Notice of Privacy Practices

Effective April 14, 2003

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.

If you have any questions about this notice, please contact the Administrative Director. Contact information is provided at the end of this notice.

This Notice Of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of The Warren Center for Communication & Learning except when the release is required or authorized by law or regulation. Except as described in this notice, your health information will only be used or disclosed with your written authorization. You can revoke your authorization by written request, except to the extent that we have taken action in reliance of such authorization.

ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE

You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your healthcare services will in no way be conditioned upon your signed acknowledgement. If you decline to provide a signed acknowledgement, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment, and healthcare operations.

WHO WILL FOLLOW THIS NOTICE

The Warren Center, its employees, volunteers and students will follow this notice. These individuals will follow this notice in their use of and disclosure of protected health information they receive or create at the Center. The Warren Center will share protected information with them so they can treat you and obtain payment and so they can assist the Warren Center to carry out its necessary operations.

WHERE WILL THIS NOTICE BE FOLLOWED

This notice describes The Warren Center practices regarding your protected health information. For this notice, The Warren Center encompasses all Warren Center services including but not limited to:
* Warren Center services at 175 Union Street, Bangor, Maine
* Telemedicine services provided by Warren Center providers
* Outreach services provided by The Warren Center at other facilities

OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION

"Protected health information" is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future healthcare services. The Warren Center is required by law to do the following:
* Make sure that your protected health information is kept private.
* Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information.
* Follow the terms of the notice currently in effect.
* Communicate any changes in the notice to you.

We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. We reserve the right to make the revised or change notice effective for health information we already have about you as well as any information we receive in the future. You may obtain a Notice of Privacy Practices by accessing our web site at www.warrencenter.org, calling the Administrative Director and requesting a copy be mailed to you, or asking for a copy at your next appointment.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION

Following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive.

Required Uses and Disclosures
By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the U. S. Department of Health and Human Services for investigations or determinations of our compliance with laws on the protection of your health information.

Treatment
We will use and disclose your protected health information to provide, coordinate, or manage your healthcare services. Information such as observations, actions, and results or tests and examinations collected by a Speech-Language Pathologist, Audiologist, or other members of your treatment team will be recorded in your medical record and used to plan your care. This includes the coordination or management of your healthcare with a third party. For example, we would disclose your protected health information, as necessary, to another person who provides care to you. We may disclose your protected health information from time to time to another facility, physician, or healthcare provider (for example, a specialist, physical therapist, occupational therapist, or case manager) who, at the request of your physician, becomes involved in your care by providing assistance with your healthcare diagnosis and treatment.

Payment
Your protected health information will be used as needed, to obtain payment for your healthcare services. A bill for your treatment may be sent to an insurance company or other third party to pay for services. The bill may include information that identifies you as well as your diagnosis and costs incurred while a patient. Payment activities may also include certain activities undertaken before your insurance carrier approves or pays for the healthcare services recommended for you such as determining eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for an evaluation or treatment might require that your relevant protected health information be disclosed to obtain approval for that treatment.

Healthcare Operations
We may use or disclose, as needed, your protected health information to support the daily activities related to healthcare. These activities include, but are not limited to, quality assessment activities, investigators, oversight or staff performance reviews, training of students, licensing, and conducting or arranging for other healthcare related activities.

For example, we may disclose your protected health information to students who are receiving training at The Warren Center. We may call you by name in the waiting room when your clinician is ready to see you. We may use or disclose your protected health information, as necessary to contact you to remind you of your appointment.

We will share your protected health information with our third-party "business associates" who perform various activities (for example, auditing, records management services). The business associates will also be required to protect your health information.

Fundraising Activities
We may use your protected health information to contact you in an effort to raise money for the Warren Center and its operations. We only would release contact information, such as your name, address, and phone number. If you do not want the Warren Center to contact you for fundraising efforts, you must notify the Administrative Director in writing.

Required by Law
We may use or disclose your protected health information if law or regulation requires the use or disclosure.

Public Health
We may disclose your protected health information to a public health authority that is permitted by law to collect or receive the information. The disclosure may be necessary to do the following:
* Prevent or control disease, injury, or disability.
* Report child abuse or neglect.
* Report problems with products.
* Notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease or condition.
* Notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect, or domestic violence.

