Behavioral Health Services North, Inc. has always committed to protecting the privacy of your health information. We now are required by law to confirm this commitment to you in writing by furnishing you with this Notice of Privacy Practices. The Notice describes our legal duties and our practices relating to the privacy of any medical or other personal information about you in our records. We must follow the procedures described in this Notice of Privacy Practices as long as the Notice remains in effect. We reserve the right to change our privacy practices at any time and, if we made changes, we will apply our new privacy practices to all the information we have in our records about you and to any new information that we get after the change.

If we make significant changes to our privacy practices, we will revise our Notice of Privacy Practices to reflect the changes. We will always have a copy of our current Notice of Privacy Practices in our offices and on our website. In addition, you may get a paper copy of our current Notice of Privacy Practices at any time by asking our front desk staff or by contacting our Privacy Officer as follows:

Ms. Susan Bigelow, RN, Privacy Officer

Behavioral Health Services North, Inc.

63 Broad Street

Plattsburgh, NY 12901

Telephone: 518 563 8000

Email: sbigelow@bhsn.org

Our Privacy Officer can also answer any questions you may have about this Notice.

Behavioral Health Services North, Inc. collects health information from you and stores it in a chart and/or on a computer. We collect your name, address and telephone number; your social security number; information regarding your medical history; information about your heath insurance and other information. This is your medical or health care record. The medical record is the property of Behavioral Health Services North, Inc. but the information in the medical records belongs to you. Your record usually contains information about your health such as your symptoms, examination findings, diagnosis and treatment. We may also gather information about you from other healthcare providers, such as your referring physician, other health care providers you have seen, healthcare facilities that have run tests on you, your health insurance plan and, sometimes, even family members or close friends that help take care of you. Because bills must show what services you received and sometimes have to contain information justifying the need for those services, the bills that we and other healthcare providers send you or your insurers also contain information about your health.

This Notice of Privacy Practices identifies types of uses and disclosures of protected health information ("PHI") that Behavioral Health Services North, Inc. is permitted to make without obtaining a written authorization from you. We have not included every kind of use and disclosure within each category but are providing examples.

Behavioral Health Services North, Inc. uses and discloses recipient health information for many purposes. We regularly attempt to limit all uses and disclosures of your health information to the minimum necessary to accomplish the task required. When other health providers are treating you, we will release your entire medical record to be sure you receive the best possible care.

1. Treatment. Behavioral Health Services North, Inc. may make requests, uses and disclosures of your Protected Health Information ("PHI") as necessary to provide, coordinate and manage your treatment. We may use your health information to send you appointment reminders or notices about the need to schedule a new appointment.

Behavioral Health Services North, Inc. may also share your health information within its programs as appropriate for your treatment. By way of example, if you are a recipient of Adult Clinic services and our residential (Breakthrough) program, health information may be shared between these two programs to coordinate your treatment. To the extent required for your treatment, the sharing of your health information may occur between our outpatient clinics, intensive psychiatric rehabilitation program (IPRT), continuing day treatment program (CDT), case management services, residential services and supported employment services.

2. Payment. Behavioral Health Services North, Inc. may make requests, use and/or disclose your health information as necessary to bill and obtain payment for our services from you or your insurance company. We may have to disclose your health information to your insurance company so they can determine your benefit eligibility; provide preauthorization for services; or determine how much they should pay us.

3. Regular Health Care Operations. Behavioral Health Services North, Inc. may use and disclose your health information for the general operation of our business. Examples of health care operations include conducting quality assessment and improvement activities (including outcomes evaluation and development of clinical guidelines); case management and care coordination; legal services and auditing functions, including fraud and abuse detection and compliance programs; business planning and development. For example, we may use our patients’ health information to evaluate and improve the quality of the health services we provide.

4. Information provide to you.

5. Notification and communication with individuals involved in your care. We may disclose information about you to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or disagree, we will give you the opportunity to object before we make this notification. However, under certain circumstances, such as in an emergency, our health professionals will use their best judgment in communicating with your family and/or other individuals involved in your care.

