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

PLEASE REVIEW IT CAREFULLY.
Protecting your privacy is important to us at South Shore Mental Health Center. We understand that protected health information (PHI) about you is personal. This notice describes the type of information we gather about you, with whom that information may be shared, and the safeguards we have in place to protect it.

We are required by law to keep PHI that identifies you private; to give you this notice of our legal duties and privacy practices with respect to PHI about you; and to follow the terms of the notice that is currently in effect.

How We May Use and Disclose Your Protected Health Information
We use and disclose PHI for a variety of reasons. For most uses and disclosures, it is the policy of South Shore Mental Health Center to obtain your consent. For others, we must have your written authorization. However, the law provides for certain conditions that permit the Center to use or disclose PHI for which consent, authorization, or opportunity to agree or object is not required, including the preliminary activities to obtain the preliminary authorization activities for you to engage in treatment.

The following categories describe different ways that we may use and disclose PHI. For each category of uses or disclosures we will give some examples.

For Treatment: We may use or disclose PHI about you to doctors, nurses, clinicians, case managers, and/or other health care professionals who are involved in providing or coordinating your health care. For example, we gather information about you through a comprehensive assessment process, then use this information in the development of a treatment plan that is consistent with your identified needs. We may share information in order to coordinate the different things you need, such as prescriptions and lab work.

For Payment: We may use or disclose PHI about you so that the treatment and services you receive may be billed to and payment may be collected from you, your insurance, or a third party. We may use and disclose PHI about you to obtain prior approval or to determine whether your insurance will cover the service.

For Health Care Operations: We may use or disclose PHI about you in the course of operating our Center. For example, we may use PHI to review the quality of our treatment and services or to evaluate the performance of our staff. Also, South Shore Mental Health Center maintains accreditation from Joint Commission on Accreditation of Healthcare Organizations, which may require review of your PHI to ensure we meet their standards and requirements.

Appointment Reminders: We may use or disclose PHI to contact you as a reminder that you have an appointment or for information about treatment or services.

Exceptions to Consent for Treatment, Payment, or Healthcare Operations: Although our policy is to seek your consent for the use/disclosure of your PHI for the activities described above, the law allows us to use/disclose your PHI without your consent. For example, we may use or disclose your PHI for emergency treatment if needed and/or provide emergency treatment if it is not reasonably possible to obtain your consent prior.

Uses and Disclosures Requiring Authorization: For uses and disclosures beyond treatment, payment, or healthcare operations purposes we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. Like consents, authorizations can be revoked via a written request at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.

Uses and Disclosures Not Requiring Authorization: The law provides that we may use/disclose your PHI without authorization in the following circumstances:

• When Required by Law: PHI may be disclosed to a public health authority authorized by law to receive reports for child/elder abuse or neglect; in response to a court order; or to a medical examiner.

• For Health Oversight Activities: PHI may be disclosed to a health oversight agency such as the Department of Mental Health, Retardation, and Hospitals and the Department of Children, Youth, and Families for activities authorized by law such as audits, investigations, inspections, and licensure.

• For Research Purposes: To Avert an Imminent Threat to Health or Safety: In order to avoid a serious threat to health and safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the serious or imminent threat of harm.

Your Rights Regarding PHI About You
You have the following rights regarding PHI we maintain about you: Right to Request Restriction of Uses and Disclosures: You have the right to request a restriction or limitation on the PHI we use or disclose about you. You may request restrictions on certain uses and disclosures, including treatment, payment, or health care operations. The Center need not agree to the restrictions requested, but will be bound by any restriction to which we agree.

Right to agree or object:
• Family/Care-giver: Limited PHI may be provided to a family member or co-habitant caregiver who lives with and provides direct care to the client, if it appears that without such direct care there would be significant deterioration in your daily functioning. In the exercise of professional judgment, PHI in this circumstance is limited to information regarding diagnosis, admission to or discharge from a treatment facility, the name of medication prescribed, and the side effects of such prescribed medication.
• Notification: Limited PHI may be disclosed to a family member, personal representative, or another person responsible for your care to notify or assist in the notification your location (if missing) or death.
• Mental Health Advocate: Limited PHI may be disclosed to the Mental Health Advocate, including the name of the person in treatment, the date and place where treatment has begun, and written protests and withdrawals of protest of involuntary treatment. All other requests for information from the Mental Health Advocate require an authorized release of information.

Right to Receive Confidential Communications:
You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Health Information. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to Inspect and Copy:
You have the right to inspect and copy PHI that may be used to make decisions about your care. Your request must be submitted to Health Information in writing in the form of an Authorization for Release of Information. If you request a copy of the information, we may charge a fee for costs of copying or mailing associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed. We will comply with the outcome of the review.

Right to Amend:
You have the right to request an amendment of the PHI we have about you for as long as the information is kept. Your request for an amendment must be made in writing to Health Information. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if you ask us to amend information that
was not created by the Center, if you do not have authorized access, if it is not part of the information we keep, or if the clinician/program manager believes the original information to be accurate and complete at the time it was written.

Right to an Accounting of Disclosures:
You have the right to receive an accounting of disclosures of PHI by the Center with certain exceptions. These exceptions include disclosures made to carry out treatment, payment or health care operations, as well as disclosures made pursuant to an authorization of release of information. Additional exceptions include those disclosures for national security or intelligence purposes and to a correctional institution or law enforcement official having lawful custody of an inmate.

You must submit your request for an accounting of disclosures in writing to Health Information. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The first list you request in a twelve month period will be free. For additional lists, we may charge you for the costs of providing the list. 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 a Paper Copy of this Notice:
You have the right to a paper copy of this notice at any time.

Changes to the Privacy Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future. Except when required by law, a material change may not be implemented prior to the effective date of the notice. We will post a copy of the notice in all Center locations. The notice will contain the effective date on the bottom of each page.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with South Shore Mental Health Center or with the Secretary of the Department of Health and Human Services. To file a complaint with the Center, contact our Human Rights Officer at the address and phone number below. All privacy complaints must be submitted in writing. You will not be penalized for filing a complaint.

Contact
South Shore Mental Health Center
Human Rights Officer
PO Box 899
Charlestown, RI 02813
(401) 364-7705