New Horizons Rehabilitation Services, Inc.
PRIVACY NOTICE

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.

New Horizons Rehabilitation Services, Inc. (“New Horizons”) abides by all Health Insurance Portability and Accountability Act regulations, otherwise known as HIPAA.

New Horizons is committed to confidentiality as required by HIPAA and state law. New Horizons is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with regard to protected health information. New Horizons is required to abide by the terms of its notice, but reserves the right to change the terms of this notice and make new notice provisions effective for all protected health information that is maintained. If New Horizons revises its notice, it will post the revised notice at all of its locations and provide a copy upon request.

Protected Health Information is information about you, including demographic information, that:

(1) is created or received by a health care provider, health plan, health care clearinghouse or an employer;

(2) identifies you or from which there is a reasonable belief that you could be identified; and

(3) relates to your past, present or future physical or mental health or condition or the provisions of health care or the past, present or future payment for the provision of health care services.

New Horizons and its business associates may use your protected health information without your consent, authorization or opportunity to agree or object for treatment, payment and health care operations as described below.

(1) TREATMENT is the provision, coordination or management of health care and related services. It also includes, but is not limited to, consultation and referrals between one or more of your providers. For example, if your treating doctor is not aware of the prescription medications that you are taking, New Horizons may disclose a list of such medications and the diagnosis or condition for which you are taking each medication.

(2) PAYMENT is activities undertaken to obtain or provide reimbursement for the provision of health care. It includes activities to determine eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and appropriateness, undertaking utilization reviews, billings, claims management, collection activities and related health care data processing. For example, New Horizons may provide protected health information to your health care plan or insurer to determine whether you are eligible for coverage for a certain service or to determine what percentage of your bill your health care plan or insurer will pay.

(3) HEALTH CARE OPERATIONS include those activities undertaken to conduct quality assessment and improvements activities, population-based activities related to improving health or decreasing the cost of health care, protocol development, case management and care coordination, reviewing the quality and performance of health care professionals, training non-health care professionals, conducting or arranging medical review, legal services or auditing, business planning and development, business management and general administrative activities. For example, New Horizons may use protected health information to determine what additional services New Horizons should offer and whether certain services are effective.

New Horizons may also contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. New Horizons may contact you to raise funds for the organization.

New Horizons may make certain uses and disclosures of your protected health information after giving you an opportunity to agree or object. If you are incapacitated, in an emergency situation or unavailable, New Horizons may use or disclosure your protected health information for these certain purposes if, in New Horizons’ professional judgment, the use or disclosure is in your best interest. These purposes include the following:

(1) If you do not object, New Horizons may use your protected health information to list your name, general condition, religious affiliation and location in New Horizons’ facility in a facility directory. New Horizons may disclose this information to anyone asking for you by name and to members of the clergy.

(2) If you do not object, New Horizons may disclose your protected health information to your family, relatives, friends, and other persons whom you identify if the protected health information is directly relevant to that person’s involvement in your care or payment for care. Similarly, if you do not object, New Horizons may use and disclose your protected health information for the purpose of notifying, identifying and locating family members, personal representatives and others responsible for your care of your location, general condition or death.

(3) If you do not object, New Horizons may use your protected health information for or disclose it to entities authorized to assist in disaster relief efforts.

New Horizons may use or disclose your protected health information in the following situations without your consent, authorization or agreement and without giving you an opportunity to object:

(1) New Horizons may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures. Under the law, New Horizons must make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine compliance with the requirements of 45 CFR 160, 164 et seq.

(2) New Horizons may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purposes of controlling disease, injury or disability. New Horizons may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority. New Horizons may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

(3) New Horizons may disclose protected health information to a health oversight agency for oversight activities authorized by law such as audits, investigations, inspections, and civil, criminal, administrative, and disciplinary proceedings. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.

(4) New Horizons may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, New Horizons may disclose to a governmental entity or agency authorized to receive such information your protected health information if it believes that you have been the victim of abuse, neglect or domestic violence. In such cases, the disclosure will be made consistent with the requirements of applicable federal and state laws.

(5) New Horizons may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biological product deviations, to track products, to make sure repairs or replacements, or to conduct post marketing surveillance.

(6) New Horizons may use and disclose protected health information in the course of any judicial or administrative proceedings, in response to an order of a court or administrative tribunal, in response to certain subpoenas, discovery requests and other lawful processes. New Horizons may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.

(7) New Horizons may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. New Horizons may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his/her duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric, organ, eye or tissue donation purposes.

(8) Under certain circumstances, New Horizons may disclose your protected health information to researchers for approved research that has established protocols to ensure the privacy of your protected health information.

