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HIPPA Information

The privacy of your personal and health information (PHI) is important to us. This notice describes how your PHI may be used and disclosed and how you can have access to this information.

Protecting Your Personal Health Information
Hillsides understands the importance of keeping your PHI private. In accordance with the State and Federal law, this notice describes Hillsides’ privacy practices. While many of these practices are already in place, certain provisions take effect April 14, 2003 and will remain in effect unless otherwise replaced or modified. We may modify or change our privacy practices from time to time, particularly as new laws and regulations become effective. When that occurs, we will provide you with a new notice advising you of the changes. For more information about our confidentiality and privacy practices, or for additional copies of this notice, please contact us.

Hillsides may use and disclose your PHI without your authorization only in the following ways:
• Treatment – Your PHI to a provider who requests this information to treat you.
• Payment – To pay claims for covered services provided to you.
• Health Care Operations – To conduct quality improvement activities, to engage in care coordination and case management, and other similar activities.
• Health & Wellness – To contact you with information about health-related services, appointment reminders or treatment alternatives.
• Family and Friends – To a family member, friend or other person if you are unavailable to agree, such as in a medical emergency or disaster relief, only to the extent necessary to help with your health care or with payment of your care.
• Public Health & Safety – To avert a serious and imminent threat to your health or safety or the health or safety of others.
• Required By Law – When we are required to do so by law.
• Process & Proceedings – In response to a court or administrative order, subpoena, discovery, request, or other lawful process.
• Law Enforcement – To a law enforcement official concerning the PHI of a suspect, fugitive, material witness, crime victim or missing person; or of an inmate or other person in lawful custody, to an official or correctional institution.
• Military and National Security (Armed Forces Personnel Only) – To authorized Federal officials such information as required for lawful purposes related to national security.

In addition to these disclosures above, Hillsides will release your PHI:
• To You – As described elsewhere in this notice.
• With Your Written Authorization – We may not use or disclose PHI without your written authorization, except as described above. Just contact us for an authorization form. You can revoke your authorization or any use or disclosures permitted by your authorization at any time while it’s in effect.
Also, you also have available to you:
• Individual Rights Access – Upon written request, you have the right to access your PHI and obtain copies of it, with certain exceptions. A fee will be charged, per page, for copies. You also may request that copies are in a format other than photocopies.
• Disclosure Accounting – You have the right to an accounting of disclosures of your PHI that Hillsides makes. When you make a written request, we will provide you with an accounting of the instances when Hillsides, or our business associates acting on our behalf, disclosed this information for other than treatment, payment or health care operations, and certain other activities. We will begin maintaining disclosures for up to six years starting on April 14, 2003. If you make more than one request for this accounting in a 12-month period, we may charge you a reasonable, cost-based fee.
• Restriction Requests – You have the right to request restrictions on the use and disclosure of your PHI, in writing. We are not required to agree to these restrictions, but if we choose to do so, we will abide by our agreement, except in emergencies.
• Confidential Communication – You have the right to receive communications about your PHI confidentially, or by alternative means or location. We will accommodate your request, if it’s specific and reasonable.

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