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NOTICE OF PRIVACY PRACTICES
(45 CFR §164.520(a))

Effective Date: 04/13/2003

THIS NOTICE DESCRIBES HOW MEDICAL, MENTAL HEALTH, AND/OR CHEMICAL DEPENDENCY 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 the Porter-Starke Services, Inc. Privacy Officer.

WHO WILL FOLLOW THIS NOTICE.
This notice describes our practices and that of:

• Any health care professional authorized to enter information into your chart.
  
  
• All departments and programs of Porter-Starke Services, Inc.
  
  
• Any member of a volunteer group we allow to help you at Porter-Starke Services, Inc.
  
  
• All employees, staff and other personnel of Porter-Starke Services, Inc.
  
  
• All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical, mental health, and/or chemical dependency information with each other for treatment, payment or Porter-Starke Services, Inc. operations purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL, MENTAL HEALTH, AND/OR CHEMICAL DEPENDENCY INFORMATION.

We understand that medical, mental health, and/or chemical dependency information about you and your health is personal. We are committed to protecting your medical, mental health, and/or chemical dependency information. We create a record of the care and services you receive at Porter-Starke Services, Inc. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Porter-Starke Services, Inc. Other Health Care Rehabilitation Facilities may have different policies or notices regarding use and disclosure of your medical, mental health, and/or chemical dependency information.

This notice will tell you about the ways in which we may use and disclose medical, mental health, and/or chemical dependency information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical, mental health, and/or chemical dependency information.

We are required by law to:

• make sure that medical, mental health, and/or chemical dependency information that identifies you is kept private;
  
  
• give you this notice of our legal duties and privacy practices with respect to medical, mental health, and/or chemical dependency information about you; and
  
  
• follow the terms of the notice that is currently in effect.

HOW WE ARE PERMITTED OR REQUIRED BY LAW TO DISCLOSE MEDICAL, MENTAL HEALTH, AND/OR CHEMICAL DEPENDENCY INFORMATION ABOUT YOU WITHOUT YOUR WRITTEN CONSENT OR AUTHORIZATION.

• As Required By Law. We will disclose medical, mental health, and/or chemical dependency information about you when required to do so by federal, state or local law.
  
  
• To Avert a Serious Threat to Health or Safety. We will use and disclose medical, mental health, and/or chemical dependency information about you when we have a .Duty to Report. under state or federal law, because we believe that it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
  
  
• Public Health Risks. We will disclose medical, mental health, and/or chemical dependency information about you for public health reporting required by federal or state law and to report any child abuse and/or neglect.
  
  
• Health Oversight Activities. We will disclose medical, mental health, and/or chemical dependency information as required by law to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensures. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  
  
• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we will disclose medical, mental health, and/or chemical dependency information about you when properly ordered to do so by a court.
  
  
• Law Enforcement. We may release medical, mental health, and/or chemical dependency information if asked to do so by a law enforcement official, and if permitted by law:
  
  
  • In response to a duly executed court order;
    
    
  • If required by state or federal law;
    
    
  • About criminal conduct at a Porter-Starke Services, Inc. facility;
  
  
• Protective Services for the President and Others. We may disclose medical and mental health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

HOW WE MAY USE AND DISCLOSE MEDICAL, MENTAL HEALTH, AND/OR CHEMICAL DEPENDENCY INFORMATION ABOUT YOU AS DISCUSSED IN THE PORTER-STARKE SERVICES, INC., CONSENT FOR TREATMENT.

To provide you with quality treatment, we may use and disclose medical, mental health, and/or chemical dependency information. For each category of uses or disclosures we will give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

• For Treatment. Different departments of Porter-Starke Services, Inc. also may share medical, mental health, and/or chemical dependency information about you in order to coordinate the different services you need. Your treatment team may discuss medical, mental health, and/or chemical dependency information about you to provide you with the most comprehensive medical treatment or services.
  
  
• For Payment. We may need to give your health plan information about treatment you received at Porter-Starke Services, Inc. so that your health plan will pay us or reimburse you for your treatment. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment.
  
  
• For Health Care Operations. We may use and disclose medical, mental health, and/or chemical dependency information about you for Porter-Starke Services, Inc. operations or to another health care provider or health plan, if you have a relationship with that health care provider or health plan . These uses and disclosures are necessary for Porter-Starke Services, Inc. to insure that all of our Clients receive quality care. We may remove information that identifies you from this set of medical, mental health, and/or chemical dependency information so others may use it to study health care and health care delivery without learning who the specific Clients are. For example, we may use medical, mental health, and/or chemical dependency information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical, mental health, and/or chemical dependency information about many Clients to decide what additional services Porter-Starke Services, Inc. should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, social workers, therapists, nurses, psychologists, technicians, medical students, and other personnel for review and learning purposes. We may also combine the medical, mental health, and/or chemical dependency information we have with medical, mental health, and/or chemical dependency information from other Health Care Providers to compare how we are doing and see where we can make improvements in the care and services we offer.
  
