NOTICE OF PRIVACY PRACTICES
In Accordance with the
Health Insurance Portability & Accountability Act (HIPAA) &
Health Information Technology for Economic and Clinical Health (HITECH)

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

Protected Health Information (PHI) is individually identifiable health information (also referred to as medical information). It includes demographic information of an individual that is created or received by Northeast. It also includes information that relates to your past, present, or future physical, mental, or behavioral health, the provision of health care to you, or payment for health care services. PHI can be written on paper, oral, stored electronically or on other media.

We protect any information that identifies you or could be used to identify you that relates to your health, your treatment, or your health insurance benefits. Your name, address and other basic identifying information is protected even if unaccompanied by information about your health, treatment, or benefits.

The following sections list ways that we may use and disclose your medical information. The term "you" in this Notice means the child/adult/family to whom Northeast are providing services. We will use and disclose your medical information only for the reasons described in this notice. We provide examples of the types of uses or disclosures that fall within a particular category. These examples are intended to help you understand what these categories mean; they do not cover every type of use or disclosure within each category. In each of the below-noted disclosures, information sharing will be guided by the following principles:

1. How We Disclose Your Medical Information without Your Consent
Northeast Parent & Child Society will use and disclose your protected health information without your consent for Treatment, Payment, and Health Care Operations. This allows us to use and disclose protected health information as explained below:

a. Treatment - Northeast will share your protected health information as necessary with the individuals and organizations that are responsible to plan, implement, and who may be coordinating and providing your treatment. For example, two health care professionals at Northeast who are treating you may share information with one another to coordinate treatment. Likewise, if you are admitted to a hospital, we may provide the hospital with information about the services we have provided you to assist the hospital in delivering appropriate care. In addition to our agency staff, this may include representatives of the organization that arranged for you to come to Northeast for treatment.

b. Payment – We will use your protected health information, as necessary, to get approval and/or payment for the services you are provided. This will include sharing information within our agency for billing and accounting purposes, sharing your information with third-party billing services, your health insurance plan, or with the organization responsible for paying for the services you receive. For example, we may submit claims for reimbursement to the Medicaid program or to a private insurer that is providing you with health insurance coverage.

c. Health Care Operations –We may use and disclose health information about you to carry out general business and health care operations. These operations include quality improvement activities, evaluating the performance of our health care practitioners, and resolving any complaints or grievances you may have. For example, we may allow a consulting nurse to review your medical chart as part of a program designed to identify whether you have received all recommended preventive services. We may also use and disclose your health information to assist other health care providers and health plans in performing certain health care operations, such as quality assessment and improvement, reviewing the competence and qualifications of health care providers, and conducting fraud detection or compliance. We may also use and disclose information to business associates providing services to Northeast, such as specialized therapies, a Pharmacy, centralized intake, laboratory tests, or closed record storage services.

d. Appointment Reminders. We may use and disclose your health information to remind you about appointments you have made to receive health care services or to encourage you to make such appointments (by telephone, fax, or mail).

e. Marketing and Fundraising. Northeast will not use your information for marketing or fundraising purposes without your permission. If you would like to request our fundraising newsletters, you will be requested to sign a request form, providing only your basic demographic information for mailing purposes – name and address and what programs where you have received services. As a function of our newsletters, donations are requested. You are not required to provide a donation, and if you do not, it will not affect your ability to receive services.

a. Family Members or Friends. We may share information about you with family members or friends assisting you in obtaining treatment or benefits, but only if you do not object. In these cases, we will share only the information that is necessary for the family member or friend to assist you. We may also notify a family member or friend about your general condition or your death. In some cases, we will share information with a disaster relief organization such as the Red Cross that is assisting with notification efforts.

b. Facility Directory & Rosters. If you are a resident in one of our facilities, we may share information about you from our facility directory with individuals who ask for you by name, but only if you do not object. We will limit the information we share through the facility directory to your location and general condition. Your name may also be on trip lists or rosters for various activities while receiving services at Northeast. Examples of rosters could include School Attendance Lists, Trip Rosters, Taxi Service Lists, School Awards, or Special Program Listings.

3. Public Interest Purposes.
We may use and disclose your health information without your written authorization for certain public interest purposes permitted or required by law:

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

b. For public health activities. We may disclose your health information to public health authorities or other agencies and organizations conducting public health activities, such as preventing or controlling disease, injury or disability, and reporting births, deaths, child abuse or neglect, domestic violence, or potential problems with products regulated by the Food and Drug Administration or communicable diseases.

c. About victims of abuse, neglect or domestic violence. We may disclose your health information to an appropriate government agency if we believe you are a victim of abuse, neglect, or domestic violence and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we disclose your health information for this purpose unless we believe that letting you know would place you at risk of serious harm or we believe that a person who usually receives information from us on your behalf is responsible for the abuse, neglect, or domestic violence.

d. For health oversight activities. We may disclose your health information to health oversight agencies for oversight activities authorized by law such as audits, investigations, inspections, and licensing surveys.

e. For judicial and administrative proceedings. We may disclose your health information in the course of any judicial or administrative proceeding in response to an appropriate order of a court or administrative body.

f. For law enforcement purposes. We may disclose your health information to a law enforcement official for a legitimate law enforcement purpose such as identifying or locating a suspect, fugitive or missing person; complying with a court order, subpoena, or administrative request; providing information about a victim of a crime or reporting a death that may be the result of a crime.

g. About deceased individuals. We may disclose your health information to a coroner or medical examiner for purposes such as identifying a deceased person or determining a cause of death. We may also disclose your health information to a funeral director as necessary to assist such a person in carrying out his or her duties.

h. For organ, eye, or tissue donations. We may disclose your health information to organ procurement organizations and similar entities for the purpose of assisting them in organ, eye, or tissue donation or transplantation activities.