(9) Consistent with applicable federal and state laws, New Horizons may disclose your protected health information, if New Horizons believes that the 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. New Horizons may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

(10) Consistent with applicable law, New Horizons may use or disclose protected health information of individuals who are Armed Forces personnel for: activities deemed necessary by appropriate military command authorities to assure proper execution of a mission and disclosures to a foreign military authority if you are a member of that foreign military service. New Horizons may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities.

(11) New Horizons may disclose your protected health information as authorized to comply with workers’ compensation laws and other similar legally established programs.

(12) New Horizons may disclose your protected health information to a correctional institution or law enforcement official having lawful custody of you if you are an inmate of a correctional facility and if the correctional facility or official makes certain representations regarding the need for the information.

New Horizons will not use or disclose protected health information for purposes other than those described in the sections above without a written authorization from you or a person authorized to act on your behalf. You or the person authorized to act on your behalf may revoke such an authorization in writing.

You have the following rights:

(1) A right to request restrictions on certain uses and disclosures of protected health information. New Horizons is not required to agree to your request to restrict New Horizons’ use or disclosure of your protected health information. To request restrictions you must make your request in writing to

Ronald N. Storing.

(2) In your written request, you must tell New Horizons what information you want to limit and to whom you want the limits to apply.

(3) A right to receive confidential communications of your protected health information. You have the right to request that New Horizons communicate your protected health information to you in alternate locations and by alternate means. For example, you can ask that New Horizons contact you by mail at an address other than your home address. To request communications by alternate means or at an alternate location, you must make your request in writing to the Privacy Officer. New Horizons will not ask you the reason for your request and will accommodate reasonable requests. You must also specify how and where you wish to be contacted. You must also provide information on how payment will be handled.

(4) A right to inspect and copy protected health information. You have the right to inspect and obtain a copy of your protected health information that New Horizons may use to make decisions about your care. During an inspection of your information, a professional staff person may be in attendance to assist you. To inspect or obtain a copy of your information that may be used to make decisions about you, you must submit your request in writing to the Privacy Leader. If you request a copy of the information, New Horizons may charge you a fee for copying and mailing incurred with your request. New Horizons may deny your request under very limited circumstances. If you are denied access to your information, you may request that the denial be reviewed. Another licensed health care professional chosen by New Horizons will review your request and the denial. The person conducting the review will not be the person who originally denied your request. New Horizons will comply with results of the review.

(5) A right to amend your protected health information. This means you may request an amendment of your protected health information maintained in a designated record set for as long as New Horizons maintains it. Your request must be in writing and submitted to the Vice President of Rehabilitation at 1814 Pond Run, Auburn Hills, MI 48326. This writing must provide a reason that supports your request. In certain cases, New Horizons may deny your request for an amendment. If New Horizons denies your request for an amendment, you will receive a written denial and you will have the right to file a statement of disagreement with New Horizons, which may prepare a rebuttal to your statement and will provide you with a copy of such rebuttal. Please contact the Vice President of Rehabilitation at 1814 Pond Run, Auburn Hills, MI 48326 if you have any question about amending your records.

(6) A right to receive an accounting of disclosures of your protected health information. You have the right to a written account of disclosures of your protected health information which New Horizons and its business associates made in the six years prior to the date of your request or for a shorter period of time. Certain disclosures are exempt from the written accounting. You must submit your request in writing to the Privacy Leader. Your request must indicate the time period for which you want the accounting. New Horizons will provide, free of charge, the first accounting you request in a twelve month period. New Horizons may impose a reasonable charge for subsequent accountings requested in a twelve month period provided that New Horizons informs you of the fee and provides you with an opportunity to withdraw or modify the request.

(7) A right to obtain a paper copy of this notice from New Horizons upon request.

If you believe that your privacy rights have been violated, you may complain to New Horizons or the Secretary of Health and Human Services. New Horizons will not retaliate against any individual filing a complaint. New Horizons’ complaint process is as follows:

(1) Contact the Privacy Leader at the location(s) where you received services. He/She will attempt to resolve the complaint.

(2) If your complaint is not resolved by the Privacy Leader, you may submit your written complaint to the Primary Privacy Leader or the Vice President of Rehabilitation. The Primary Privacy leader will respond in writing to you, or your guardian/advocate with copies to the Privacy Leader and your Employment Coordinator.

(3) If your complaint is not resolved by the Primary Privacy Leader, you should direct your complaint in writing to the President/CEO.

(4) If you still do not feel your complaint has been resolved, you can contact the Department of Health and Human Services for further resolution.

If you want further information regarding New Horizons’ privacy policies and procedures you should contact Ronald N. Storing at 248-340-0559. The effective date of this notice is April 14, 2003.