Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL

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					                                        Notice of Privacy Practices


      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

This notice is effective as of April 14, 2003 and tells yo u how The Arc, Oneida-Lewis Chapter
NYSARC uses and discloses health information about you.
The Arc, Oneida-Lewis Chapter NYSARC (The Arc) is required by law to maintain the privacy of your
health information and to provide you with this notice of our privacy practices and legal
responsibilities.
Any individually identifiable information about your past, present or future health status, the provision
of health care to you, or payment for that health care is considered to be Protected Health Information
(PHI). The Arc collects PHI from you and/or your personal representatives in an effort to provide
quality, individualized services to you.
The Arc reserves the right to revise or change this Notice of Privacy as necessary and to make the
new Notice of Privacy practice effective for all Protected Health Information maintained by us.
Revisions made to this Notice of Privacy will be mailed out to all service recipients and will be posted
on our website at www.thearcolc.org.

Your Rights Regarding the Use/Disclosure of Your Health Information


You have the following rights relating to your health information:
1. You have the right to limit who sees health information about you (Request Restrictions on
   Routine Use and Disclosure).
2. You have the right to look at your health information and ask us to make copies of that information
   for you (To Inspect and Copy Your Health Information).
3. You have the right to ask us to change the health information we have developed for you and that
   we keep in your file (To Request Amendments to Your Clinical File).
4. You have the right to see who we have given your health information to (The Right to Request a
   List of Disclosures).
5. You can have a copy of this notice (The Right to Receive a Written Copy of this Notice).




 The Arc, Oneida-Lewis Chapter NYSARC                                           Notice of Privacy Practices
 April 14, 2003                                                                                 Page 1 of 3
The Arc, Oneida-Lewis Chapter NYSARC Responsibilities for Your Health Information


The Arc, Oneida-Lewis Chapter NYSARC will:
1. Protect your health information according to Federal and State Laws
2. Give to you in writing what our responsibilities are to you.
3. Follow the rules in this notice.
4. When changes are made to this notice, we will put the changes on our website.
5. We will obtain a one-time consent to use or disclose your health information for normal and
   routine treatments, payments and operations.

How The Arc, Oneida-Lewis Chapter NYSARC May Use or Disclose Your Health Information


1. Treatment:
   We will use or disclose health information from your clinical file to provide you with treatment and
   services. We may disclose your health information to doctors, nurses, psychologists, service
   coordinators, and/or Arc personnel, volunteers and contractual staff or other health care providers
   who are involved in the provision of your care. For example, staff involved in your care may share
   information about you during a team meeting.
2. Payment:
   The Arc will use your health information to bill and collect payment from you, from a third party,
   from your insurance, from Medicare or Medicaid or other government agencies. For example, we
   may need to give Medicaid information about you so that we can be paid for those services.
3. Health Care Operations:
   The Arc will use your health information to provide the appropriate service(s) to you. For example,
   we may use your health information to monitor and review your treatment and services and to
   evaluate the performance of our staff in caring for you.

Special Uses that do not require your Permission (Other Uses and Disclosures that Do Not
Require Separate Authorization)


In addition to your treatment, payment and health care operations, The Arc will use your health care
information for the following reasons:
1. When we are required to do so by local, state , or federal law
2. For public health activities
3. About victims of abuse, neglect or domestic violence
4. For health oversight activities
5. For judicial and administrative proceedings
6. For law enforcement purposes
7. Information about decedents
8. For cadaveric organ, eye or tissue donation purposes
9. For research purposes
 The Arc, Oneida-Lewis Chapter NYSARC                                          Notice of Privacy Practices
 April 14, 2003                                                                                Page 2 of 3
10. To avert a serious threat to health or safety
11. For specialized government functions
12. For workers’ compensation

Uses and Disclosures Requiring Your Authorization


For all other types of uses and disclosures not described in this Notice of Privacy, The Arc will ask
you to sign an authorization describing who the information is going to, and what information is being
used or disclosed. You may stop the authorization in writing, at any time. Your request to stop this
authorization must be received by us before the information is disclosed. We will not be responsible if
the information has already been sent out.

The Possibility of Re-Disclosure


It is possible that once information is disclosed about you, with your permission, by The Arc the
person or agency receiving this information may re-disclose this information without our knowledge or
permission. If this happens The Arc is not responsible for any episodes of re-disclosure and will not
assume any liability if this happens.

Complaints
If you think your privacy rights have been violated or you disagree with a decision we have made
about your health information, you may file a written complaint with The Arc HIPAA Privacy Officer,
at:
                                The Arc, Oneida-Lewis Chapter NYSARC
                                         HIPAA Privacy Officer
                                          245 Genesee Street
                                         Utica, New York 13501
                                             (315) 735-6477

You may also file a complaint with the Secretary of the Department of Health and Human Services at:
                                         Office for Civil Rights
                           US Department of Health and Human Services
                                     Jacob Javits Federal Building
                                    26 Federal Plaza – Suite 3312
                                      New York, New York 10278

The Arc, Oneida-Lewis Chapter NYSARC will take no retaliatory action against you if you file a
complaint.

Contact Person for Information

For more information, please contact The Arc, Oneida-Lewis Chapter NYSARC HIPAA Privacy
Officer.


 The Arc, Oneida-Lewis Chapter NYSARC                                          Notice of Privacy Practices
 April 14, 2003                                                                                Page 3 of 3