Privacy Notice

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

General Information

Information regarding your health care, including payment for health care, is protected by two federal laws: The Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Cornerstone may not say to a person outside the hospital that you attend the program, nor may Cornerstone disclose any information identifying you as an alcohol or drug abuser, or disclose any other information except as permitted by Federal Law.

Cornerstone must obtain your written consent before it can disclose information about you for payment purposes. Example, Cornerstone must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Cornerstone can share information for treatment purposes or for health care operations. However, Federal Law does permit Cornerstone to disclose information without your written permission for the following purposes:

• Pursuant to an agreement with a business associate;
• For research, audit, or evaluations;
• To report a crime committed at Cornerstone premises or against Cornerstone personnel;
• To medical personnel in a medical emergency;
• To appropriate authorities to report suspected child abuse or neglect;
• As allowed by a court order or valid subpoena
• As otherwise required by law

Therefore, Cornerstone can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a business associate agreement in place. If you do refuse to consent to the use and disclosure of your Protected Health Information to carry out Treatment, Payment, and Healthcare Operations, Cornerstone may refuse to treat you.

Before Cornerstone can use or disclose any information about your health in a manner, which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. You may revoke any such written consent in writing.

Patient's Rights

Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Cornerstone is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.

You have the right to request that we communicate with you by alternative means or at an alternative location. Under HIPAA you also have the right to inspect and have a copy of your own health information maintained by Cornerstone, except to the extent that the information contains psychotherapy notes or information complied for the use in a civil, criminal or administrative proceeding or in other limited circumstances. Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Cornerstone records, and to request and receive an accounting of disclosures of your health related information made by Cornerstone during the six years prior to your request. You also have the right to receive a paper copy of this notice.

Cornerstone Duties

Cornerstone is required by law to maintain the privacy of your health information and to provide you notice of its legal duties and privacy practices with respect to your health information. Cornerstone is also required by law to abide by the terms of this notice. It reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. The Organization must also notify you if we are unable to agree to a requested restriction.

Complaints and Reporting Violations

You may complain to Cornerstone's Health Information Management Director or Privacy Officer and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. You will not be retaliated against for filing such a complaint.

A violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.

Contact

For further information, contact the Health Information Management Director or Privacy Officer @ Cornerstone's main facility Phone (800)-233-9999 extension 3117.

EFFECTIVE DATE: April 14, 2003