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.

If you have any questions about this notice, please contact: Greg Simpson, Program Director/Privacy Officer at 773/883-3906.

WHO WILL FOLLOW THIS NOTICE:

This notice describes our facility’s practices and that of:

• Any health care professional authorized to enter information into your medical chart.
• All departments and units of the facility.
• Any member of a volunteer group we allow to help you while you are here.
• All employees, staff and other facility personnel.

OUR PLEDGE REGARDING MEDICAL INFORMATION:

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at this facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated, whether made by personnel or our medical doctors.

Our uses and disclosures of information about you are protected by federal law and regulations on Confidentiality of Alcohol and Drug Abuse Patient Records, by federal law and standards protecting individually identifiable health information under the Health Insurance Portability and Accountability Act (HIPAA), and by state law and regulations.

This notice will tell you about the ways in which we may use and disclose medical information about you. This notice will also describe your rights and certain obligations that we have regarding the use and disclosure of your medical information.

We are required by law to:

• Make sure that medical information that identifies you is kept private;
• Give you this notice, which contains our legal duties and privacy practices with respect to medical information about you
• Follow the terms of the notice that is currently in effect

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

I. USES AND DISLOSURES WITHOUT YOUR AUTHORIZATION OR CONSENT

• For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at this facility. Different departments of the facility also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays.
• For Health Care Operations. Health Care Operations include internal administration and planning and various activities that improve the quality and effectiveness of care. For example, we may use information about your care to evaluate the quality and competence of our clinical staff. We may disclose information to qualified personnel for outcome evaluation, management audits, financial audits, or program evaluation; however, such personnel may not identify, directly or indirectly, any individual patient in any report of such audit or evaluation, or otherwise disclose patient identities in any manner. We may disclose your information as needed within the facility in order to resolve any complaints or issues arising regarding your care. We may also disclose your protected health information to an agent or agency which provides services to us under a qualified service organization agreement and/or business associate agreement, in which they agree to abide by 42 CFR Part 2 and HIPAA. Health Care Operations may also include use of your protected health information for programs offered by us, such as sending you invitations to alumni events and workshops sponsored by us. This list of examples is for illustration only and is not an exclusive list of all of the potential uses and disclosures which may be made for health care operations.
• Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for ongoing treatment.
• Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication 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, trying to balance the research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the facility. We will most always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the facility.
• As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
• Medical Emergencies. We may disclose your protected health information to medical personnel to the extent necessary to meet a bona fide medical emergency (as defined by 42 CFR Part 2).
• Minors. We may disclose facts relevant to reducing a threat to the life or physical well being of the applicant or any other individual to a parent, guardian, or other person authorized under state law to act in the minors behalf if the program director judges that the minor applicant lacks capacity to make a rational decision and the applicants situation poses a substantial threat to the life or physical well being of the applicant or any other individual which may be reduced by communicating relevant facts to such person.

• Incompetent and Deceased Patients. In such cases authorization of a personal representative, guardian or other substituted decision?maker may be given in accordance with 42 CFR Part 2.

• Decedents. We may disclose protected health information to a coroner or medical examiner as authorized by law.

• Duty to Warn. Where the program learns that a patient has made a specific threat of serious physical harm to another specific person or the public, and disclosure is otherwise required under statute and/or common law, the program will carefully consider appropriate options which would permit disclosure, subject to 45 CFR 164.512(i).

• Judicial and Administrative Proceedings. We may disclose your protected health information in response to a court order that meets the requirements of federal regulations, 42 CFR Part 2 concerning Confidentiality of Alcohol and Drug Abuse Patient Records. Note also that if your records are not actually patient records within the meaning of 42 CFR Part 2 (e.g. if your records are created as a result of your participation in the family program or another non?treatment setting), your records may not be subject to the protections of 42 CFR Part 2.
• Law Enforcement Officials. We may disclose your protected health information to the police or other law enforcement officials for the purpose of seeking assistance of law enforcement agencies if you commit a crime on the premises or against program personnel or threaten to commit such a crime.

• Public Health Activities. We may disclose your protected health information for the following public health activities and purposes: (1) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; and (2) to report deaths as required by law.

• Health Oversight Activities. We may disclose protected health information to a health oversight agency, e.g., state licensure or certification agencies, the Joint Commission on Accreditation of Healthcare Organizations, which oversees the health care system and ensures compliance with regulations and standards.
• Fundraising Communications. We may contact you to request a tax?deductible contribution to support our many important activities. In connection with any fundraising, we may use certain demographic information about you and dates of health care provided to you. If you do not want to receive fundraising requests, contact us at 1?800?707-4673 and we will make good faith efforts to honor your request.
• Marketing Communications. We may contact you with information about our health?related services and products that may be beneficial to you. Such communications are a part of Health Care Operations, and examples of these communications are invitations to continuing care programs, alumni events and catalogs of recovery and self?help materials such as books, videotapes and other items.

II. USES AND DISCLOSURES WITH YOUR AUTHORIZATION OR CONSENT

Other than as described above, we may use or disclose your protected health information only when you give your authorization to do so in writing on a form that specifically meets the requirements of laws and regulations cited previously herein. You may revoke your authorization by delivering a written statement to your primary counselor or therapist during the time you are receiving care or, after you are discharged, by sending the written statement to our Privacy Officer, except to the extent that the program has acted in reliance upon the authorization. Please be aware of the fact that a court or other third party could request or compel you to sign an authorization.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:

You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
• To inspect and copy medical information that may by used to make decisions about you, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
• We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by us will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
• Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the facility.
• To request an amendment, your request must be made in writing. 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 if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  o Is not part of the medical information kept by or for the facility;
  o Is not part of the information which you would be permitted to inspect and copy; or
  o Is accurate and complete.
• Right to an Accounting of Disclosures. Upon written request, you may obtain an accounting of disclosures of your protected health information other than those for which you gave written authorization or those related to your treatment or our health care operations. The accounting will apply only to covered disclosures prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, there will be a charge. You will be told the cost prior to the request being filled.