SOUND COMMUNITY SERVICES, INC. NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

PLEASE REVIEW IT CAREFULLY

Effective Date: April 14, 2003

Sound Community Service is committed to maintaining the privacy of your health information. We are providing you with this Notice so that you understand your rights regarding your health information, and so that you understand how Sound Community Service may use your health information. We will follow the terms of this Notice and will notify you if we make any significant changes to it.

For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

PURPOSE OF THE NOTICE OF PRIVACY REGULATIONS

This Notice of Privacy Practices (the “Notice”) is meant to inform you of the uses and disclosures of protected health information that Sound Community Service, Inc. may make. It also describes your rights to access and control your protected health information and certain obligations we have regarding the use and/or disclosure of your protected health information. Your “protected health information” is information about you created and received by us that may reasonably identify you. This information relates to your past, present or future physical or mental health or condition or payment for the provision of your health care. We are required by law to maintain the privacy of your protected health information. We are also required by law to provide you with notice of our legal duties and privacy practices with respect to our protected health information and to abide by the terms of the Notice that is currently in effect. We may however, change our notice at any time. The new revised Notice will apply to all of your protected health information maintained by us. You will not automatically receive a revised Notice. If you would like to receive a copy of any revised Notice you should contact the Sound Community Service Privacy Officer or ask your Sound Community Service contact person at your next meeting.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

During the admission process to Sound Community Service services you will be asked to sign a consent form that allows Sound Community Service to use and disclose your protected health information for treatment, payment and health care operations. You will also be asked to acknowledge receipt of this Notice. The following are types of uses and disclosures of your protected health information that Sound Community Service is permitted to make once you have signed our consent form.

TREATMENT, PAYMENT, HEALTH CARE OPERATIONS

Treatment – We may use and disclose your protected health information to provide you with psychosocial/rehabilitation services on an as needed basis. We may also use or disclose your protected health information in an emergency situation.

Payment – We may use and disclose your protected health information so that we can bill and receive payment for the services we provide to you. For billing and payment purposes, we may disclose your health information to your payment source, including an insurance or managed care company, Medicare, Medicaid, or another third party payer.

Healthcare Operations – We may use and disclose your health information to assist us in running our programs. For example, we may use your information to determine the quality of our staff and their interactions with you, or to evaluate the success of our programs. Sound Community Service may also use your information for general business purposes.

AUTHORIZATIONS – We will obtain your written authorization (an “Authorization”) prior to making any use or disclosure other than those described above. A written Authorization is designed to inform you of a specific use or disclosure, other than those set forth herein, that we plan to make of your health information. The Authorization describes the particular health information to be used or disclosed and the purpose of the use or disclosure. Where applicable, the written Authorization will also specify the name of the person to whom we are disclosing the health information. The Authorization will also contain an expiration date. You may revoke a written Authorization previously given by you at any time, but you must do so in writing. If you revoke your Authorization, we will no longer use or disclose your health information for the purposes specified in that Authorization except where we have already taken actions in reliance on your Authorization.

DISCLOSURES TO FAMILY AND PERSONAL REPRESENTATIVES – We may be required to disclose your health information to your personal health care representatives, if you have any. Personal representatives may include parents of minor children, guardians, conservators or other individuals authorized by law to handle your healthcare issues. We will verify a representative’s relationship to you prior to disclosing any of your health information. Otherwise, we may only share your health information with a family member if authorized do so by your signed Authorization. In the event of your incapacity or in emergency circumstances, we will disclose health information based on a determination using our professional judgment, disclosing only health information that is directly relevant to the person’s involvement in your healthcare.

OTHER USES – Sound Community Service may use or disclose your health information for certain other purposes without your permission. These circumstances include:

• Disclosures required by law, including required public health and safety reporting
• For research projects meeting privacy rule requirements
• To respond to investigations
• To respond to a subpoena, discovery request or other lawful process
• For law enforcement purposes and judicial/administrative proceedings
• Health Oversight Activities, for example, disclosure of information to the government for auditing purposes or disclosure for program licensing purposes
• Disclosures related to workers compensation claims involving you
• Disclosures to prevent a serious threat to your health and safety or the health and safety of the public or another person.
• Disclosures to Business Associates such as billing services, legal or accounting consultants, or clinical services to perform the job we have asked them to do.
• To inform you about treatment alternatives and health related benefits and services
• In response to your donation of organs or tissues
• If you are a member of the armed forces, we may use and disclose your protected health information as required by military command authorities or the Department of Veterans Affairs.
• For national security if required by law to authorized federal officials to provide Protection to the President, other authorized persons or foreign heads of state or conduct special investigations
• To correctional institutions, or if you are under the custody of a law enforcement official, for certain purposes including your own health and safety as well as that of others.

SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE AND HIV RELATED INFORMATION

For disclosures concerning protected health information related to care for psychiatric conditions, substance abuse or HIV-related testing and treatment, special restrictions may apply. For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special Authorization or a court orders the disclosure.

Psychiatric Information – Certain mental health information may be disclosed for treatment, payment and health care operations as permitted or required by law. Otherwise, we will only disclose such information pursuant to an authorization, court order or as otherwise required by law.

Substance Abuse Treatment information – If you are treated in a specialized substance abuse program, your permission will be needed for certain disclosures, not including emergencies, certain reporting requirements and other disclosures specifically allowed under Federal law.

HIV Related Information--- We will disclose HIV-related information as permitted or required by Connecticut law. For example your HIV related protected health information, if any, might be disclosed in the event of a significant exposure to HIV-infection to personnel or members of Sound Community Service or a known partner. Any use and disclosure for such purposes will be limited to someone able to reduce the outcome of the exposure and limited in accordance with Connecticut and Federal law.

YOUR RIGHTS

Access to Records – You may ask for copies of your health care information by submitting a request in writing. Sound Community Service may charge you certain reasonable costs to cover copying expenses and postage related to your request. You may contact Sound Community Service if you wish to receive your health information in a specific format or if you would like a summary of your health information. In certain circumstances, Sound Community Service may deny you access to your health information. If we do deny you access, we will tell you why and tell you how you may appeal the denial.

Accounting of Certain Disclosures – You may ask Sound Community Service to provide you with information about whom your health information has been given to. Sound Community Service is not required to account for disclosures for treatment, payment or health care operations, disclosure to you or your representatives, or for disclosures made pursuant to an Authorization.

Restrictions and Alternative Communication – You may ask Sound Community Service to restrict the use of your health information. Depending on the nature of your request we may or may not agree to those restrictions. If we do agree to your requested restrictions, we must follow those restrictions, except in emergency treatment situations or other exceptions as described above. You may also make requests about how we communicate with you. For example, you may ask that we send all correspondence to your work rather than to your home. You must make such requests in writing.

Amendments to Your Records – You have the right to request that we change information in your record at Sound Community Service if you believe it is incorrect. Such requests must be made in writing and must explain why the information should be amended. Amendments can only be made to records created by Sound Community Service. We may deny your request under certain circumstances.

QUESTIONS AND COMPLAINTS

If you want more information about our privacy practices or have questions or concerns, please contact our Privacy Officer or other staff. If you are concerned that we may have violated your privacy rights, you may complain to us using the contact information listed below. You also may submit a written complaint to the U.S. Department of Health and Human services. We will provide you with the address to file such a complaint upon request.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Please direct any of your questions or complaints to: Tracey Hauser, Privacy Officer, Sound Community Service, Inc., 38 Green Street, New London, CT (860) 443-0036.

Sound Community Services, Inc.
PO Box 2170
New London CT 06320-2170
(860) 443-0036