New York State law is, in certain circumstances, stricter than applicable federal law and therefore will control in such circumstances. The exceptions set forth below are not all inclusive, but are meant to provide you with a general overview of situations in which New York State law, and not HIPAA, controls. Confidentiality requirements with regard to alcohol and drug treatment records are, for example, beyond the scope of this summary.

* Psychotherapy notes are not exempted from the consent requirement under state law;

* If disclosure would cause substantial harm to another person, Behavioral Health Services North, Inc. may deny access to all or part of the information and may grant access to a prepared summary of the information if, after considering all the attendant facts and circumstances, Behavioral Health Services North, Inc. determines that the request to review all or a part of the patient information can reasonably be expected to cause substantial and identifiable harm to the subject or others, which would outweigh the qualified person’s right of access to the information;

* If a parent requests information concerning a child over 12 years of age, Behavioral Health Services North, Inc. may notify the child and if the child objects to disclosure, may deny the request;

* Behavioral Health Services North, Inc. may deny access to all or part of the information and may grant access to a prepared summary of the information if, after consideration of all the attendant facts and circumstances, Behavioral Health Services North, Inc. determines that disclosure would have a detrimental effect on its professional relationship with a minor (a person under 18 years of age) or on the minor’s relationship with his or her parents;

* Confidential HIV information obtained in the course of providing any health or social service may not be disclosed without your consent except to an authorized agency in connection with foster care or adoption of a child or to an employee or agent of the division of probation and correctional alternatives or any local probation department or an employee or agent of the commission of correction; and

* A physician may disclose confidential HIV information pertaining to a protected individual to a person (known to the physician) authorized pursuant to law to consent to health care for a protected individual when the physician reasonably believes that: (1) disclosure is medically necessary in order to provide timely care and treatment for the subject of the HIV information; (2) after appropriate counseling as to the need for such disclosure, the subject of the HIV information will not inform a person authorized by law to consent to healthcare, provided; however, that the physician will not make such disclosure if, in the judgment of the physician: (1) the disclosure would not be in the best interest of the subject of the HIV information; of (b) the subject of the HIV information is authorized by law to consent to such treatment.

6. Other Uses and Disclosures. Behavioral Health Services North, Inc. may make certain other uses and disclosures of your health information without your authorization for any of the following public policy purposes:

a. Requirements of Applicable Federal, State or Local Law. We may use or disclose information about you whenever we are required by law; such as a court order.

b. Public Health Reporting. We may disclose your health information to proper public health authorities for purposes related to preventing and reporting disease; injury or disability. Public health authorities include the Centers for Disease Control, the Occupational Safety and Health Administration, the Environmental Protection Agency as well as a number of other state and local authorities.

c. Victims of Abuse, Neglect or Domestic Violence. We may disclose health information about you to public health authority or other appropriate government or protective services agencies if we have reason to think that you are a victim of abuse, neglect or domestic violence and you authorize the disclosure or if the law requires us to report regardless of whether you agree.

d. Judicial and Administrative Proceedings that Involve You. We may disclose your health information in the course of a judicial or administrative proceeding that involves you if we get an order from a court or administrative tribunal. We may also release health information about you in the absence of such an order in response to a discovery request, but we will do so only if we have made an effort to notify you or to get a protective order covering your information from the court or administrative tribunal.

e. Law Enforcement Activities. We may disclose your health information to a law enforcement officer for purposes such as identifying or locating a suspect, fugitive, material witness or missing person. We may also be required to disclose information about you if we receive a warrant, subpoena or other order from a court or administrative hearing body to assist law enforcement authorities.

f. Disclosures to Coroners, Medical Examiners and Funeral Directors. We may disclose information to help a coroner or medical examiner identify a deceased person or determine the cause of death. We may also release health information that funeral directors need to do their jobs.

g. Organ Procurement Organizations, Transplant Centers and Eye Tissue Banks. We may disclose information about organ donors or potential organ recipients to organ procurement organizations, transplant centers and eye tissue banks.

