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HIPPA: Notice of Privacy

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, YOUR RIGHTS, AND OUR RESPONSIBILITIES.

PLEASE REVIEW IT CAREFULLY.
If you have questions about this notice or need further information, please contact:
Segue Administration
P.O. Box 6159
Jackson, MI 49204
(517) 784-6729

OUR PLEDGE REGARDING MENTAL HEALTH INFORMATION:
We understand that information about you and your mental health is personal. We are committed to protecting your mental health information. We create a record; both paper and electronic, of the care and services you receive from us. This record assists us in providing you with quality care and to comply with certain legal requirements. This notice applies to all of your treatment records generated by Segue and/or the LifeWays' Provider Network.

Our Legal Responsibilities:
Maintain the privacy of your healthcare record; Provide you this with this notice of our legal responsibilities and privacy practices with respect to mental health or medical information about you; Follow the terms of the notice that is currently in effect; Notify you if we are unable to agree to a requested restriction, and; Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following areas are ways that we use and disclose mental health/medical information:

For Treatment
We may use information about you to provide you with mental health treatment and related services. We may disclose information about you to doctors, hospitals, pharmacists, laboratories, treatment teams and their supervisors, support staff or students and volunteers who are involved in taking care of you or your records. For example, a doctor treating you for depression may need to know if you are taking medication for seizures before prescribing a medication for the depression.

For Payment
We may use/disclose information about you so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give information to your health plan about the types of treatment you are receiving so that your health plan will reimburse us for your treatment.

For Health Care Operations
We may use and disclose information about you for the LifeWays' Provider Network operation in order to make sure that all our consumers receive quality care. For example, we may use information to review our treatment or to evaluate our staff. We may also combine information about many consumers to decide what additional services are needed and whether certain new treatments are effective.

Fundraising/Marketing
We may use or disclose to a business associate or to an institutionally related foundation for the purpose of raising funds and/or marketing. For example, we may use limited data sets to include demographic information, dates of health care provided and other non-identifiable information.

Business Associates
There are some services provided in our organization through contracts with business associates. When any services are contracted, we may disclose your health information so they may perform the job we have asked them to do. For example, the nurse may have to send your blood to a laboratory for testing prior to giving you a medication.

Appointment Reminders
We may use and disclose information to contact you as a reminder that you have an appointment with us, or with a provider within the LifeWays' Provider Network.

Treatment Alternatives
We may use and disclose information to tell you about, or recommend possible treatment options or alternatives when making referrals.

Health-Related Benefits and Services
We may use and disclose information to tell you about health-related benefits or services.

Research/Grants
Under certain circumstances, we may use and disclose information about you for research or grant purposes. For example, a research project may involve comparing the health and recovery of all clients, with the same condition, who received one medication to those who received another type of medication.

As Required by Law
We will disclose information about you when required to do so by federal, state or local law. For example, the State of Michigan requires us to submit certain types of information to the Department of Community Health.

To Avert a Serious Threat to Health or Safety
We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public, or another person. This disclosure would only be made to someone able to help prevent the threat.

Military and Veterans
If you are a member of the armed forces, we may release information about you as required by military command authorities.

Public Health Risks
We may disclose information about you for public health activities.

These activities include the following:
• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report child abuse or neglect;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using;
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• To notify the appropriate government authority if we believe a person has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or as authorized by law.

Health Oversight Activities
We may disclose information to a health oversight agency for activities authorized by law. For example, these activities would include audits, investigations, inspections and licensure.

Lawsuits and Disputes
If you are involved in a lawsuit or dispute, we may disclose information about you in response to a court or administrative order. For example, these orders would include subpoena, discover request or other lawful processes by someone else involved in the dispute.

Law Enforcement
We may release information if asked to do so by a law enforcement official.

Coroners, Medical Examiners and Funeral Directors
We may release information to a coroner or medical examiner. For example, this information may be needed to identify a deceased person or determine the cause of deaths.

National Security and Intelligence Activities
We may release information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.

Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release information about you to the correctional institution or law enforcement official.
Such information would be used for (a) the institution to provide you with health care; (b) to protect your health and safety or the health and safety of others; or (c) for the safety and security of the correctional institution.

YOUR RIGHTS REGARDING MENTAL HEALTH/MEDICAL INFORMATION ABOUT YOU:
The following categories are rights you have regarding mental health and/or medical information we maintain about you.

Right to Inspect and Copy
You have the right to inspect and copy information from your record with the exception of any psychotherapy notes. In certain very limited circumstances we may deny your request. If this occurs, you may request a review of this denial.

Right to Amend
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to our organization. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

• Is not part of the medical information kept by or for our organization;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

Right to Request Confidential Communications
You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we contact you only at work, home or strictly by mail.

Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of the disclosures that we made of information about you; other than those covered in this notice.

Right to a Paper Copy of This Notice
To obtain a paper copy of this notice, please contact our organization. A copy will be offered to you anytime our notice has been altered, or at least every three years.

CHANGES TO THIS NOTICE:
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for mental health/medical information we already have about you as well as any information we receive in the future. If the notice changes, we will re-distribute the notice to all current or new consumers receiving Segue, Inc. services. We will have a copy of the current notice at our organization. This notice will contain the effective date on the top of the first page. In addition, this notice will be distributed during the intake or first appointment with our organization.

COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization it must be submitted in writing to Segue Administration.

You will not be penalized for filing a complaint.

OTHER USES OF MENTAL HEALTH/MEDICAL INFORMATION:
Other uses and disclosures of information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

JOINT NOTICE BY SEPARATE COVERED ENTITIES:
The LifeWays’ Provider Network is made up of separate entities that contract with LifeWays to provide behavioral health care services. The LifeWays’ Provider Network is participating in the organized health care arrangement and will share protected health information with each other as necessary, to carry out treatment, payment or health care operations relating to the organized health care arrangement. We have developed this joint notice to cover all participating entities that are part of the LifeWays’ Provider Network. Our physicians, as Business Associates agree to abide by this Notice when providing treatment for Segue, Inc.