Privacy Practices for Protected Health Information
This Notice of Privacy Practices for Adaptive Community Support Services describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. If you have any questions about this Notice, please contact a member of Adaptive Community Support Services. 

Who Will Follow This Notice
The Notice of Privacy Practices describes information about privacy practices followed by the staff, directors and other members of the workforce employed by Adaptive.
All Adaptive service providers listed above must comply with the terms of this Notice of Privacy Practices for all services provided to you by Adaptive. These facilities will share your medical information with each other in order to efficiently provide services to you, including services related to your treatment and payment for services provided to you. These services are described in more detail on the following pages.

What Locations Are Covered
This Notice of Privacy Practices applies to all services provided to you by Adaptive Community Support Services. It also covers services provided by Adaptive Nursing and Healthcare Services, if they provide services to you as well. It does not cover services provided to you at your doctor’s or dentist’s office.

Your Protected Health Information
We are legally required to protect the privacy of your medical information and provide you with this Notice. This Notice of Privacy Practices describes how we may use and disclose your medical information to provide health care services to you. It also describes your rights to access and control your medical information. Your medical information includes your medical records, billing records and any other information we have or receive that may identify you and relates to your physical or mental health condition or health care services provided to you.

How We May Use and Disclose Your Protected Health Information
We use and disclose medical information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

We may use and disclose your medical information for treatment, payment and healthcare operations
without your prior authorization:

• For treatment. We may use and disclose your medical information in order to provide medical treatment to you. For example, we may provide your medical information to your doctors or their nurses and staff in order to assist with your medical treatment in the event of an emergency.

• To obtain payment for treatment. We may use and disclose your medical information in order to bill and collect payment for the treatment and services provided to you. For example, we give portions of your medical information to our billing department and to get paid for the services we provided to you. We may also provide your medical information to billing companies, claims processing companies and others that process our service billing claims.

• For healthcare operations. We may disclose your medical information in order to operate our agency. For example, we may use your medical information in order to evaluate the quality of services that you received or to evaluate the performance of the staff who provided services to you. We may also send portions of your medical information to our accountants, attorneys, consultants and others in order to comply with legal or other matters that affect us. Your medical information may also be used for operations such as quality assessment activities, employee review activities, training of staff, and conducting or arranging for other business activities.

We may also use and disclose your medical information without your authorization for the following
reasons:

• Required by law. We may disclose your medical information when we are required by federal, state or local law, judicial or administrative proceedings or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence; when dealing with gunshot and other specific types of wounds; or when ordered in a legal proceeding.

• Public health activities. We may disclose your medical information for public health reasons. For example, we report information about births, deaths and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners and funeral directors necessary information relating to an individual’s death.

• Survey oversight activities. We will provide medical information to assist oversight agencies for audits, investigations, inspections or licensing purposes.

• Research. In limited circumstances, we may provide medical information for research projects which are subject to a special approval process. We will ask for your written authorization if the researcher will have access to your name, address or other information that reveals who you are.

• To avoid a serious threat to health or safety. In order to avoid a serious threat to the health or safety of a person or the public, we may provide medical information to law enforcement personnel or persons able to prevent or lessen such harm.

• Certain government functions. We may disclose medical information of military personnel and veterans in certain situations. We may provide medical information about a patient’s condition to the American Red Cross for the Red Cross to provide emergency communication services for members of the U.S: military, such as notification of family illness or death. We may also disclose medical information for national security purposes, such as protecting the President of the United States or assisting with intelligence operations.

• Workers’ Compensation. We may provide medical information in order to comply with workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

• Appointment reminders and alternative treatment or benefits. We may also use your medical information to send you appointment reminders or to provide you with information about alternative treatments which may be available to you or other health-related benefits and services that may be of interest to you.

• To business associates. We will share your medical information with other businesses that help us provide our services. For example, we may provide your medical information to a business that transcribes medical information for us. Whenever an arrangement between our healthcare organization and a business associate involves the use or disclosure of your medical information, we will have a written agreement that contains terms that will protect the privacy of your medical information.

You have the right to object to the following disclosures:

• Disclosures to family, friends or others. We may provide your medical information to a family member, friend or other person that you indicate is involved in your care or the payment for your health care, unless you object.

All other uses and disclosures require your prior written authorization. In any other situation not described above, we will ask for your written authorization before using or disclosing any of your medical information. If you choose to sign an authorization to disclose your medical information, you can revoke that authorization in writing to stop any future uses and disclosures to the extent that we have not already taken action relying on the authorization. This written decision to revoke that authorization will be filed and implemented immediately.

What Rights You Have Regarding Your Medical Information
You have the following rights with respect to your medical information:

• The right to request limits on uses and disclosures of your medical information. You have the right to ask that we limit how we use and disclose your medical information. We will consider your request but we are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations where the information is needed. You may not limit the uses and disclosures that we are legally required to make.

• The right to choose how we send medical information to you. You have the right to ask that we send information to you at an alternate address (for example, sending information to your work address rather than your home address) or by alternate means. We must agree to your request so long as we can easily provide it in the format you requested.

• The right to see and get copies of your medical information. In most cases, you have the right to look at or get copies of your medical information that we have, but you must make the request in writing. If we don’t have your medical information, but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed, if you request copies of your medical information, we will charge you a reasonable fee as permitted by Indiana law. Instead of providing the medical information you requested, we may provide you with a summary or explanation of the medical information as long as you agree in advance to pay the reasonable cost of preparing the summary or explanation.

• The right to get a list of certain disclosures we have made. You have the right to request a list of instances in which we have disclosed your medical information. The list will not include uses or disclosures made for treatment, payment, to Case Managers, Surveyors, Auditors and healthcare operations. The list will also not include information given to your family, printed in our facility directory, released for national security purposes or given to correctional institutions. It will also not include disclosures made directly to you or when you have given us a written authorization for the release of medical information. To obtain this list, you must make a request in writing. The list we will give you will include disclosures made by Adaptive Community Support Services. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable fee for each additional request.

• The right to correct or update your medical information. If you believe that there is a mistake in your medical information or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing to the Director of your services. We may deny your request in writing if the medical information is:

• correct and complete;
• not created by us;
• not allowed to be disclosed; or
• not part of our records.

Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file a statement of disagreement, you have the right to ask that your request and our denial be attached to all future disclosures of your medical information. If we approve your request, we will make the change to your medical information, tell you that we have done it, and tell others that need to know about the change to your medical information.

What to Do If You Believe Your Privacy Rights Have Been Violated
If you think that we may have violated your privacy rights, or you disagree with a decision we made about your medical information, you may file a complaint as outlined in this handbook. We will not take any action to retaliate against you and you will not be penalized if you file a complaint about our privacy practices.