1. THIS NOTICE DESCRIBES HOW MENTAL, BEHAVIORAL, AND OTHER HEALTH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice or want additional information, please contact Megan Georges at 412 788 8219.

2. Purpose. We are required by State and Federal law to maintain the confidentiality and privacy of your protected health information and to give you this notice of legal duties and privacy practices regarding your protected health information. “Protected health information” is information about you, that may identify you and that relates to your past, present or future physical or mental health or condition, and related to health care services. This notice describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. We are required to abide by the terms of this notice, which is effective April 14, 2003. We reserve the therapeutic right to change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time and for information we receive in the future. We will post a current copy of the policy and will have copies of our current policy available. We will also provide you with any revised Notice of Privacy Practices upon a request made by you.

3. Uses and Disclosures of Protected Health Information for Treatment, Payment or Operations. We are permitted by State and Federal law to use and disclose to our staff and professionals, your protected health information for treatment, payment, and other health care operations of The Bradley Center. Relevant portions or summaries of your protected health information may be used and disclosed to those actively engaged in treating you or to persons at other agencies and licensed facilities, when you are referred to that facility and a summary or portion of the record is necessary to provide for continuity of proper care and treatment. Your protected health information may also be used and disclosed to third party payors to pay your health care bills, provided that the information is limited to staff names, dates, types, and cost of therapies or services, and a short description of the general purpose of each treatment session or service. We may also use your protected health information to assist in the operation of The Bradley Center. Described below are some examples of the types of uses and disclosures of your protected health care information that we are permitted to make. Please be aware that not every use or disclosure is listed.

A. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your mental, behavioral, and other health care and any related services. For example we may disclose your protected health information to: *Clinical staff or other personnel who are helping to provide you with health care services. *Those participating in interagency meetings, required for behavioral health services. *Intensive care managers, or other county officials, permitted to participate and contribute to your care, such as Juvenile Probation, the RTF Group, etc. *Consultation with another provider of mental, behavioral, and other health care services or your referral to another provider of mental, behavioral, and other health care services, such as wraparound, PCP, family-based treatment, outpatient treatment, etc. *Psychiatrists, psychologists, social workers, mental health professionals, or other agency personnel who are helping to care for you, such as a school psychologist, speech therapist, etc. *Different departments of the agency may share protected health information about you in order to coordinate various therapeutic services you need, such as prescriptions or lab work. In addition, by participating in group therapy, other residents may observe or become aware of protected health information regarding you.

B. Payment: Your protected health information will be used to obtain approval for, and payment of, your mental, behavioral, and other health care services. This may include certain activities that your health insurance plan or government agency may undertake before it approves or pays for the mental, behavioral, and other health care services that we recommend for you, such as making a determination of eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for behavioral health services requires that your relevant protected health information may be disclosed to state and county officials in order to obtain prior approval for services.

C. Mental Health Care Operations: We may use or disclose your protected health information as needed in order to support our operations. These activities include, but are not limited to, quality assessment activities, employee review activities, personnel training programs, licensing, case management and care coordination, auditing, and other Bradley Center business functions. For example, we may disclose your protected health information to: *State licensure and other reviewers and inspectors, including the Department of Public Welfare and other accreditation organizations *Parents, legal guardians and others, when necessary to obtain consent to medical treatment *Use a sign-in sheet at the reception desk *Contact parents, legal guardians, and others to remind them of appointments/meetings *Contact parents, legal guardians, and others for follow up *Business and clinical development, such as conducting cost management and planning, as well as related analyses Finally, we will share your protected health information with third party “business associates” who perform various activities involving protected health information (e.g. billing, service auditors) for us. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

4. Other Permitted and Required Uses and Disclosures We may use and disclose your protected health information in the following instance: Disclosure is in your best interest. In this case, only the protected health information that is relevant to your mental, behavioral, or other health care will be disclosed. For example:

A. Others Involved in Your Health Care: Unless you object, we may disclose to a member of your family, a relative, or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest, based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, of your location, or general condition. Finally, we may use or disclose your protected health information to an authorized public, or private, entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care.

B. Emergencies: We may use or disclose your protected health information in an emergency treatment situation, when use and disclosure of the protected health information is necessary to prevent serious risk of bodily harm or death. Only specific information pertinent to the relief of the emergency may be released without your authorization.

5. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent or Authorization. In certain circumstances, we may use or disclose your protected health information without your consent or authorization. These situations include, but are not limited to the following: *Required by law: We may use or disclose your protected health information if, and to the extent, we are required by Federal or State law. You will be notified, if required by law, of any such uses or disclosures. *Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, if we believe that you have been a victim of abuse, neglect, or domestic violence, we may disclose your protected health information to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable Pennsylvania laws. *Health Oversight: We may disclose protected health information to the Department of Public Welfare for overseeing health care activities through audits, investigations, inspections, and licensure. Oversight agencies include government agencies that oversee the health care system, government benefit programs, or other governmental regulatory programs and civil rights laws. *Legal Proceedings: We may disclose protected health information in the course of any judicial proceedings, in response to an order of a court or administrative tribunal (but only the protected health information expressly authorized by such order). *Required Uses and Disclosures: Under the law, we must make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

6. Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization Other uses and disclosures of your protected health information, not covered by this Notice or by laws that apply to use, will be made only with your written authorization. You may revoke this authorization at any time in writing. If you revoke this authorization, we will no longer use or disclose your protected health information for the reasons covered by the authorization. However, we cannot undo any disclosures we have already made with the authorizations, and are required to retain our records of the care that we provided to you.

7. Your Rights Regarding Your Protected Health Information: You have the following rights with respect to your protected health information and a brief description of how you may exercise these rights.

A. You Have the Right to Request Restrictions: You have the right to request a limitation or restriction on the protected health information we use or disclose about you for treatment, payment, or healthcare operations. You may also request that we limit the protected health information we disclose to family members or others who may be involved in your care or for the payment of your case. For example, you could ask that we not use or disclose information about a test that you had. However, we are not required to agree to a restriction that you request. If we agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your therapist. You may request a restriction by making your request in writing, including (a) what protected health information you want to limit; (b) whether you want us to limit our use, disclosure or both; and (c) to whom you want the limits to apply (e.g. disclosures to certain relatives).

B. Right to Request Confidential Communication: You have the right to request to receive confidential communications from us in a certain way or at an alternative location. For example, you can ask that we contact you at home or by mail. We will accommodate reasonable requests. We may also condition this accommodation by asking you for specification of an alternate address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact, Megan Georges, at 412-788-8219 (Fax: 412-788-8215) specifying how or where you wish to be contacted.

C. Right to Inspect and Copy: You have the right to inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records, and any other records we use for making decisions about your care. To inspect and copy protected health information, submit your request in writing to our Medical Record Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other related costs. We may deny your request to inspect and copy in certain limited circumstances. Under Federal law, for example, you may not inspect or copy the following records: psychotherapy notes and information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. Federal and state law permits us to deny your request to inspect or copy if the protected health information was obtained from someone under a promise of confidentiality Finally, State law permits us to deny access upon documentation by the treatment leader that disclosure of specific information will constitute a substantial detriment to the client’s treatment. Depending on the circumstances, a decision to deny access may be reviewable. Please contact our Privacy Contact, Megan Georges at 412-788-8219, if you have questions about access to your medical record.

D. You May Have The Right to Amend: If you believe we have protected health information about you in a designated record set that is incorrect or misleading, you may prepare a statement for inclusion as part of your record. Your statement shall accompany all released records. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact, Megan Georges at 412-788-8219 if you have questions about amending your medical record.

E. Right to Receive an Accounting of Disclosures: You have the right to an accounting of disclosures for purposes other than treatment, payment or healthcare operations, as described in this notice. It excludes disclosures we may have made to you, to family members, or others involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions, and limitations.

F. Right to a Paper Copy of this Notice: You have the right to a paper copy of this notice, upon request. To obtain a paper copy, contact our Privacy Contact, Megan Georges at 412-788-8219.

8. Complaints: If you believe we have violated your privacy rights, you may complain to us or to the Secretary of Health and Human Services, or the Department of Public Welfare. You may file a complaint with us by notifying our Privacy Contact, Megan Georges at 412-788-8219.

You may contact our Privacy Contact, Megan Georges by phone, at 412-7688-8219, for further information about the complaint process. We are required by law to inform you that we will not retaliate against you for filing a complaint.