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.

Purpose of the Notice

The Center for Psychosocial Development, Inc. is committed to preserving the privacy and confidentiality of your health information that is created and/or maintained at our agency. State and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of your health information. This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA).

This Notice will provide you with information regarding our privacy practices and applies to all of your health information created and/or maintained at our agency, including any information that we receive from other health care providers or facilities. Your "health information" means any of your written and verbal health information, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present, or future physical or mental health or condition.

The Notice describes the ways in which we may use or disclose your health information and also describes your rights and our obligations concerning such uses or disclosures. This Notice describes how the Center for Psychosocial Development, Inc. may use and disclose your health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law.

We will abide by the terms of this Notice, including any future revisions that we may make to the Notice as required or authorized by law. We reserve the right to change this Notice and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice, which will identify its effective date, in our agency.

1. Use and Disclosures of Health Information

The Center for Psychosocial Development, Inc. may use your health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your health information may be used or disclosed only for these purposes unless the Center for Psychosocial Development, Inc. has obtained your authorization or the use or disclosure is otherwise permitted by the HIPAA Privacy Regulation or state law. Disclosures of your health information for the purposes described in this Notice may be made in writing, verbally, or by facsimile.

A. Treatment. The Center for Psychosocial Development, Inc. may use or disclose your health information to provide, coordinate, or manage your care and any other related services. This includes sharing information that you provide with supervisors, consultants, or Center for Psychosocial Development, Inc. staff so that we can assist in determining the best course of care and services for you. To assist with your care outside our organization, we may disclose your health information to outside providers. For example, if you are referred for psychiatric hospitalization, your information will be shared with practitioners at the facility.

B. Payment. The Center for Psychosocial Development, Inc. may use or disclose your health information, as needed, to obtain payment for the services provided to you. This may include certain activities that your health insurance plan or service funder may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits or reviewing proposed services for medical necessity. For example, we may need to give health information to your health plan in order to obtain prior approval to refer you to a mental health specialist, such as a psychologist to perform specialized testing. We may also disclose your information to another provider involved in your care for their payments purposes as part of ensuring your eligibility for services.

C. Healthcare Operations. The Center for Psychosocial Development, Inc. may use or disclose your health information, as necessary, for our own health care operations in order to facilitate the function of the Center for Psychosocial Development, Inc., to provide quality administrative, educational, quality service, and business functions for our agency. Health care operations include such activities as:

• Quality assessment and improvement activities.
• Employee review activities.
• Training programs including those in which students, trainees, or practitioners in health care learn under supervision.
• Accreditation, certification, licensing or credentialing activities.
• Review and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs.
• Business management and general administrative activities.

In certain situations, the Center for Psychosocial Development, Inc. may also disclose your health information to another provider or health plan for their health care operations.

D. Other Uses and Disclosures. As part of treatment, payment and health care operations, the Center for Psychosocial Development, Inc. may also use or disclose your health information, for the following purposes:

• To remind you of an appointment.
• To inform you of potential treatment alternatives or options.
• To inform you of health related benefits or services that may be of interest to you.
• To inform you about general health matters, our services, health fairs, wellness programs, and similar events.
• To contact you to raise funds for the Center for Psychosocial Development, Inc. or the University of Alaska Anchorage Center for Human Development.
• Family members and professionals.

We may disclose your health information to individuals, such as family members and professionals, who are involved in your care or who help pay for your treatment. We may make such disclosures when: a) we have your verbal agreement; b) we make such disclosures and you do not object; and c) we can infer from the circumstances that you would not object to such disclosures. For example, if your mother attends a meeting with you, we will assume that you agree to our disclosure of your information while your mother is present in the room.

Also, we may disclose your health information to family members or professionals in instances when you are unable to agree or object to such disclosures, provided that we feel that it is in your best interests to make such disclosures and the disclosures relate to that family member or professional's involvement in your care. For example, if you present at the Center for Psychosocial Development, Inc., with an emergency, we may share information with the family member or professional that comes with you to our agency.

2. Uses and Disclosures Requiring an Opportunity to Agree or Object

A. Directory. Unless you object, the Center for Psychosocial Development, Inc., may include certain limited information about you in our agency's directory, including a service list that may alert others to the fact you are receiving services through our agency. This information may include your name, services you receive, and appointment times. Directory information may be released to people who designate you by name. If you wish to opt out or restrict some of the directory disclosures, please notify in writing the Center for Psychosocial Development Inc., privacy officer, through Karen Ward Ed.D. at (907)272-8270. If you opt out, then we will not tell callers or visitors that you are present or release times that you receive services.

B. Others Involved in Your Healthcare. Unless a danger is posed to you, we may disclose health information to your guardian, other legally designated individuals, or personal representative who is directly responsible for your care, even if you object to the disclosure. However, unless you object, we may also disclose, as needed, some of your health information to a family member, close friend, or any person that you identify who is involved in your care or in the payment of your care. If you are not present or if you are unable to agree or to object to a disclosure, the Center for Psychosocial Development, Inc. in our professional judgment may disclose health information in your best interests to the extent that the information is relevant to a person's involvement in your care.

C. In the Event of a Disaster. We may disclose your health information to an authorized public or private entity assisting in a disaster relief effort to coordinate care and so that your family and other individuals involved in your care can be notified of your condition or location.

3. Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted Without Authorization or Opportunity to Agree or Object

Federal privacy rules allow us to use or disclose your health information without your permission or authorization for a number of reasons including the following:

A. Legally Designated Individual or Personal Representative. Certain minors and incapacitated adults may have legally designated individuals or personal representatives that act on their behalf for health care matters. Our organizations may disclose health information about you to these legally designated individuals or personal representatives. These individuals may be able to act on the person's behalf and exercise the person's privacy rights. If we have a reason to believe an individual poses a past or future harm to the person, we may elect not to treat the individual as a person's personal representative.

B. When Legally Required. The Center for Psychosocial Development, Inc. may disclose your health information when we are required by federal, state, or local law to do so.

C. When There Are Risks To Public Health. The Center for Psychosocial Development, Inc. may disclose your health information for the following public health activities and purposes:

• To prevent, control, or report disease, injury or disability as permitted by law.
• To report vital events such as birth or death as permitted or required by law.
• To conduct public health surveillance, investigations and interventions as permitted or required by law.
• To collect or report adverse events and product defects, track FDA regulated products, enable product recalls, repairs or replacements to the FDA and to conduct post marketing surveillance.
• To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.
• To report to an employer, information about an individual who is a member of the workforce as legally permitted or required.

D. To Report Abuse, Neglect or Domestic Violence. The Center for Psychosocial Development, Inc. may disclose health information about an individual we reasonably believe to be the victim of abuse, neglect, or domestic violence to a government authority authorized by law to receive such reports. We will make the disclosure if the individual agrees to the disclosure. We will also make the disclosure if the disclosure is required by law. If the disclosure is authorized by law, but not required, then we will disclose the information as long as the individual agrees or if we believe the disclosure is necessary to prevent harm to the individual or other potential victims.

E. To Conduct Health Oversight Activities. The Center for Psychosocial Development, Inc. may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure, disciplinary actions, or other activities necessary for appropriate oversight as authorized by law. The Center for Psychosocial Development, Inc. will not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.

F. In Connection With Judicial and Administrative Proceedings. The Center for Psychosocial Development, Inc. may disclose your health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes. We may disclose your health information pursuant to a court order, a subpoena, a discovery request, or other lawful process issued by a judge or other person involved in the dispute, but only if efforts have been made to (i) notify you of the request for disclosure or (ii) obtain an order protecting your health information.

G. For Law Enforcement Purposes. The Center for Psychosocial Development, Inc. may disclose your health information in response to a request received from a law enforcement official to report criminal activity or to respond to a subpoena, court order, warrant, summons, or similar process.

H. To Coroners, Medical Examiners, or Funeral Directors. The Center for Psychosocial Development, Inc. may disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We also may disclose your health information to a funeral director for the purpose of carrying out his/her necessary activities.

I. Organ Procurement Organizations or Tissue Banks. If you are an organ donor, the Center for Psychosocial Development, Inc. may disclose your health information to organizations that handle organ procurement, transplantation, or tissue banking for the purpose of facilitating organ or tissue donation or transplantation.

J. For Research Purposes. The Center for Psychosocial Development, Inc. may use or disclose your health information for research purposes under certain limited circumstances. Because all research projects are subject to a special approval process, we will not use or disclose your health information for research purposes until the particular research project for which your health information may be used or disclosed has been approved through this special approval process. The Center for Psychosocial Development, Inc. may use or disclose your health information to individuals preparing to conduct the research project in order to assist them in identifying individuals with specific health care needs who may qualify to participate in the research project. In most instances, the Center for Psychosocial Development, Inc. will only disclose health information pursuant to your authorization.

K. In the Event of a Serious Threat to Health or Safety. The Center for Psychosocial Development, Inc. may consistent with ethical standards of conduct and applicable law disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals.

L. National Security and Intelligence Activities. The Center for Psychosocial Development, Inc. may disclose your health information to authorized federal officials for intelligence, counterintelligence, special investigations, and other national security activities authorized by law.

M. For Worker's Compensation. The Center for Psychosocial Development, Inc. may release your health information to comply with worker's compensation laws or similar programs.

N. Fundraising. The Center for Psychosocial Development, Inc. may use certain information about you to raise money for our organization and its operations. This may include telling you about projects funded by our organization and sending you fundraising materials or requests. Fundraising materials will tell you how you may decline to receive future fundraising materials or requests. If the Center for Psychosocial Development, Inc. receives your request to decline, then we will make reasonable efforts so you will not be sent future fundraising materials or requests.

O. Military. If you are a member of the armed forces, the Center for Psychosocial Development, Inc. may release health information about you as required by your military command authorities.

P. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, the Center for Psychosocial Development, Inc. may disclose health information about you to the correctional institution or a law enforcement official as may be necessary (i) for the institution to provide you with health care; (ii) to protect the health or safety of you or another person; or (iii) for the safety and security of the correctional institution.

Q. Incidental Disclosures. Certain incidental disclosures of your health information may occur as a by-product of permitted uses and disclosures. For example, a group member may hear a discussion about your care during a shared group.

R. Limited Data Sets. The Center for Psychosocial Development, Inc. may disclose limited health information, contained in a "limited data set", to certain third parties for research, public health, and health care operations. Before disclosing limited data sets, the Center for Psychosocial Development, Inc. will contract with the recipient to limit use and disclosure of the information.

S. De-identified Information. The Center for Psychosocial Development, Inc. may use and disclose health information that reasonably has been "de-identified" by removing certain "identifiers" (such as name, address, or social security number) making it unlikely that individuals can be identified.

T. Mental Health Information. Your information about your mental health is confidential. The Center for Psychosocial Development, Inc. will not use or disclose your mental health information unless we obtain an authorization from you to do so, except:

• As required by a court order
• To a designated hospital where an individual is involuntarily committed
• To direct service personnel in an emergency
• To mental health professionals designated to conduct program or on-site reviews
• For research purposes if the anonymity of the individual is preserved
• To insurance, medical assistance, or other programs for payment
• As required by law
• To the Division of Mental Health and Developmental Disabilities (DMHDD).

4. Uses and Disclosures Which You Authorize

Except for the purposes identified in this Notice and laws that apply to the Center for Psychosocial Development, Inc. we will not use or disclose your health information for any other purposes unless we have your specific written authorization. You have the right to revoke a written authorization at any time as long as you do so in writing. If you revoke your authorization, we will no longer use or disclose your health information for the purposes identified in the authorization, except to the extent that we have already taken some action in reliance upon your authorization. We cannot take back any disclosures that we already made with your authorization. We must retain our records of the care that we provided to you.

5. Your Rights

You have the following rights regarding your health information:

A. The right to inspect and copy your health information. You may inspect and obtain a copy of your health information that is contained in a designated record set for as long as the Center for Psychosocial Development, Inc. maintains the health information. A "designated record set" contains medical and billing records and any other records that the Center for Psychosocial Development, Inc. uses for making health care decisions about you.

Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and health information that is subject to a law that prohibits access to health information. Depending on the circumstances, you may have the right to have a decision to deny access reviewed.

The Center for Psychosocial Development, Inc. may deny your request to inspect or copy your health information if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.

To inspect and copy your medical information, you must request this information in writing from the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. (907-272-8270). If you request a copy of your information, we may charge you a fee for the costs of copying, mailing, or other costs incurred by the Center for Psychosocial Development, Inc. in complying with your request.

B. The right to request an amendment to your health information. You may request an amendment of your health information that is maintained by or for the Center for Psychosocial Development, Inc. and is used to make health care decisions about you. We may deny your request if it is not properly submitted or does not include a reason to support your request. We may also deny your request if the information sought to be amended: (i) was not created by us, (ii) is not part of the information that is kept by or for the Center for Psychosocial Development, Inc., (iii) is not part of the information which we are permitted to inspect and copy; or (iv) is accurate and complete. To request an amendment, you must request this information in writing from the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. (907-272-8270).

C. The right to request a restriction on uses and disclosures of your health information. You may request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have a right to request a limit on the health information that we disclose about you to someone such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular aspect of treatment that you received. We are not required to agree to your request. If we do agree, the agreement must be in writing and signed by you and us. To request a restriction, you must request this information in writing from the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. (907-272-8270).

D. The right to receive an accounting. You have the right to request an accounting of certain disclosures of your health information made by the Center for Psychosocial Development, Inc. This right applies to disclosures for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. The Center for Psychosocial Development, Inc. is not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures to friends or family members involved in your care, or certain other disclosures the Center for Psychosocial Development, Inc. is permitted to make without your authorization. To request an accounting, you must request this information in writing from the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. (907-272-8270). This request should specify the time period sought for the accounting. The Center for Psychosocial Development, Inc. is not required to provide an accounting for disclosures that took place prior to June 30, 2003. Accounting requests may not be made for periods of time in excess of six years. If you request an accounting of your information, we may charge you a fee for the costs of copying, mailing, or other costs incurred by the Center for Psychosocial Development, Inc. in complying with your request.

E. The right to request confidential communications. You may request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we only contact you at your home or by mail. To request confidential communications, you must request this information in writing from the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. (907-272-8270).

F. The right to obtain a paper copy of this notice. You may request a copy of this Notice even if you have already received one. To request a copy of this Notice, you must request this information in writing from the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. (907-272-8270).

6. Our Duties

The Center for Psychosocial Development, Inc. is required by law to maintain the privacy of your health information and to provide you with this Notice of our duties and privacy practices. The Center for Psychosocial Development, Inc. is required to abide by the terms of this Notice as may be amended from time to time. The Center for Psychosocial Development, Inc. reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that the Center for Psychosocial Development, Inc. maintains. The current Notice will be available from our organization.

7. Complaints

You have the right to express complaints to the Center for Psychosocial Development, Inc. and to the Secretary of Health and Human Services in Washington D.C. if you believe that your privacy rights have been violated. You may complain in writing by contacting the Center for Psychosocial Development, Inc. privacy officer, through Karen Ward Ed.D. using the contact information below. The Center for Psychosocial Development, Inc. encourages you to express any concerns you may have regarding the privacy of your information. You will not be penalized for filing a complaint.

8. Contact Person

The Center for Psychosocial Development, Inc. contact person for all issues regarding an individual's privacy and rights under the Federal privacy standards and information regarding matters covered by this Notice is the Center for Psychosocial Development, Inc. privacy officer, contacted through Karen Ward Ed.D. Complaints against the Center for Psychosocial Development, Inc. can be mailed to the privacy officer by sending it to: Karen Ward Ed.D., Center for Psychosocial Development, Inc., 2702 Gambell St, Ste 103, Anchorage, Alaska 99503. Karen Ward Ed.D. can be contacted by telephone at 907-272-8270.

9. Effective Date

This Notice is effective June 30, 2003.