Health Oversight
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the healthcare system, government benefits programs, other government regulatory programs, and civil rights laws.

Food and Drug Administration
We may disclose protected health information to a person or company
required by the Food and Drug Administration to do the following:
* Report adverse events, product defects, or problems and biologic product deviations.
* Track products.
* Enable product recalls.
* Make repairs or replacements.
* Conduct post-marketing surveillance as required.

Legal Proceedings
We may disclose protected health information during any judicial or administrative proceeding in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process.

Law Enforcement
We may disclose protected health information for law enforcement purposes, including the following:
* Responses to legal proceedings
* Information requests for identification and location
* Medical records pertaining to victims of a crime
* Crimes occurring at a Warren Center Site

Research
We may disclose your protected health information to researchers when authorized by law, for example, if an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information has approved their research.

Threats to Health and Safety
Under applicable Federal and State laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Workers' Compensation
We may disclose your protected health information to comply with workers' compensation laws or other similar legally established programs.

Inmates
We may disclose your protected health information if you are an inmate of a correctional facility as necessary for the institution to provide you with healthcare.

Parental Access
Some state laws concerning minors permit or require disclosure of protected information to parents, guardians, and persons acting in a similar legal status. We will act consistently with Maine Law and will only make disclosures following such laws.

Communication Barriers
If we try but cannot obtain your consent to use or disclose your protected health information because of substantial communication barriers, your physician, using his or her professional judgment, may consent or determine a course of action for you.

USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION REQUIRING YOUR PERMISSION

In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required.

Individuals Involved in your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your healthcare. We may also give information to someone who helps pay for your care. Additionally we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care, of your location or 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 healthcare.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You may exercise the following rights by submitting a written request or electronic message to the Administrative Director. Please be aware that the Administrative Director might deny your request; however, in some cases you may seek a review of the denial.

Right to Inspect and Copy
You may inspect and obtain a copy of your protected health information 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 that we use to make decisions about you. To request access to your protected health information; please make your request in writing to the Administrative Director. We will respond to your request as soon as possible, but no later than 30 days from the date of your request. We have the right to charge a reasonable fee for providing copies of your protected health information.

Right to Request Restrictions
You may ask us not to use or disclose any part of your protected health information for treatment, payment, or healthcare operations. Your request must be made in writing to the Administrative Director. In your request, you must tell us what specific protected health information you wish restricted and the individual(s) who should not receive the restricted protected health information. We are not required to agree to your restriction request, but if we do agree to the request, we will not use or disclose the restricted protected health information.

Right to Request Confidential Communications
You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.

Right to Request Amendment
You have the right to request that we amend the protected health information in your "designated record set" for as long as we maintain the protected health information. Please make your request in writing to our Administrative Director. We will respond to your request as soon as possible, but not later than 60 days from the date of your request. If we deny your request for amendment, you have the right to submit a written statement of reasonable length disagreeing with the denial and we have the right to submit a rebuttal statement. A record of any disagreement about amendment will become part of your medical records and may be included in subsequent disclosures of your protected health information.

Right to an Accounting of Disclosures
You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. Please make your request in writing to our Administrative Director. We will respond to your request as soon as possible, but no later than 60 days from the date of your request. We will provide you with one accounting every 12 months free of charge. We will change a reasonable fee based upon our costs for any subsequent accounting requests.

Right to Obtain a Copy of this Notice
You may obtain a paper copy of this notice from the Administrative Director or view it electronically at www.warrencenter.org

STATE AND FEDERAL PRIVACY LAWS

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). Maine privacy laws also apply. These laws have not been superseded and have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information.

COMPLAINTS

If you believe that we are not complying with our legal obligations to protect the privacy of your protected health information, you may file a written complaint with the Administrative Director or the United States Department of Health and Human Services. You must make your complaint to the Secretary in writing within 180 days of the act or omission forming the basis of your complaint. No retaliation will occur against you for filing a complaint.

CONTACT INFORMATION

You may contact the Administrative Director for further information about the complaint process or for further explanation of this document.

The Warren Center
Executive Director
175 Union Street
Bangor, ME 04401
207-941-2850

This notice is effective in its entirety as of April 14, 2003