h. Research. We may use or disclose certain health information about your condition and treatment for records based research so long as an Institutional Review Board (IRB) or Privacy Board has determined that obtaining permission from you and the other patients’ whose records need to be reviewed would be impractical and that the privacy interest of all patients involved in the study will be adequately protected.

i. Military and National Security. We may release health information about you to military command authorities, for national security and intelligence activities and for the provision of protective services for heads of state.

j. Prevention of Serious Threats to Health or Safety. We may disclose your health information to prevent a serious threat to your health and safety or to the health and safety of others.

k. Workers’ Compensation. We may disclose health information about you to workers’ compensation insurers or other similar programs which provide benefits for work related injuries or illnesses without regard to fault in accordance with the requirements of the laws governing the programs.

l. As required by law, we will release health information to the Secretary of the Department of Health and Human Services for enforcement of HIPAA.

7. Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health related benefits and services that may be of interest to you.

8. Change of Ownership. In the event that Behavioral Health Services North, Inc. is sold or merged with another organization, your health information/record will become the property of the new owner.

Except as described in this Notice of Privacy Practices, Behavioral Health Services North, Inc. will not use or disclose your health information without your written authorization. If you do authorize Behavioral Health Services North, Inc. to use or disclose your health information for another purpose beyond those permitted uses and disclosures described above, you may revoke your authorization in writing at any time.

If you revoke your permission, we will no longer use or release health information about you for the reasons covered by your written authorization except to the extent that we have already relied on your original permission.

1. You have the right to request restrictions on certain of our uses and disclosures of your health information for treatment, payment and healthcare operations. Your request must describe in detail the restriction you are requesting. Behavioral Health Services North, Inc. is not required to agree to the restriction that you requested under HIPAA but we will accommodate reasonable requests when appropriate.

2. Request for confidential communication. You have the right to receive your health information through a reasonable alternative means or at an alternative location. For example, you may request that messages not be left on voice mail or sent to a particular address. Requests for confidential communication must be in writing and addressed to the Privacy Officer, 63 Broad Street, Plattsburgh, NY, 12901. We will honor reasonable requests and let you know if a request cannot be honored.

3. You have the right to inspect and copy your health information that we maintain and/or information compiled for use in a civil, criminal or administrative proceeding. Behavioral Health Services North, Inc. will charge $.75/page for copying and we will require you to pay us for postage if you ask us to mail copies of your records to you.

4. You have a right to request Behavioral Health Services North, Inc. to change your health information that you think is incorrect or incomplete. To be considered, your request must be in writing, must be signed by you or your representative and must state the reasons for the amendment/correction request. We may deny your request if we think the records are correct and complete or if the information you are questioning was created by another healthcare provider.

5. You have a right to receive a listing of certain uses and disclosures of your health information made by Behavioral Health Services North, Inc. except for those uses and disclosures made for purposes of treatment, payment or healthcare operations; disclosures made to you under your right to see and copy your records and disclosures you have given us a written authorization to make or any uses and disclosures of your health information made before April 14, 2003 among others. If you request this accounting more than once every twelve months, we may charge you a fee of each additional listing. Our fee is currently set at seventy-five cents ($.75)/page.

6. You have a right to a paper copy of this Notice of Privacy Practices.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact -

Susan Bigelow, RN, Privacy Officer

Behavioral Health Services North, Inc.

63 Broad Street

Plattsburgh, NY 12901

Telephone: 518 563 8000

Complaints about this Notice of Privacy Practices or how Behavioral Health Services North, Inc. handles your health information should be directed to:

Susan Bigelow, RN, Privacy Officer

Behavioral Health Services North, Inc.

63 Broad Street

Plattsburgh, NY 12901

Telephone: 518 563 8000

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: Department of Health and Human Services

Office of Civil Rights

Hubert H. Humphrey Building

200 Independence Avenue, S.W.

Room 509F HHH Building

Washington, DC 20201

You may also address your complaint to the regional Office for Civil Rights:

Region II, Office for Civil Rights

U. S. Department of Health and Human Services

Jacob Javits Federal Building

26 Federal Plaza, Suite 3312

New York, NY 10278

Telephone: 212 264 3313