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Notice of Privacy Practices

Revised June, 2003

THIS NOTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY AND SIGN BELOW.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, (i.e. electronically, on paper, or orally) are kept confidential. This Act gives you significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

As a requirement of HIPAA, Didlake, Inc. is providing to you an explanation of how we are required to maintain the privacy of your health information. HIPAA regulates how information may be used and disclosed. The following describes each of the different ways that we may use or disclose your Protected Health Information (PHI) without your written authorization. Other uses and disclosures will be made only with your written authorization. You also have certain rights with respect to your PHI which are also described in this Notice.

Uses or Disclosures for Purposes of Treatment, Payment or Health Care Operations

Didlake, Inc. may use and disclose your medical information without written authorization for each of the following purposes: treatment, payment and operations.

• Treatment includes providing, coordinating, or managing rehabilitation services. An example of this would be speaking with case managers.
• Treatment also includes Didlake coordination with Community Services Boards (CSB), the Department of Rehabilitative Services (DRS), other governmental or rehabilitation agencies involved in your care, Case Managers, etc. Didlake, Inc. may coordinate with and disclose your information to these agencies and individuals without written authorization, as they are necessary for quality services. Per HIPAA regulations, we will only disclose the minimum amount necessary to ensure quality services.
• Payment includes obtaining reimbursement for services, confirming coverage, billing or collection activities.
• Operations include the conducting of quality improvement activities, auditing functions, etc.

Uses and Disclosures Following Your Written Authorization

We may use or disclose your PHI pursuant to a written authorization. You have the right to revoke any written authorization at any time so long as your revocation is provided to us in writing. If you revoke your written authorization, we will no longer use or disclose your health information for purposes identified in the authorization, except to the extent that we have already taken action in reliance on your authorization. The following uses and disclosures require a written authorization:

• For marketing purposes such as a request to provide certain health information to a pharmaceutical company to provide marketing material and information to you;
• Uses and disclosures of psychotherapy notes.

Uses and Disclosures Following Your Verbal Agreement

We may use or disclose your health information, pursuant to your verbal agreement, for purposes of including you in our directory or for purposes of releasing information to persons involved in your care as described below:

• Directory We may use or disclose certain limited health information about you in our directory. This information may include your name, your religious affiliation and a general description of your condition. Your religious affiliation may be given to a member of the clergy. The directory information, except for religious affiliation, may be given to people who ask for you by name.
• Individuals Involved in your Care We may disclose your health information to individuals, such as family and friends, who are involved in your care or who help pay for your care. We also may disclose your health information to a person or organization assisting in disaster relief efforts for the purpose of notifying your family or friends involved in your care about your condition, status and location.

Disclosures to Business Associates

We may disclosure your health information to certain business associates that are under contract with us to perform or assist in a function or activity that requires the use or disclosure of health information. We have obtained satisfactory assurance that each such business associate will appropriately safeguard your health information. Examples of business associates include consultants, lawyers and third party billing companies.

Uses or Disclosures Required by Law

We may use or disclose your health information as required by federal, state or local law.

Uses or Disclosures Permitted by Law

Certain state and federal laws and regulations either require or permit us to make certain uses or disclosures of your health information without your permission. These uses or disclosures are generally made to meet public health reporting obligations or to ensure the health and safety of the public at large. The uses or disclosures which we may make pursuant to these laws and regulations include the following:

• Public health activities. We may use or disclose your health information to public health authorities that are authorized by law to receive and collect health information for the purpose of preventing or controlling disease, injury or disability.

• Health oversight activities. We may use or disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities. These oversight activities may include audits, investigations, inspections, or licensure and certification surveys. These activities are necessary for the government to monitor the organizations or persons that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.

• Judicial or administrative proceedings. We may use or disclose your health information in response to an order of a court or administrative tribunal, but we may only disclose the health information expressly authorized by such order. We may also disclose your health information pursuant to a subpoena, discovery request, or other lawful process not accompanied by an order of a court or administrative tribunal, but only if we receive satisfactory assurance that the requesting party has made reasonable efforts: (i) to notify you of the request for disclosure; or (2) to obtain a qualified protective order protecting your health information.

• Workers compensation. We may use or disclose your health information to workers compensation programs when your health condition arises out of a work-related illness or injury.

• Law Enforcement official. We may use or disclose your health information in response to a request received from a law enforcement official for the following purposes:
  • In response to a court order, subpoena, warrant, summons or similar lawful process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • Regarding a victim of a crime if, under certain limited circumstances, we are unable to obtain the persons agreement;
  • To report a death that we believe may be the result of criminal conduct;
  • To report criminal conduct at Didlake;
  • In emergency situations, to report a crime; the location of the crime and possible victims; or the identity, description, or location of the individual who committed the crime.

• To avert a serious threat to health or safety. We may use or disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals. Any such use or disclosure would be made solely to the individual(s) or organization(s) that have the ability and/or authority to assist in preventing the threat.

• Military and veterans. If you are a member of the armed forces, we may use or disclose your health information as required by military command authorities.

• National security and intelligence activities. We may use or disclose your health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.

Your Rights Regarding Your Health Information

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

• Right to inspect and copy. You have the right to inspect and copy health information that may be used to make decisions about your care. Generally, this includes medical and billing records, but does not include psychotherapy notes. 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 your health information in certain circumstances. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional selected by Didlake will review your request and the denial. The person conducting the review will not be the person who initially denied your request. We will comply with the outcome of this review.

• Right to request an amendment. If you feel that the health 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 Didlake.

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:

1. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
2. is not part of the health information kept by or for Didlake;
3. is not part of the information which you would be permitted to inspect/copy; or
4. is accurate and complete.

• Right to an accounting of disclosures. You have the right to request an accounting of the disclosures that we have made of your health information. This accounting will not include disclosures of health information that we made for purposes of treatment, payment, or health care operations.

Your request must state a time period which may not be longer than six (6) years prior to the date of your request and may not include dates before April 14, 2003. Your request should indicate in what form you want to receive the accounting (for example, on paper or via electronic means). The first accounting that you request within a twelve (12)-month period will be free. For additional accountings, we may charge you for the costs of providing the accounting. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

• Right to request restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you.

To request restrictions, your request must include (a) what information you want to limit; (b) whether you want to limit our use, disclosure or both; and (c) to whom you want the limits to apply (for example, disclosures to a family member).

• Right to request confidential communications. You have the right to request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

• Right to a paper copy of this notice. You have the right to receive a paper copy of this notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact the Privacy Officer.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Didlake or with the Secretary of the Department of Health and Human Services. To file a complaint with Didlake, contact the Privacy Officer at 8641 Breeden Ave., Manassas, VA 20110. All complaints must be submitted in writing. To file a complaint with the Department of Health and Human Services, you can contact: The US Department of Health and Human Services, Office of Civil Rights, 200 Independence Avenue, S.W., Washington, DC 20201, (202) 619-0257, (Toll free: 1-877-696-6775). You will NOT be penalized for filing a complaint.

This notice is effective as of June 30, 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.

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© 2003 Didlake, Inc. All rights reserved.