1. Our pledge regarding medical information:

 The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.

Any regulations of the Commonwealth of Massachusetts or any agency practices that            provide greater protections of your medical information will not be superceded by any     statements in this document

2. Our legal duty:

Law requires us to:

1. Keep your medical information private
2. Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
3. Follow the terms of the notice that is now in effect.

       We have the right to:

a.    Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.

b.    Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

      Notice of change to privacy practices:

a.    Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request. 

3. Use and disclosure of your medical information:

The following section describes different ways that we use and disclose medical information. For each kind of use or disclosure, we will explain what we mean and give an example. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. We will not use or disclose your medical information for any purpose not listed below without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us.

For treatment:

We may use or disclose medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, social workers, medical students, other interns or other people who are taking care of you.

      Example:      You come to the agency (or subsidiary) with a behavioral health issue. You also have diabetes. If you are seeing anyone other than, or in addition to, your primary care provider it is possible that a number of health care and support staff will need to know about your diabetes

·        The provider treating you needs to know if you have diabetes because diabetes may effect the healing process and may effect any medication the provider might prescribe for you.

·        The information about your diabetes may help in diagnostics, testing and x-ray work.

·        We may also share information about you with your other health care providers to assist them in treating you.

      For Payment:

 We may use and disclose your medical information for payment purposes.

     Example:    You are treated in the agency (or subsidiary) and you are not the primary person listed on your health plan, or it is difficult for you to remember your health plan.

·        We may need to give your health insurance plan information about treatment you received at our agency (or subsidiary) so that your health plan will pay us or repay you for any treatment that you paid for.

·        We may also tell your health plan about a treatment you are going to receive to get approval or to determine if your plan will pay for the treatment.

      For Health Care Operations:

 We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of our employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.

Additional Uses and Disclosures:

Notification: Medical information to notify or help notify:

·        A family member

·        Your personal representative

·        Another person responsible for your care

     We will share information about your location, general condition, or death. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of an emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interests about allowing someone to pick up medicine, medical supplies, or medical information for you.

 Research in Limited Circumstances:  Medical information for research purposes in limited circumstances where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information.

Specialized Government Functions:  Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for disability applications and for government programs providing public benefits.

Court Orders and Judicial Proceedings:  We may disclose medical information in response to a court order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials. We may share limited medical information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person.

Public Health Activities:  As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs or replacements, to track products, or to conduct activities required by the Food and Drug Administration. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

Victims of Abuse, Neglect, or Domestic Violence:  We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health or safety of others.

Workers Compensation:  We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or similar programs.

Health Oversight Activities:  We may disclose medical information to an agency providing health oversight for oversight activities authorized by law, including audits, inspections, licensure or other authorized activities. 

4. Your Individual Rights:

 You have a right to:

Look at or get copies of your medical information. You must make your request in writing. You may get the form to request access by sending a letter to the contact person listed at the end of this notice

Receive a list of all the times we or our business associates share your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions.

Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we abide                          by our agreement (except in the case of an emergency).

Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or at different locations must be made in writing to the contact person listed at the end of this notice.

Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.

Obtain a copy of this notice.

      Questions and Complaints

      If you have any questions about this notice, please contact:

                        Art Kantor, Compliance Officer

                        Clinical and Support Options, Inc

                                215 Shelburne Road

                                Greenfield, MA 0103-1365

 If you think we may have violated your privacy rights, contact the person named above. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint.