THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice of Privacy Practices (the "Notice" is meant to inform you of the uses and disclosures of protected health information that we may make. It also describes your rights to access and control your protected health information and certain obligations we have regarding the use and disclosure of your protected health information.

Your "protected health information" is information about you created and received by us, including demographic information, that may reasonably identify you and that relates to your past present or future physical or mental health or condition or payment for the provision of your health care.

Jewish Family Service of New Haven will ask you to sign a consent form that allows the Jewish Family Service of New Haven to use and disclose your protected health information for treatment, payment and health care operations. You will also be asked to acknowledge receipt of this Notice.

The following categories describe some of the different ways that we may use or disclose your protected health information. Even if not specifically listed below, Jewish Family Service of New Haven may use and disclose your protected health information as permitted or required by law or as authorized by you. We will make reasonable efforts to limit access to your protected health information to those persons or classes of persons, as appropriate, in our workforce who need access to carry out their duties. In addition, we will make reasonable efforts to limit the protected health information to the minimum amount necessary to accomplish the intended purpose of any use or disclosure and to the extent such disclosure is limited by law.

For Treatment-We may use and disclose your protected health information to provide you with medical treatment and related services. Your protected health information my be used by our professional staff, for example, to consult with each other and with our Psychiatric Consultants about the best way to help you. If we are permitted to do so, we may also disclose your protected health information to individuals or facilities that will be involved with you care after you leave Jewish Family Service and for other reasons. We may also use or disclose your protected health information in an emergency situations.

For Foster care and Adoption Services- If you are receiving foster care and/or adoption services we may use and disclose your protected health information with other State of Connecticut agencies, such as the Department of Children and Family, and the State Police in the process to approve your home.

For Health Care Operations- We may use and disclose your health information as necessary for operations of the Jewish Family Service of New Haven, such as quality assurance and improvement activities, reviewing the competence and qualifications of health care professionals, medical review, legal services and auditing functions, and general administrative activities of Jewish Family Service of New Haven. For example, our auditors may need to review the fees collected in regard to the service you receive from us.

Business Associates There may be some services provided by our business associates, such as a billing service, transcription company or legal or accounting consultants. We may disclose your protected health information to our business associate so that they can perform the job we have asked them to do. To protect your health information, we require our business associates to enter into a written contract that requires them to appropriately safeguard your information.

Treatment Alternatives and Other Health-related benefits and Services- We may use and disclose protected health information to tell you about or recommend possible treatment options or alternatives and to tell you about health related benefits, services, or medical education classes that may be of interest to you.

Fund raising Activities- We may use your contact information, such as your name, address, and telephone number to contact you in an effort to raise money for Jewish Family Service. A description of how to opt out of receiving any further fund raising communications will be included with any fund raising materials you receive from Jewish Family Service New Haven.

Individuals Involved in your care or Payment of your care. Unless you object, we may disclose your protected health information to a family member, a relative, a close friend or any other person you identify if the information relates to the person’s involvement in your health care or payment related to your health care. In addition, we may disclose your protected health information to a public or private entity authorized by law to assist in a disaster relief effort. If you are unable to agree or object to such a disclosure we may disclose such information if we determine that it is in your best interest based on our professional judgment or if we reasonably infer that you would not object.

Public Health Activities. We may disclose your protected health information to a public health authority that is authorized by law to collect or receive such information such as for the purpose of preventing or controlling disease, injury, or disability, reporting births or deaths, reporting child abuse or neglect, notifying individuals of recalls of products they may be using, notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.

Health Oversight Activities- We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.

Judicial and Administrative Proceedings- If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process if such disclosure is permitted by law.

Law Enforcement- We may disclose your protected health information for certain law enforcement purposes if permitted or required by law. For example, reporting of gunshot wounds, to report emergencies or suspicious deaths; to comply with a court order, warrant, or similar legal process; or to answer certain requests for information concerning crimes.

Research Purposes- It is the policy of Jewish Family Service New Haven not to engage in research for any purpose.

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

Military and National Security- If required by law, if you are a member of the armed forces, we may use and disclose your protected health information as required by military command authority or the Department of Veterans Affairs

If required by law, we may disclose your protected health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security activities authorized by law. If required by law, we may disclose your protested health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Workers compensation- We may use or disclose your protected health information as permitted by laws relating to workers’ compensation or related programs

Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and HIV-Related Information- For disclosures concerning protected health information relating to care for psychiatric conditions, substance abuse or HIV related testing and treatment, special restrictions may apply. For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special Authorization or a court orders the disclosure.

-Psychiatric information. Certain mental health information may be disclosed for treatment, payment and health care operations as permitted or required by law. Otherwise, we will only disclose such information pursuant to an authorization, court order or as otherwise required by law. For example, all communications between you and a social worker or psychiatrist will be privileged and confidential in accordance with Connecticut and Federal law.

-Substance abuse treatment information. If you are treated in a specialized substance abuse program, your permission will be needed for certain disclosures, not including emergencies, certain reporting requirements and other disclosures specifically allowed under Federal Law.

-HIV-related information. We will disclose HIV related information as permitted or required by Connecticut law. For example your HIV related protected health information, if any, maybe disclosed in the event of a significant exposure to HIV-infection to personnel of Jewish Family Service New Haven, another person, or a known partner. Any use and disclosure for such purposes will be to someone able to reduce the outcome of the exposure and limited in accordance with Connecticut and Federal law.

-Minors. We will comply with Connecticut law when using or disclosing protected health information of minors. For example, if you are an unemancipated minor consenting to a health care service related to HIV/AIDS, venereal disease, abortion, or alcohol/drug dependence, and you have not requested that another person be treated as a personal representative, you have the authority to consent to the use and disclosure of your health information.

Except as described in this Notice, or as permitted by Connecticut or Federal law, we will not use or disclose your protected health information without your written authorization.

Your written authorization will specify particular uses or disclosures that you choose to allow. If you do authorize us to use or disclose your protected health information for reasons other than treatment, payment or health care operations, you may revoke your authorization in writing at any time by contacting the Jewish Family Service Privacy Officer. If you revoke your authorization, we will no longer use or disclose your protected health information for the purposes covered by the authorization except where we have already relied on the authorization.

Psychotherapy Notes

A signed authorization is required for any use or disclosure of psychotherapy notes except to carry out certain treatment, payment or health care operations and for use by Jewish Family Service for training programs or for defense in a legal action.

Marketing

A signed authorization is required for the use or disclosure of your protected health information for a purpose that encourages you to purchase or use a product or service except for certain limited circumstances such as when the marketing communication is face-to-face or when marketing includes the distribution of a promotional gift of nominal value provided by Jewish Family Service New Haven.

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You have the following rights with respect to your protected health information. The following briefly describes how you may exercise these rights.

-Right to Request Restrictions

of your Protected Health Information.

You have the right to request certain restrictions or limitations on the protected health information we use or disclose about you. You may request a restriction or revise a restriction on the use or disclosure of your protected health information by providing a written request stating the specific restriction requested and to whom you want the restriction to apply. You can request a restriction request form from Jewish Family Service New Haven. We are not required to agree to your requested restriction. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you with emergency treatment. If restricted protected health information is disclosed to a health care provider for emergency treatment, we will request that such health care provider not further use or disclose the information.

-Right to Receive Confidential Communications- You have the right to request a reasonable accommodation regarding how you receive communications of protected health information. You have the right to request an alternative means of communication or an alternative location where you would like to receive communications. You may submit such a request in writing to Jewish Family Service New Haven.

-Right to Amend Your Protected Health Information You have the right to request an amendment to your protected health information maintained by Jewish Family Service New Haven for as long as the information is maintained by or for Jewish Family Service New Haven. Your request must be made in writing to Jewish Family Service New Haven and must state the reason for the requested amendment. You can request a form from Jewish Family Service New Haven to request an amendment to your information. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial. We may rebut your statement of disagreement. If you do not wish to submit a written statement disagreeing with the denial, you may request that your request for amendment and your denial be disclosed with any future disclosure of your relevant information.

-Right to Receive An Accounting of Disclosures

of Protected Health Information You have the right to request an accounting of certain disclosures of your protected health information by Jewish Family Service New Haven or by others on our behalf. To request an accounting of disclosures you must submit a request in writing, stating a time period beginning after April 14, 2003 that is within six (6) years from the date of your request. The first accounting provided within a twelve-month period will be free. We may charge you a reasonable, cost-based fee for each future request for an accounting within a single twelve-month period. However, you will be given the opportunity to withdraw or modify your request for an accounting of disclosures in order to avoid or reduce the fee.

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Right to Complain You may file a complaint with us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. You will not be penalized for filing a complaint and we will make every reasonable effort resolve your complaint with you.

Jewish Family Service New Haven

Sandy Hagan, Privacy Officer

1440 Whalley Ave.

New Haven, CT 06515

(203) 389-5599 or toll free 1-866-389-5599, ext. 126