Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health is referred to as Protected Health Information (PHI). We respect our legal obligation to keep this information that identifies you private. We are obligated by law to provide you with notice of our legal duties and privacy practices. This Notice describes how we may use and disclose your PHI in accordance with applicable law and the NASW Code of Ethics. It also describes your rights regarding your PHI.

This Notice takes effect April 14, 2003, and will remain in effect until we replace it. We reserve the right to change this notice at any time as permitted by law. If we change this Notice, the new privacy practices will apply to your health information that we already have, as well as any information that we may generate in the future. If we change our Notice, we will post the new notice in our office, have copies available in our office, and post it on our Web site.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment: Your health information may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose your health information to any other consultant only with your authorization.

For Payment: We may use and disclose your health information so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it become necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of information necessary for purposes of collection.

For Health Care Operations: We may use or disclosed, as needed, your health information in order to support our business activities, including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your health information with third parties that perform various business activities (e.g. billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your health information. For training or teaching purposes, your health information will be disclosed only with your authorization.

Required by Law: Under the law, we must make disclosures of your health information to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

Without Authorization: Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are:

• Required by Law, such as the mandatory reporting of child abuse or neglect, or mandatory government agency audits or investigations (such as the social work licensing board or the health department);
• Required by Court Order;
• Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat, it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Verbal Permission: We may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

Marketing and Fundraising: We may use or disclose your health information in connection with limited marketing or fundraising communications permitted under the Federal Privacy Rules. Any such communications addressed to you will contain instructions describing how you may “opt out” of receiving further such communications.

With Authorization: We will not make any other uses or disclosures of your health information unless you sign a written “Release of Information Form” authorizing us to do so. You may revoke this authorization at any time, however revocations must be in writing and mailed to our office. Your revocation could not be honored if the information had already been released.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding the health information we maintain about you. To exercise any of these rights, please submit your request in writing to the VCAS office where your services are being provided:

· Right of Access to Inspect and Copy: You have the right, which may be restricted only in exceptional circumstances, to inspect and copy your health information that may be used to make decisions about your care. Your right to inspect and copy your health information will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. We may charge a reasonable, cost-based fee for copies.
· Right to Amend: You have the right to request that we amend your health information, if you feel it is incorrect or incomplete. Your written request must state the reason(s) for your request and your request will be placed in your record. We are not required to agree to the amendment.
· Right to an Accounting of Disclosures: You have the right to request an accounting of the disclosures that we make of your health information. By law, those disclosures can be limited. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
· Right to Request Restrictions: You have the right to request a restriction or limitation on the use or disclosure of your health information, for treatment, payment, or health care operations. We are not required to agree to your request.
· Right to Request Confidential Communication: You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
· Right to a Copy of This Notice: You have the right to a copy of this notice.

COMPLAINTS
If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer at one of the addresses listed below, or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201, or by calling (202) 619-0257. We respect your right to file a complaint and will not take any action against you if you file a complaint.