NOTICE OF PRIVACY PRACTICES

Effective Date: 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.

Diagnostic and Therapeutic information regarding psychiatric, drug/alcohol abuse, or sexually transmitted diseases (including HIV status) will not be disclosed without your specific permission, unless required by law.

WHO WILL FOLLOW THIS NOTICE

This notice describes how practices of your physicians, ARNP’s, nurses, clinicians, our staff, and others outside our office who are involved in your care and treatment for the purpose of providing health services to you. Your protected health information may also be used and disclosed to pay your care bills and to support the operations of the facility. In addition, our facilities may share medical information with each other for treatment, payment, or operations purposes describe in this notice.

We are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information (PHI). We are legally required follow the privacy practices that are described in this notice.

If you have questions about any part of this notice or if you want more information about the privacy practices, please contact our Chief Privacy Officer at 727-820-8050.

HOW WE (INCLUDING OUR AFFILIATED ENTITIES AND DOCTORS WHO ARE TREATING YOU) MAY USE OR SHARE YOUR HEATLH INFORMATION

We collect health information from you and store it in a chart and on a computer. This is your medical record. The medical record is the property of the Harbor Behavioral Health Care Institute, but the information in the medical record belongs to you. We protect the privacy of your health information. The law permits us to use or disclose your health information for the following purposes:

* Treatment. We may use or share your PHI with physicians, nurses, and other health care personnel who provide you with health care services or are involved in your care. For example, your PHI may be provided to a physician or hospital for emergency or immediate treatment needed to ensure that the physician or hospital has the necessary information to diagnose or treat you.

* Payment. We may use or disclose your PHI to obtain payment for health care services. For example, obtaining approval for payment of services may require that your PHI be disclosed to your health plan to obtain approval for the services. We may also provide your PHI to our business associates, such as billing companies or transcriptionists.

* Health Care Operations. We may use or disclose your PHI in order to operate our facilities. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to accountants, attorneys, consultants, accrediting agencies, outside funding sources and others in order to make sure we’re complying with the laws that affect us. We may also call you by name in the waiting room when we are ready to see you.

* Notification and Communication with Family. With your written authorization, also called a “Release of Information,” we may disclose to a member of your family, a relative, close friend, or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. With your written authorization, we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care in your emergency situation of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

* Required by law, legal proceedings, or law enforcement. We may disclose PHI when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with crime; or when ordered in a judicial or administrative proceeding.

* Public Health. As required by law, we may disclose PHI to public health authorities for purposes related to preventing or controlling disease, injury or disability; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

* Health Oversight Activities. We may disclose PHI to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.

* Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

* Public Safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

* Specific Government Functions. We may disclose your health information for military, national security, and prisoner purposes.

* Worker’s Compensation. We may disclose your health information as necessary to comply with worker’s compensation laws.

* Appointment Reminders & Health-Related Benefits or Services. We may use your PHI to contact you to provide appointment reminders or to give information about other treatments or health-related benefits and services that may be of interest to you.

Except as described in this Notice of Privacy Practices, we will not use or disclose your health information without your written authorization. If you do authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

Your Health Information Rights

* You have the right to request limits on certain uses and disclosures of your health information. We will consider your request, but are not required to accept it. These requests must be in writing.

* You have the right to choose how you receive your health information. You have the right to ask that we send information to you at an alternative address or by other means (for example telephone instead of mail, post office box instead of home address). We must agree to your request so long as we can easily provide it in the format you requested. These requests must be in writing.

* You have the right to see and get copies of your health information. In most cases, you have the right to look at or get copies of your PHI that we have. These requests must be in writing.

* You have a right to request that we correct or update information that is incorrect or incomplete. We are not required to change your health information. If we deny your request, we will provide you with information about our denial and how you can disagree with the denial. These requests must be in writing.

* You have a right to receive a list of certain disclosures we have made. This request must be in writing and must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.

* You have a right to receive a paper copy of this Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time.

Changes to this Notice of Privacy Practices

We reserve the right to change this Notice of Privacy Practices at any time in the future. We reserve the right to make the changed notice effective for health information we already have about you as well as any we receive in the future. We will post a current copy of the Notice. In addition, you may obtain a copy of the current notice in effect upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Harbor Behavioral Health Care Institute or with the Secretary of the Department of Health and Human Services. To file a complaint with the Harbor Behavioral Health Care Institute, contact the Compliance Officer/Risk Manager at (727) 841-4200, extension 257.

You will not be penalized for filing a complaint.