i. For research. We may use or disclose your health information for research purposes, such as studies comparing the benefits of alternative treatments received by our patients. We will use or disclose your health information for research purposes only with the approval by our regulatory bodies, which follows a special approval process. Northeast will balance the needs of the researchers and the potential value of their research against the protection of your privacy.

j. To avert a serious threat to health or safety. We may use or disclose your health information to prevent or lessen a serious and immediate threat to your health or safety or to the health or safety of another person or the general public. We will disclose your health information for this purpose only to someone who may be able to prevent or lessen this type of threat.

k. For specialized government functions. We may use or disclose your health information to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, we may disclose your health information to appropriate military authorities, as they deem necessary to carry out military missions. We may also disclose your health information to federal officials for lawful intelligence or national security activities and for the purpose of providing protective services to the President of the United States and other officials. In addition, if you are in the custody of a correctional institution or law enforcement official, we may disclose your health information to that institution or official for certain purposes.

l. For workers' compensation. We may use or disclose your health information as permitted by the laws governing the workers' compensation program or similar programs that provide benefits for work-related injuries or illnesses.

4. Obtaining Your Authorization for Other Uses and Disclosures.
Northeast will not use or disclose your health information for any purpose not specified in this Notice without your written authorization. If you give us your authorization, you may revoke it at any time, in which case we will no longer use or disclose your health information for this purpose, except to the extent we have already relied on your authorization. You are not required to sign an authorization form and we will not deny you treatment if you refuse to do so unless the treatment is part of a research study.

Special Protections. There are special protections for sensitive health information. Special privacy protections apply to HIV-related information, alcohol and substance abuse treatment information, mental health information, reproductive care information, and genetic information. Some parts of this general Notice of Privacy Practices may not apply to these types of information. For further information, please contact your Program Director or our Privacy Officer at 1473 Erie Boulevard, Schenectady, N.Y. 12305.

If you are a minor child and you have the capacity to make decisions about your medical information on your own behalf under the law, you may exercise your rights under this Notice; otherwise, a parent or legal guardian may exercise your rights for you. A person who is entitled to exercise your rights must sign any consents or authorizations or give any other approval or permission required by this Notice. You or your Personal Representative may exercise any of the rights specified in the items in this section by speaking with your Program Director, or writing to our Privacy Officer at: 1473 Erie Boulevard Schenectady, N.Y. 12305.

1. Right to Inspect and Copy. You have the right to inspect and obtain a copy of your protected health information for as long as it is maintained by Northeast. This includes medical and billing records. All requests to review your medical information should be made in writing and describe the information you want to review and the format in which you want to receive; for example, whether you want to inspect your records at our offices, receive paper copies, or get the information in electronic form. If you request a copy of your records in paper or electronic form, we may charge a reasonable fee. The fee is generally paid before or upon receipt of the records.

2. Right to Request Amendments. If you believe there is an error in fact or interpretation in the personal health information contained in your record, you may request that it be amended. We do not have to agree to make the changes you request. If we do not believe the changes you requested are appropriate, we will notify you in writing how you can have your objection to our decision included in our records. You may provide a written statement requesting changes to your health information to your Program Director or by mailing it to our Privacy Officer at Northeast Parent & Child Society, Inc., 1473 Erie Boulevard, Schenectady, NY 12305.

3. Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures of your health information that have been made by Northeast. The list will not include disclosures made for certain types of purposes, such as disclosures for treatment, payment, or health care operations or disclosures you authorized in writing.

4. Right to Request Restrictions. You may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or agency operations. You may also request that your protected health information not be disclosed to family members or others involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply.

5. Right to Request Confidential Communications. You have the right to ask us to send health information to you in a different way or at a different location if you believe that will provide you with additional privacy protection. For example, you may ask us to send mail to your work address rather than your home address. Your request should also specify where and/or how we should contact you. We will accommodate all reasonable requests. Any such requests must be submitted in writing to your Program Director or to our Privacy Officer at Privacy Officer at Northeast Parent & Child Society, Inc., 1473 Erie Boulevard, Schenectady, NY 12305.

6. Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice of Privacy Practices at any time. You may receive a paper copy even if you have previously requested to receive this Notice electronically. You may obtain a copy of this Notice at our website, www.neparentchild.org., by requesting a copy from your Program Director, or by writing to our Privacy Officer at Northeast Parent & Child Society, Inc., 1473 Erie Boulevard, Schenectady, NY 12305.

If you believe your privacy rights have been violated, you may file a written complaint with Northeast Parent & Child Society by mailing it or delivering it to our Privacy Officer at Northeast Parent & Child Society, Inc., 1473 Erie Boulevard, Schenectady, NY 12305. In addition, you may file a complaint to the Secretary of Health and Human Services (HHS) by writing to the 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; by calling 1-877-696-6775; or by sending an email to OCRcomplaint@hhs.gov. Northeast cannot, and will not, make you waive your right to file a complaint with HHS as a condition of receiving care from us, or penalize you for filing a complaint with HHS.

We reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms shall apply to all health information that we maintain, including information about you collected or obtained before the effective date of the revised Notice. We will post any revised Notice in our agency offices. You will also be able to obtain your own copy of the revised Notice upon request or by visiting our agency website at www.neparentchild.org. 6

If you have any questions or would like additional information about this Notice or Northeast Parent and Child Society’s privacy practices, please contact our Privacy Officer, at 1473 Erie Boulevard, Schenectady, N.Y.12305 or by calling him/her at 518-346-1285.

Effective Date
This Notice will take effect on July 1, 2012.
Updated March 25, 2005
Updated November 10, 2009

Updated July 1, 2012