NEW DIMENSIONS IN HEALTH CARE

NOTICE OF PRIVACY PRACTICES

Notice of Privacy Practices
Effective: April 14, 2003

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: our Privacy Officer is Chris Ward at (518) 954-3142 .

This Notice of Privacy describes how we may use and disclose your Protected Health Information ( PHI ) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information “ ( PHI ) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Information pertaining to HIV, alcohol and substance abuse, mental health and genetics is highly sensitive and has additional protections under federal and state law. You may request a copy of our policy regarding disclosure of this information.

We are required to abide by the terms of this Notice. We may change the terms of our Privacy Notice, at any time. The new Notice will be effective for all protected health information ( PHI ) that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling New Dimensions in Health Care (NDHC) and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment. A copy of the current Notice will be prominently displayed in our facility at all times.

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION ( PHI )

Uses and Disclosures of Protected Health Information ( PHI )

Prior to disclosing your PHI to outside health care providers or to obtain payment, NDHC will obtain your general consent, usually at your first visit to NDHC and thereafter as required by regulation or law.

Treatment: We will use and disclose your PHI to provide, coordinate or manage your health care and any related treatment. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI. For example, we would disclose your PHI as necessary, to a residential care facility that provides care to you. We also will disclose PHI to other physicians or therapists who may be treating you or to a physician or therapist to whom you have been referred to ensure that the necessary information is available to diagnose or treat you.

Payment: Your PHI will be used, as needed, to obtain payment for your health care services. Routine disclosures to our payers include the date, service, provider and diagnosis information. This may include certain activities that your health insurance plan may undertake before it approves or pays for the services we recommend for you such as: determining your eligibility or coverage for insurance benefits; reviewing services provided to you for medical necessity; and undertaking review activities. For example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed to your insurer to obtain approval for the hospital admission.

Health Care Operations: We may use or disclose, as needed, your PHI in order to support the business activities of NDHC. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may disclose your PHI to an insurer or accreditation agency that performs chart audits. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your provider. We also may call you by name in the waiting room when your provider is ready to see you. We may also use or disclose your PHI, as necessary, to contact you or remind you of your appointment.

We will share your PHI with third party “business associates” that perform various activities for NDHC (e.g., computer consulting company, law firm or other consultants). Whenever an arrangement between NDHC and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI.

We may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a newsletter about the services we offer. We may also send you information about products or services we believe may be beneficial to you. You may contact our Privacy Officer to request that these materials not be sent to you.

Uses and Disclosures of Protected Health Information ( PHI ) Based upon Your Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You have the right to revoke your authorization at any time, in writing and signed by you. However, such a revocation shall not affect any disclosures NDHC may have already made in reliance on your earlier authorization.


Other Permitted and Required Uses and Disclosures that may be made With Your Permission or Opportunity to Object

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information, as necessary, if we determine it is in your best interest based upon our professional judgment.

Other Permitted and Required Uses and Disclosures that may be Made Without Your Consent or Authorization

Required by Law: We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use and disclosure will be made in compliance with the law.

Public Health: We may disclose your PHI for public health activities to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose your PHI to a governmental agency for activities authorized by law, such as audits, investigations and inspections.

Abuse or Neglect: We may disclose your PHI to a public authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information.

Product Monitoring and Recalls: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, and biological product deviations; to track products; to enable product recalls; to make repairs or replacements, or in connection with post-marketing surveillance, as required by law.

Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of NDHC, and (6) medical emergency (not on NDHC’s premises) and it is likely that a crime has been occurred.

Decedents: PHI may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

Organ/Tissue Donation: Your PHI may be used or disclosed for cadaver organ, eye or tissue donation purposes.

Criminal Activity: We may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel for authorized military purposes, as required by law.

Workers’ Compensation: Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.

Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and your provider created or received your protected health information in the course of providing care to you.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the federal privacy regulations.

2. YOUR RIGHTS

You have the right to inspect and copy your protected health information ( PHI ). This means you may inspect and obtain a copy of PHI about you that is contained in a medical record maintained by NDHC, for as long as we maintain the PHI. We may charge you our standard fee for the costs of copying, mailing or other supplies we use to fulfill your request.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in a civil, criminal, or administrative action or proceeding, and that is subject to law that prohibits access to PHI. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have any questions about access to your medical record.

You have the right to request a restriction of your protected health information ( PHI ). This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

NDHC is not required to agree to a restriction that you may request. If NDHC believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If NDHC does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your provider. You may request a restriction using the form for requests for restrictions on PHI from the Privacy Officer, or you may provide us your request, in writing. Your request must include (a) the information you wish restricted; (b) whether you are requesting to limit NDHC’s use, disclosure, or both; and (c) to whom you want the limits to apply.

You have the right to request to receive confidential communications from NDHC by alternative means or at an alternative location. For example, you may ask us to contact you by mail, rather than by phone at home. You do not have to provide us a reason for this request. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. Please make this request in writing to NDHC’s Privacy Officer.

You may have the right to have NDHC amend your protected health information ( PHI ). This means you may request an amendment of PHI about you that we maintain. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have a right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.

You have a right to receive an accounting of certain disclosures we have made, if any, of your protected health information ( PHI ). This right applies to disclosure for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes disclosures we have made to you, or in putting together a facility directory, or to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding other disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The first list you request is free of charge, but there is a charge involved with any additional lists within the same 12-month period. We will inform you of any costs involved with additional requests, and you may withdraw your request before you incur any costs.

You have a right to obtain a paper copy of this notice from us.

3. COMPLAINTS

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.

You may contact our Privacy Officer at either (518) 954-3142 for further information about the complaint process.