CONFIDENTIALITY AND NOTICE OF PRIVACY PRACTICES

This notice has been prepared by New Horizons Youth and Family Center. It tells how Protected Health Information about you can be created, shared, protected and maintained. You have the right to the confidentiality of your health information and the right to approve or refuse the release of specific information, except when the release is required by law. If the practices described in this notice meet your expectations, there is nothing that you need to do.

Who will follow this Notice?
This notice describes New Horizons practice regarding the use of your protected health information. It relates to:
· Any agency health care professional authorized to enter information into your medical record.
· All departments and units of the agency and all employees, staff, and other personnel who may need access to your protected health information.
· Any volunteer or student you meet while you are a client of the agency.
All entities, sites and locations of the agency follow the terms of this notice and may share protected health information with each other for treatment, payment or health care operations as described in this notice.

Our pledge regarding your Protected Health Information
We understand that health information about you is personal and confidential. We create a record of the care and services that you receive. 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 by New Horizons staff.

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

We are required by law to:
· Maintain the privacy of your protected health information
· Keep medical records that identify private information about you
· Give you this notice of our legal duties and privacy practices
· Follow the terms of this notice.

What is my Protected Health Information?
Anything from the past, present, or future about your mental or physical health or condition that is spoken, written, or electronically recorded, and is created by or given to anyone providing care to you, such as, a health plan, a public health authority, your insurance company, your school or university, or anyone who processes health information about you.

What rights do I have about my Protected Health Information?
You have the right to consent to the use and disclosure of your Protected Health Information for the limited purpose of diagnosing you, administering your treatment, and paying for your treatment. You do this the first time you are here by signing an Informed Consent for Treatment.

You have the right to authorize the sharing of your Protected Health Information for other purposes. You do this when you sign one or more Authorization to Use and Disclose Protected Health Information form(s).

You have the right to see and receive a copy your Protected Health Information. Exceptions to this are psychotherapy notes, information prepared for certain legal proceedings, and information maintained by clinical laboratories. The copying fee is fifteen cents per page. New Horizons is not obligated to provide copies if you are not willing to pay this fee. When we receive this kind of request we will generally provide a copy of the Intake Evaluation, Psychiatric Evaluation (if available), and the current Individualized Service Plan (treatment plan).

You have the right to request that we amend your Protected Health Information. We also have the right to deny your request.

You have the right to request to be informed about and share your Protected Health Information in a confidential manner chosen by you. The manner you request must be possible and reasonable for us to do.

You have the right to restrict certain uses and disclosures of your Protected Health Information. We do not have to agree to your restrictions. If we do agree, we must follow your restrictions.

You have the right to obtain a copy of certain disclosures of your Protected Health Information that we make. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request.

You have the right to obtain this Notice of Privacy Practices electronically and/or in paper form. We may change the terms of this notice from time to time. If and when we do make significant changes, we will post these changes at all our office locations and provide you a copy of these changes at your request. You can always get a copy of the current Notice of Privacy Practices by requesting it from the Front Desk Receptionist.

Consent
If I consent to disclose my information by signing the Informed Consent for Treatment form, how will the information be used?
Treatment:
With your consent, we can share information about your health with other clinical staff so that you can receive the most appropriate treatment. For example, your therapist or case manager could share with your psychiatrist that you are depressed. The doctor could then prescribe medication to help you feel better.
Payment:
With your consent, we can share information about when and for what purpose you were seen, so that we can be paid for treating you. For example, we could send a form to your insurance company stating when and for what condition you received treatment from us. They can then send us money to help cover the costs of treating you.
Operations:
With your consent, we can share your information with other healthcare entities to ensure that you obtain the correct diagnosis. For example, we could communicate with a laboratory about your blood work. They could send us a report and we can share the results with you.

Can I revoke my consent?
Yes. You can revoke your consent. You must do this in writing and bring it to us so that we can stop using and disclosing your Protected Health Information. We are permitted to use and disclose your Protected Health Information based on your consent until we receive your revocation in writing. However, if you revoke your consent, we reserve the right to terminate further treatment to you, on the basis of your refusal to allow us to share your information for purposes of treatment, payment, and healthcare operations.

Authorization
What can be done with my information if I authorize its disclosure for other purposes?
With your permission by signing one or more Authorization To Use and Disclose Protected Health Information forms, we can share your Protected Health Information for reasons other than to treat you and to administer and pay for your treatment. For example, you might agree to allow us to share your Protected Health Information with a drug company so that your eligibility for reduced cost medications or free medication samples may be determined.

Can I revoke my authorization?
Yes. You can revoke your authorization. You must do this in writing and bring it to us so that we can stop sharing your Protected Health Information. We are permitted to share your Protected Health Information until we receive your revocation in writing. All authorizations you make are voluntary, and you can continue to receive treatment at New Horizons even if you revoke your authorization(s).

We send the following notice every time we release information with your permission:

NOTICE TO RECIPIENT OF PROTECTED HEALTH INFORMATION Prohibition Against Re-Disclosure: This information has been disclosed to you from records protected by federal confidentiality rules. The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 C.F.R., Part 2. A general authorization for the release of medical or other information is not sufficient for this purpose. The federal rules restrict any use of information to criminally investigate or prosecute any alcohol or drug abuse client. Drug abuse patient records are also protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. parts 160 and 164. These conditions apply to every page disclosed and a copy of this authorization will accompany every disclosure.

Are there any circumstances when my information can be shared without my consent or authorization?
Yes. Your Protected Health Information can be shared without your prior consent or authorization in the following circumstances:
1. In an emergency so long as your consent is obtained as soon as possible;
2. When mandated or allowed by law according to specific requirements:

• For certain public health activities
• To protect victims of abuse or neglect
• For health oversight activities
• Pursuant to a Court Order
• For court-ordered treatment that is part of a Children’s Services case plan, or that relates to dependency, neglect, abuse or custody proceedings
• For law enforcement purposes
• To a coroner/medical examiner
• For organ/eye/tissue donation
• To avert serious threats to the health or safety of a person or the public
• To facilitate specialized government functions such as national security, intelligence activities and protective services
• For federal privacy law compliance and enforcement efforts

3. When there are substantial communication barriers and it is reasonable for us to believe that you are giving your consent or authorization.

What about any other uses of my medical information?
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain all records of the care that we provide to you.

Note: For certain appointments we may call your home to confirm and remind you. We may also leave messages regarding appointments. Please advise us if you do not wish us to call your home.

What will you do to protect my health information?
We will maintain the privacy of your Protected Health Information as required by law. We are providing you with this Notice of Privacy Practices containing our legal responsibilities and privacy practices regarding Protected Health Information. At your request at any future time we will again provide you with this notice.

We will follow the terms of the Notice of Privacy Practices currently in effect.

What can I do if I have questions or want to complain about the use and disclosure of my Protected Health Information?
All questions or complaints concerning our privacy policies may be sent to our Privacy Officer or Client Rights Officer.

We will not penalize or retaliate against you for complaining about the use or disclosure of your Protected Health Information.

New Horizons Youth and Family Center is not responsible for the misuse or re-release of your Protected Health Information by another individual, agency or entity.