BURDMAN GROUP, INC.
NOTICE OF PRIVACY PRACTICES

1. 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.
    

2. Our Duty to Safeguard Your Protected Health Information.
   
   Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered “Protected Health Information” (PHI). We are required to give certain protections to your PHI, and to give you this Notice about our privacy practices. This Notice explains how, when and why we may use or disclose you PHI. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure.
   
   We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, we will post a new Notice in our offices. You may ask for a copy of the Notice at any time.
    

3. How We May Use and Disclose Your Protected Health Information.
   
   We may use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, payment or our health care operations. For uses beyond that, we must have your written authorization unless the law permits or requires us to make the uses or disclosure without your authorization. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must have in place an agreement with the outside entity that it will extend the same degree of privacy protection to your information that we must apply to your PHI. However, the law says that we are permitted to make some uses/disclosures without your consent or authorization. The following offers more description and some examples of our potential uses/disclosures of your PHI.
    

   Uses and Disclosures Relating to Treatment, Payment or Health Care Operations. Generally, we may use or disclose your PHI as follows:

    

   For treatment: We may disclose your PHI to Burdman Group clinicians, doctors, nurses and other health care professionals who are involved in providing services to you. For example, your PHI could be shared among members of our residential or vocational staff. Your PHI may also be shared with employees of other agencies who perform services relating to your treatment, but we will ask for your authorization before doing so. These kinds of disclosures may include consultation with case managers of other agencies for coordination of your care.
    

To obtain payment: We may use/disclose your PHI in order to bill and collect payment for your health care services. For example, we may release portions of your PHI to the Medicaid program, the local ADAMH/CMH Board through the Multi-Agency Community Services Information System (MACSIS), and/or other public or private payment programs like the Bureau of Rehabilitation Services, to get paid for services that we provide to you.
 

For health care operations: We may use/disclose your PHI in the course of operating Burdman Group. For example, we may use your PHI in evaluating the quality of services provided, or disclose your PHI to our accountant or attorney for audit purposes. Since we operate many different services, we may share your PHI with designated staff in our other departments to coordinate the services you receive. Release of your PHI to MACSIS and/or county agencies might also be necessary to determine your eligibility for publicly funded services.
 

Appointment Reminders: Unless you tell us not to do so, we may send appointment reminders and other similar materials to your home.
 

Uses and Disclosures Requiring Authorization: Before we give your information to any other health care providers, we will ask for your written authorization. Also, for other uses and disclosures beyond treatment, payment and operations purposes, we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. You can revoke your authorization at any time to stop future uses of your information.
 

Uses and Disclosures of PHI that do not Require Your Authorization: The law allows us to use or disclose your PHI without your consent or authorization in the following circumstances:
 

When required by law: We may disclose PHI when a law requires that we report information about suspected abuse or neglect of children, in response to a court order, or to Ohio Legal Rights. We must also disclose PHI to authorities that monitor our compliance with these privacy requirements.
 

For public health activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authorities.
For health oversight activities: We may disclose PHI to another agency responsible for monitoring the health care system for reasons like reporting or investigation of unusual incidents, or to evaluate us to see if we comply with health care standards.
 

Relating to decedents: We may disclose PHI relating to an individual’s death to the executor of an estate, to coroners, medical examiners or funeral directors, or to organ donor organizations relating to organ, eye or tissue donations or transplants.
 

To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
 

For specific government functions: We may disclose PHI to correctional institutions in certain situations, to government benefit programs relating to eligibility and enrollment, or for military or national security reasons.
 

For workers compensation compliance: We may disclose PHI to workers compensation authorities concerning work related injuries.
 

For involuntary commitment proceedings: We may disclose PHI to the local ADAMH/CMH Board or their attorney to perform an involuntary commitment.
 

For emergency treatment: We may disclose PHI to health care personnel to provide emergency treatment. We will attempt to obtain your authorization as soon as possible after the emergency treatment.
 

Your Rights Regarding Your Protected Health Information. You have the follow-ing rights relating to your protected health information:
 

• Unless your access is restricted for clear and documented treatment reasons, you have a right to see your protected health information upon your written request. If we deny your access, we will give you written reasons for the denial and explain how you can appeal the denial. If you want copies of any portion of your PHI, we may charge you for the copies depending on your situation.
   
• You have the right to request that we amend your PHI if you feel that the information is incorrect or incomplete. We may deny the request if we feel that the information in your file is accurate.
   
• You have the right to obtain a copy of a record of certain disclosures of your PHI that we make to others. This list will not include any disclosures that were made in accordance with state and federal law, or that were made prior to April 2003.
   
• You have the right to choose how we contact you or where we mail information to you. Your request on how we contact you must be reasonable.
   
• You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not bound to agree with your restriction. If we do agree, we must follow your restrictions.
   
• You have the right to receive a paper copy of this notice.
   

How to Complain about our Privacy Practices.

If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with our Clients Rights Officer. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We will take no retaliatory action against you if you make such complaints.

Questions and complaints about the use and disclosure of your PHI may be sent to:

Nancy Flinn
Clients Rights Officer
284 Broadway, Youngstown, OH 44504
330-743-9275

U. S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, Washington, D.C. 20201
1-866-627-7748
 

This notice was effective April 14, 2003.
Burdman Group, Inc.
Notice of Privacy Practices