LANDMARK PRIVACY NOTICE
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of “protected health information.” “Protected health
information” includes individually identifiable health information, including demographic information, that
- the past, present, or future physical or mental health or condition of an individual;
- the provision of health care to an individual; or
- the past, present, or future payment for the provision of health care to an individual.
Beyond the requirements of law, we at Landmark understand and respect your right to the confidentiality
of your protected health information, and we maintain numerous safeguards to protect your privacy.
As required by law, this notice provides you with information about your rights to access and control your
protected health information, and our legal duties and privacy practices, including the types of uses and
disclosures we will make of your protected health information.
We are required to abide by the terms of this notice, although we reserve the right to change the terms of
this notice from time to time and to make the new notice provisions effective for all protected health
information we maintain. You can always request a copy of our most current privacy notice by calling our
Customer Service Department at (800) 298-4875, or you can access it on our web site at www.LHP-CA.com.
How We May Use and Disclose Protected Health Information About You
We are permitted by law to use or disclose your protected health information for purposes of treatment,
payment, and health care operations.
For Treatment. This means the provision, coordination, or management of your health care and related
services, including consultations between health care providers regarding your care, and referrals for
health care from one health care provider to another. For example, one of your doctors may ask
Landmark to supply copies of records in our possession pertaining to your treatment, or we may need to
refer to your records in order to make a referral to an appropriate practitioner.
For Payment. This means activities we undertake to determine and provide the appropriate
reimbursement to providers for the health care provided to you, including determinations of eligibility,
coverage (including dual coverage), and appropriateness of care, and other utilization review activities.
For Health Care Operations. This means the support functions of Landmark related to treatment and
payment, such as quality assurance activities, case management, provider reviews, compliance
programs, audits, and business planning, development, management, and administrative activities. For
example, we may use your protected health information to evaluate the performance of our providers in
caring for you. We may also combine medical information about many patients to decide what additional
services we should offer, what services are not needed, and whether certain new treatments are
effective. If, to accomplish any of these purposes, we engage the services of a third-party “business
associate”, we will have a written contract with the business associate containing terms that will
safeguard the privacy of your protected health information.
Additionally, we are permitted by law to make the following uses and disclosures of protected health
To Individuals Involved in Your Care or Payment for Your Care. Under certain circumstances, we
may disclose protected health information about you to family members, friends, or any other persons
identified by you when they are involved in your care or the payment for your care. We will only disclose
the protected health information directly relevant to their involvement in your care or payment. We may
also use or disclose your protected health information to notify, or assist in the notification of, a family
member, a personal representative, or another person responsible for your care, of your location, general
condition, or death. If you are available, we will give you an opportunity to object to these disclosures,
and we will not make these disclosures if you object. If you are not available, we will determine whether a
disclosure to your family or friends is in your best interest, and we will disclose only the protected health
information that is directly relevant to their involvement in your care. We will allow your family or friends
to act on your behalf to pick up medical supplies, X-rays, or other similar forms of protected health
information, when we determine, in our professional judgment that it is in your best interest to make such
When permitted by law, we may disclose protected health information about you to a public or private
entity authorized by law or by its charter to assist in disaster relief efforts, to coordinate notification to your
family of your location, general condition, or death.
As Required by Law. We may use or disclose protected health information when required by law,
limiting this use or disclosure to the relevant requirements of such law.
For Public Health Activities. We may disclose protected health information for public health activities
and purposes, which generally include the following:
- to prevent or control disease, injury, or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with products to persons under the jurisdiction of
the Food and Drug Administration, for the purpose of activities related to the quality, safety, or
effectiveness of such FDA-regulated products;
- to notify people of product recalls, repairs, or replacement;
- to notify a person who may have been exposed to a disease or may otherwise be at risk of
contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a patient has been the victim of
abuse, neglect, or domestic violence. We will only make this disclosure if the patient agrees or
when required by law, or when authorized by law and the patient is incapacitated and thus unable
For Health Oversight Activities. We may disclose protected health information to a health oversight
agency for such authorized activities as audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system, government programs, and
compliance with civil rights laws.
For Legal Proceedings. We may disclose protected health information about you in response to a court
or administrative order. We may also disclose protected health information about you in response to a
subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about
the request or to obtain an order protecting the information requested.
For Law Enforcement. We may disclose protected health information:
- in response to a court order, subpoena, warrant, summons, or similar process, or as otherwise
required by law;
- in response to a law enforcement official’s request, to identify or locate a suspect, fugitive,
material witness, or missing person;
- in response to a law enforcement official’s request for information about the victim of a crime, if,
under certain limited circumstances, we are unable to obtain the individual’s agreement;
- to alert law enforcement about a death that we believe may be the result of criminal conduct;
- to alert law enforcement about criminal conduct on our premises; and
- in an emergency, to alert law enforcement to the commission and nature of a crime; the location
of the crime or victims; or the identity, description, and location of the person who committed the
To Coroners, Medical Examiners, and Funeral Directors. We may disclose protected health
information to a coroner or medical examiner in order, for example, to identify a deceased person or
determine the cause of death. We may also disclose protected health information about patients to
funeral directors as necessary to carry out their duties.
For Organ and Tissue Donation. For organ donors, we may disclose protected health information to
organizations that handle organ, eye, or tissue procurement, banking, or transplantation, for the purpose
of facilitating organ, eye, or tissue donation and transplantation.
