PROJECT SAMARITAN HEALTH SERVICES, INC.

NOTICE OF PRIVACY PRACTICES

(Effective April 14, 2003)

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Introduction

At Project Samaritan Health Services, Inc. (PSHS) we are committed to protect your health information. This Notice, which is required by the Federal Health Insurance Portability and Accountability Act (HIPAA), informs you of our privacy practices. It also describes your rights as they relate to your protected health information. This Notice is effective April 14, 2003 and applies to all protected health information as defined by federal regulations.

Our Responsibilities

Project Samaritan Health Services, Inc. is required to:

· Maintain the privacy of your health information,

· Provide you with this notice as to our legal duties and privacy practices with respect to protected health information,

· Abide by the terms of this notice,

· Notify you if we are unable to agree to a requested restriction,

· Notify you if we are unable to provide you with access to your protected health information,

· Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations,

· Reserve the right to change the terms of this Notice.

If PSHS changes the terms of this notice, we will

provide you with a paper copy of the revised Notice

within 60 days of the revision.

You will receive the revised Notice at the time of your next visit. If the visit is not scheduled within the 60-day time frame the Notice will be mailed to you.

How We Use and Disclose Your Health Information

We will not use or disclose your individually identifiable health information without authorization, except as permitted by this Notice.

Treatment: All entries in your health record are deemed protected health information (PHI). This includes information regarding your diagnosis, treatment, procedures and results of tests done. We may release such health information to other health care providers in order to provide you with quality care and to ensure the appropriate and timely provision of care and services.

Payment. In order to receive payment for the care and treatment that we provide for you we must submit a bill to you or your insurance company. The bill will include information regarding your diagnosis, procedures done and treatments rendered.

Health Care Operations: Members of the PSHS staff, may use information in your health record for other purposes which includes but is not limited to: improve the quality and effectiveness of the healthcare and services we provide, staff training, evaluating staff performance, auditing functions, strategic planning.

Special Protections for Health Information: Additional protections apply under the Public Health Laws governing release of HIV related information and Federal law, 42 CFR Part 2, governing release of information for substance abuse treatment. PSHS will comply with these regulations.

Your Health Information Rights

Be provided with the paper copy of this Notice, even if it was sent electronically.
Inspect and request a copy of your health record,
Request an amendment to your health record in accordance with PSHS procedures,
Obtain an accounting of certain disclosures of your health information,
The right to request restriction on certain uses and disclosures of your protected health information. However, PSHS is not obligated to agree to all such requests.
Request communications of your health information by reasonable alternative means or at alternative locations, such as, you can request that we contact you at work rather than home, by cell phone rather than home phone.
Revoke an authorization to use or disclose health information, unless that action has already been taken or the action is required by law.

Family Members/Relatives/Friends: PSHS staff may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. When communicated to us, PSHS will comply with your requests for restrictions on disclosures to any of these persons.

Appointment Reminders: We may also contact you to provide appointment reminders. If you wish to be notified by alternative means at addresses or telephone numbers not on file please notify PSHS staff of any restrictions on such notifications and alternate contact information.

Marketing/Treatment Alternatives: We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you

Research: We may disclose information to researchers when an institutional review board has reviewed and approved the research proposal and has established protocols to ensure the privacy of your health information.

Funeral Directors/Coroners: We may disclose health information to these persons, consistent with applicable law, to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Fund raising: We may contact you as part of a PSHS fund-raising effort but will not use information regarding your health care or treatment for any fund raising purposes.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Law Enforcement: We may disclose health information to correctional institutions and for law enforcement purposes, as defined by law or in response to a valid subpoena.

Oversight Agencies: Federal law also makes provision for your health information to be released to public health, regulatory and governmental authorities for the purposes of:

Investigating unlawful conduct and/or violations of professional or clinical standards that may potentially endanger patients, workers or the public.

Reporting cases of child abuse or neglect, domestic violence, elder abuse.
Preventing serious threats to public health and safety.
Reporting diseases that may pose a threat to the public.
Legal proceedings, as required by law.

How to Contact Us:

If you require additional information regarding this Notice and/ or believe your privacy rights have been violated, you can file a complaint with PSHS Privacy Contact person, as noted below.

Title: Director of Patient Care Services, PSHS

Telephone: (718) 298-5100, Ext. 115

You may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services.

The address is:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201

There will be no retaliation for filing a complaint with either the PSHS Privacy contact person or the Office for Civil Rights.