMH will include the signed form in the client’s health record.
     
  5. DOCUMENTATION RETENTION
    1.  DMH will retain all documents created or completed under this policy for a period of at least six (6) years from the date of its creation or the date when it last was in effect, whichever is later.