MONTEREY COUNTY BEHAVIORAL HEALTH AUTHORIZATION FOR DISCLOSURE OF

MONTEREY COUNTY BEHAVIORAL HEALTH AUTHORIZATION FOR DISCLOSURE OF CONFIDENTIAL HEALTH INFORMATION “WITHIN” MONTEREY COUNTY BEHAVIORAL HEALTH SYSTEMS (EFFECTIVE 7/1/18)

OBJECTIVES • What is the Authorization for Disclosure of Confidential Health Information “WITHIN” Monterey County Behavioral Health Systems • Demonstrate updated Authorization for Disclosure “WITHIN” • Expectations on completion of the “WITHIN” form

AVAILABILITY OF FORMS • Available in Avatar • Available on QI Website > printable documents • http: //qi. mtyhd. org/index. php/home/printable-documents/

EXPECTATIONS ON COMPLETION • This form replaces the current “WITHIN” form effective 7/1/18 • Effective 7/1/18 All programs and staff shall obtain client’s signature on the updated “WITHIN” form • • For already existing clients For new clients • This form Authorizes the disclosure of health information as part of the integrated record (“within”) • The signed “within” form allows for communication between Monterey County Behavioral Health and it’s contracted Substance Use Disorder treatment provider programs for coordination of care. • Every client open to mental health or SUD treatment services

• Completed once at onset/start of treatment • Does every program episode need to complete this form? • No. Once the form has been completed 1 time AND there has been no break in services greater than 365 day, this form remains valid. • Programs episodes may choose to do this, if they would like • Completed if client RETURNS to treatment after 365 day laps in care (this means client was previously discharged from all programs)

LIMITATIONS OF “WITHIN” FORM • A “general” Authorization to Use, Exchange, and/or Disclosure is REQUIRED for extensive communication among entities, individuals and program • 42 CFR Part 2 does not allow for disclosures of substance use treatment health information without prior consent from the individual • The “general” Authorization is available in Avatar and the QI website > printable documents • http: //qi. mtyhd. org/index. php/home/printable-documents/

REVOKE • The client has a right to revoke any prior Authorization for Disclosure • They may do so verbally or in writing • If client revokes or refuses to sign “WITHIN” Authorization, please contact MCHB Quality Improvement Department and request a restriction to be place on client record.

THANK YOU • Please visit the Monterey County Behavioral Health QI website • www. MTY. ORG/QI • Thank you, • QI 6/29/18