  
• Appointment Reminders. We may use and disclose medical, mental health, and/or chemical dependency information to contact you as a reminder that you have an appointment for treatment.
  
  
• Treatment Alternatives. We may use and disclose medical, mental health, and/or chemical dependency information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  
  
• Health-Related Benefits and Services. We may use and disclose medical, mental health, and/or chemical dependency information to tell you about health-related benefits or services that may be of interest to you.
  
  
• Research. Under certain circumstances, we may use and disclose medical, mental health, and/or chemical dependency information about you for research purposes. For example, a research project may involve comparing the health and recovery of all Clients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical, mental health, and/or chemical dependency information, trying to balance the research needs with Clients' need for privacy of their medical, mental health, and/or chemical dependency information. Before we use or disclose medical, mental health, and/or chemical dependency information for research, the project will have been approved through this research approval process, but we may, however, disclose medical, mental health, and/or chemical dependency information about you to people preparing to conduct a research project, for example, to help them look for Clients with specific medical needs, so long as the medical, mental health, and/or chemical dependency information they review does not leave Porter-Starke Services, Inc.. We will ask for your permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care.

SPECIAL SITUATIONS

• Coroners, Medical Examiners and Funeral Directors. We may release medical, mental health, and/or chemical dependency information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical, mental health, and/or chemical dependency information about Clients of Porter-Starke Services, Inc. to funeral directors as necessary to carry out their duties.
  
  
• National Security and Intelligence Activities. We may release medical, mental health, and/or chemical dependency information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities as authorized by law.
  
  
• Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical and/or mental health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

YOUR RIGHTS REGARDING MEDICAL, MENTAL HEALTH, AND/OR CHEMICAL DEPENDENCY INFORMATION ABOUT YOU.

You have the following rights regarding medical, mental health, and/or chemical dependency information we maintain about you:

• Right to Inspect and Copy. You have the right to inspect and receive a copy medical, mental health, and/or chemical dependency information that may be used to make decisions about your care.
  
  To inspect and receive a copy of medical, mental health, and/or chemical dependency information that may be used to make decisions about you, you must submit your request in writing to Porter-Starke Services, Inc. Privacy Officer. If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other supplies associated with your request.
  
  We may deny your request to inspect and /or receive a copy. If your request is denied, you may request that the denial be reviewed. Another licensed health care professional chosen by Porter-Starke Services, Inc. will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
  
  
• Right to Amend. If you feel that medical, mental health, and/or chemical dependency information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Porter-Starke Services, Inc.
  
  To request an amendment, your request must be made in writing and submitted to Porter-Starke Services, Inc. Privacy Officer. In addition, you must provide a reason that supports your request.
  
  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
  
  
  • Was not created by us, or unless the person or entity that created the information is no longer available to make the amendment;
    
    
  • Is not part of the medical, mental health, and/or chemical dependency information kept by or for Porter-Starke Services, Inc., Inc.
    
    
  • Is accurate and complete.
  
  
• Right to an Accounting of Non-routine Disclosures. You have the right to request an "Accounting of Non-routine Disclosures."
  
  
• To request this list or Accounting of Non-routine Disclosures, you must submit your request in writing to Porter-Starke Services, Inc. Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before February 26, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we will charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
  
  
• Right to Request Restrictions. You have the right to request a restriction or limitation on the medical, mental health, and/or chemical dependency information we use or disclose about you for treatment, payment or health care operations.
  
  
• We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
  
  To request restrictions, you must make your request in writing to Porter-Starke Services, Inc. Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
  
  
• Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
  
  To request confidential communications, you must make your request in writing to Porter-Starke Services, Inc., Privacy Officer. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
  
  
• Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
  
  You may obtain a copy of this notice at our website, www.porterstarke.org.
  
  To obtain a paper copy of this notice, contact Porter-Starke Services, Inc., Privacy Officer

CHANGES TO THIS NOTICE

• We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical, mental health, and/or chemical dependency information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in each of our facilities. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to Porter-Starke Services, Inc. for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with Porter-Starke Services, Inc. or with the Secretary of the Department of Health and Human Services. To file a complaint with Porter-Starke Services, Inc., contact Porter-Starke Services, Inc., Privacy Officer at 601 Wall St., Valparaiso, In. 46383. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL, MENTAL HEALTH, AND/OR CHEMICAL DEPENDENCY INFORMATION.

Other uses and disclosures of medical, mental health, and/or chemical dependency information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical, mental health, and/or chemical dependency information about you, you may revoke that permission at any time. If you revoke your permission, we will no longer use or disclose medical, mental health, and/or chemical dependency information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.