Accessibility Statement

Tri-City Mental Health is committed to providing access to our electronic and information technology, including our web pages, for individuals with disabilities in accordance with Section 508 of the Rehabilitation Act.

Section 508 requires us to ensure that City employees with disabilities, and members of the public with disabilities seeking information or services from us, have access to and use of information and data that is comparable to the access and use by City employees, or members of the public who are not individuals with disabilities, unless an undue burden would be imposed on us. To meet this commitment, we strive toward our web pages meeting or exceeding the Section 508 standards.

If you have a disability and the format of any materials on our web pages interferes with your ability to access the information, please contact Tri-City's webmaster at webmaster@tricitymhs.org. The webmaster will undertake the proper procedure to ensure your request receives a response. To enable us to respond in a manner most helpful to you, please indicate the nature of the accessibility problem, the web address of the requested material, you preferred format in which you want to receive the material (electronic format (ASCII, etc.), standard print, large print, etc.) and your contact information.

Your Rights

Tri-City Mental Health encourages respect for the personal preferences and values of each individual. It is our goal to ensure that your rights as a client are observed and to act as a partner in your decision making process.

Each client of Tri-City Mental Health has the right to:

• • • Receive the best possible service regardless of race, color, sex or sexual preference, age, handicap, national origin, religious or political affiliation.
    • Be fully informed, prior to becoming a client, of the services available and related charged for services.
    • Be free to choose providers and to request change of providers.
    • Be assured confidentiality of records and to approve or refuse their release to any individual outside the agency, except as required by law.
    • Refuse services, including medication, to the extent permitted by law and to be informed of the consequences of such refusal.
    • Be free from all forms of sexual harassment and sexual contact from other clients, staff, or other individuals associated directly or indirectly with Tri-City Mental Health Services.

Feedback and Problem Resolution
If a Tri-City Mental Health Authority (TCMHA) Client, Participant, or Stakeholder experiences any concern or dissatisfaction with TCMHA services or the TCMHA system of care, they have the right to file a grievance or an appeal at any time without retaliation.

Consumers who are not satisfied with the services they are receiving are encouraged to let a Tri-City staff member know. The staff will work with the consumer to solve the problem. The consumer will continue to receive the same services, if you choose, while your problem is being resolved. The consumer will not be subject to any penalty for filing a complaint or grievance.

 
How do I start the issue resolution process for my grievance or appeal?
Tri-City has an Issue Resolution: Grievances and Appeals process. The consumer may also ask to speak to the Complaint Representative. If you do not get your problems resolved with the Complaint Process, a formal grievance process is available to you. To start the Grievance/Appeal process, please complete the Tri-City Grievance/Appeal Issue Resolution Form.

Tri-City Mental Health is committed to providing you quality care and the best possible consumer experience. We believe it is important that our clients have information available that will help them make informed choices about the services and supports they receive.

• • • Medi-Cal Behavioral Health Services Member Handbook (LA County Department of Mental Health)
      • • Servicios de Salud Conductual: Manual Para Miembros Medi-Cal (Condado de Los Angeles)
    • Consumer Resource Directory
    • Mental Health Services Provider Directory (LA County Department of Mental Health): This guide includes locations of publicly funded mental health services in the county of Los Angeles
    • Privacy of Your Health Records
    • Client, Consumer and Participant Rights

What is the Privacy Rule?  

The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without client authorization. The Rule also gives client's rights over their health information, including rights to examine and obtain a copy of their health records and to request corrections.

Notice of Privacy Practices

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by US Congress to bring about health insurance reform and to ensure that client health information is not used for any unintended or unauthorized purpose. As part of HIPAA's implementation, any organization providing health-related services that exchanges client health information electronically must provide its clients with a document that states how the information may be used and their rights concerning its use. That document is called the Notice of Privacy Practices, and is available on this page.

Getting Your Medical Records

How do I obtain my medical records?        

Release of Information Authorization/Request forms may be obtained by your provider or at Tri-City Mental Health Services locations: 

Adult Services - 2008 N. Garey Avenue Pomona, CA 91767

Child and Family Services - 1900 Royalty Drive Suite 180 Pomona, CA 91767

All requests for mental health records require a properly completed Authorization for the Release/Disclosure of Information including subpoena requests.  Authorizations not properly completed and signed will not be processed and may delay records to be sent.  Prior to releasing information and records, releases are reviewed and approved by designated case provider.  Fees may apply.  Please contact Medical Records department for details. 

Before submitting your request, it is important to review the form for completion, including:

1. Personal identifying information of client, including full name, date of birth and Social Security Number (the last four digits are acceptable) 
2. Name, address and phone number of the individual or organization to which you want the records released 
3. What the information will be used for 
4. Description of Requested Information 
5. Time period for the information requested 
6. Initials where required 
7. Signature and date 

Where may I get a Release of Information form?

Insert links to Release of Information documents

Please contact the Medical Records Department at (909) 623-6131.

Adult Program Medical Records Department fax:  (909) 865-9281

Child and Family Program Medical Records Department fax:  (909) 865-0730

Where may I learn more about HIPAA?

You can learn more at http://www.hhs.gov/hipaa/

How does "consent" differ from "authorization"?

Consent refers to instances in which the privacy rule does not require a covered entity/health care provider to obtain consent for uses and disclosures of protected health information, such as for treatment, payment and healthcare operations. 

Authorization is required by the Privacy Rule for uses and disclosures of protected health information (PHI) not otherwise allowed by the Rule. 

Who has the right to view my medical records without my permission/authorization?

In some situations, PHI disclosures may be made without the client's authorization, but they require an opportunity for the client to verbally agree or object. 

These situations include: 

• Disclosures to the client's next-of-kin or to another person (designated by the client) involved in the client's health care  
• Notification of a family member (or the client's personal representative) of the client's location, general condition or death 
• Disaster relief situations. 

Authorization in an emergency: 

If the client is incapacitated or in cases of an emergency, EMS responders, in the exercise of professional judgment, may determine whether disclosure of PHI is in the client's best interests. 

This provision of the Privacy Rule allows responders to inform relatives or others involved in a client's care that a client has suffered an affliction and to provide updates on the client's progress and prognosis. 

When Authorization Is NOT Required 

For certain uses and disclosures, an authorization or opportunity to agree or object, is not required: 

1. Required by law 
2. Public health activities (injury/disease control/prevention) 
3. Victims of abuse, neglect, or domestic violence 
4. Health oversight activities (DHS, regional EMS council) 
5. Judicial and administrative proceedings 
6. Law enforcement purposes
7. Decedents 
8. Cadaver donation of organs, eyes, or tissues 
9. Research purposes 
10. To avert a serious threat to health or safety 
11. Specialized Government Functions 
12. To comply with worker’s compensation law 

How may I file a HIPAA-related complaint?

• You may file a complaint with the Privacy Officer by using a Grievance Form in English or Spanish and/or by calling (909) 784-3298 

To learn more about your rights regarding HIPAA, visit http://www.hhs.gov/hipaa/index.html 
In Spanish: hhs.gov/hipaa/for individuals/spanish/

What is the Privacy Rule? 

The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without client authorization. The Rule also gives client's rights over their health information, including rights to examine and obtain a copy of their health records and to request corrections.

Notice of Privacy Practices

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by US Congress to bring about health insurance reform and to ensure that client health information is not used for any unintended or unauthorized purpose. As part of HIPAA's implementation, any organization providing health-related services that exchanges client health information electronically must provide its clients with a document that states how the information may be used and their rights concerning its use. That document is called the Notice of Privacy Practices, and is available on this page.

Getting Your Medical Records

Frequently Asked Questions - Coming Soon