PATIENT PRIVACY NOTICE

THIS NOTICE DESCRIBES HOW MEDICAL AND 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. § 132d 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. There is also New York State law that protects your health information. Except as permitted by federal or state law, the Urban Resource Institute (URI) may not say to a person outside URI that you attend the program, nor may URI disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information.

URI must obtain your written consent before it can provide treatment or disclose information about you for payment purposes. For example, URI 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 URI can share information for treatment purposes or for health care operations. However, federal and state law permits URI to disclose information without your written permission:

1. Pursuant to an agreement with a business associate;
2. For research, audits or evaluations performed by URI staff or authorized regulatory bodies;
3. To report a crime committed on URI's premises or against URI personnel;
4. To medical personnel in a medical emergency;
5. To appropriate authorities to report suspected child abuse or neglect, or if it is suspected that you may cause harm to yourself or others;
6. As allowed by a court order

For example, URI 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.

Before URI can use or disclose any information about your health in a manner that 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 at any time.

Your Rights:

Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. URI 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, or as required by federal and state law. You have the right to request that URI communicates with you by alternative means or at an alternative location. URI will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by URI, except to the extent that the information contains psychotherapy notes or information compiled for 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 URI's records, and to request and receive an accounting of disclosures of your health related information made by URI during the six years prior to your request. You also have the right to receive a paper copy of this notice, and a copy of any consent form that you sign.

URI's Duties:

URI is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. URI is required by law to abide by the terms of this notice. URI reserves the right to change the terms of this notice, and to make new notice provisions effective for all protected health information it maintains.

URI may change this privacy policy in the future. If it does, URI will revise this notice so you will have an accurate summary of its policies. Any changes will be effective upon the release of a revised privacy policy and will be made available to you upon request. In addition, all revised notices will be posted in the reception area.

Complaints and Reporting Violations:

You may complain to URI 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. To file a complaint with URI, please contact a Patient Advisory Committee (PAC) member, any staff or call the Privacy Officer. You will not be retaliated against for filing such a complaint. Violation of HIPAA or the Confidentiality Law by a program is a crime. Suspected violations of HIPAA or the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.

Contact:

For further information, contact:

Maureen Clements, Privacy Officer
22 Chapel Street
Brooklyn, New York 11201
718-260-2900