For Research. Under certain circumstances, we may use and disclose protected health information for
research purposes. For example, a research project may involve comparing the health and recovery of
all patients who received one treatment to those who received another for the same condition. All
research projects, however, are subject to a special approval process. This process evaluates a
proposed research project and its use of medical information, trying to balance the research needs with
patients' need for privacy of their medical information. Before we use or disclose protected health
information for research, the project will have been approved through this research approval process, but
we may, however, disclose protected health information to people preparing to conduct a research
project, for example, to help them look for patients with specific medical needs, so long as the protected
health information they review does not leave our premises.
To Avert a Serious Threat to Health or Safety. We may use and disclose protected health information
when necessary to prevent or lessen a serious and imminent threat to the health and safety of a person
or the public. Any disclosure, however, would only be made to someone able to help prevent or lessen
With Regard to Armed Forces Personnel. We may use and disclose the protected health information
of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military
command authorities. We may also use and disclose the protected health information of individuals who
are foreign military personnel to the appropriate foreign military authority.
For National Security and Intelligence Activities; For Protective Services for the President and
Others. We may disclose protected health information to authorized federal officials for the conduct of
lawful intelligence, counter-intelligence, and other national security activities authorized by law; for the
provision of protective services to the President or other authorized persons, or to foreign heads of state;
or for the conduct of authorized investigations.
For Workers’ Compensation. We may disclose protected health information about you as authorized by
and to the extent necessary to comply with laws relating to workers’ compensation or other similar
programs established by law to provide benefits for work-related injuries or illness.
For Health-Related Benefits and Services. We may use and disclose protected health information to
contact you to provide information about other health-related benefits or services that may be of interest
Other Uses and Disclosures
Except for the situations set forth above, we will not use or disclose your protected health information for
any other purpose unless you provide written authorization. You may revoke that authorization at any
time, provided that the revocation is in writing, except to the extent that we have already taken action in
reliance on your authorization.
Your Rights Regarding Protected Health Information About You
Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of
protected health information about you for treatment, payment, or health care operations. You also have
the right to request restrictions on the protected health information we disclose about you to someone
who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request. If we do agree, we will not use or disclose protected health
in-formation about you in violation of such restriction, unless the information is needed to provide you
To request restrictions, you must make your request in writing to our Privacy Officer at the address below.
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.
Right to Request Confidential Communications. You have the right to request that we communicate
protected health information to you in a certain way or at a certain location if disclosure of all or part of
that information could endanger you. For example, you can ask that we only contact you at work or by
To request confidential communications, you must make your request in writing to our Privacy Officer at
the address below, including a statement that other disclosure could endanger you. Your request must
specify where or how you wish to be contacted. We will accommodate all reasonable requests.
Right to Inspect and Copy. You have the right to inspect and obtain a copy of protected health
information about you that may be used to make decisions about your care. Usually, this includes
enrollment, payment, claims adjudication, and case management records. There are a few exceptions to
the sorts of protected health information available to you, such as psychotherapy notes and information
compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or
To inspect and copy medical information that may be used to make decisions about you, you must make
your request in writing to our Privacy Officer at the address below. If you request a copy of the
information, we may charge a fee for the costs of copying, postage, and other supplies associated with
In certain very limited circumstances, we may deny your request to inspect and copy, but in those cases,
not including those types of exceptions noted above, you have the right to have the denial reviewed. A
licensed health care professional who did not participate in the original decision to deny will be
designated by Landmark to review the denial. We will comply with the outcome of the review.
Right to Amend. If you feel that protected health information we have about you is incorrect or
incomplete, you may request that we amend the information. You have the right to request an
amendment for as long as the information is kept.
To request an amendment, you must make your request in writing to our Privacy Officer at the address
below. In addition, you must provide a reason that supports your request. We may deny your request for
an amendment if it is not in writing or does not include a reason to support the request. In addition, we
may deny your request to amend protected health information that:
- Was not created by us, unless the person or entity that created the information is no longer
available to make the amendment;
- Is not part of the protected health information kept by Landmark;
- Is not part of the information that you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures."
This is a list of the disclosures we have made of protected health information about you within the six
years prior to the date on which you request the accounting, or such shorter time period as you request.
There are some few exceptions to the disclosures we must account for. Examples include disclosures to
carry out treatment, payment, and health care operations; those made to you; those made pursuant to an
authorization by you; those made for national security or intelligence purposes; and those that occurred
prior to April 14, 2003.
To request this list or accounting of disclosures, you must make your request in writing to our Privacy
Officer at the address below. Your request should indicate in what form you want the list (for example, on
paper, or electronically). The first list you request within a 12-month period will be free. For additional
lists, we may charge you for the costs of providing the list. 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 incurred.
Right to a Paper Copy of This Notice. You have the right to a paper 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. To obtain a paper copy of this notice, you must make your request in writing to our Privacy Officer
at the address below.
If you believe your privacy rights have been violated, you may file a complaint with Landmark or with the
Secretary of the U.S. Department of Health and Human Services. You may contact the Secretary at:
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: (877) 696 – 6775
(202) 619 – 0257
To file a complaint with Landmark, contact our Privacy Officer at the address below. All complaints must
be submitted in writing.
You will not be penalized for filing a complaint.
Landmark Healthplan of California, Inc.
1610 Arden, Suite 280
Sacramento, CA 95825
(916) 329 1708
This notice is effective April 14, 2003.