TRANSITIONAL LEARNING CENTER at GALVESTON

TRANSITIONAL LEARNING CENTER RESIDENTIAL CORPORATION

JOINT NOTICE OF PRIVACY PRACTICE

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.

I WHO WILL FOLLOW THIS NOTICE:

· All Transitional Learning Center Residential Housing Corp. and Transitional Learning Center at Galveston employees.

· Any member of a volunteer group, students, and interns.

· Any person authorized to collect data for research purposes.

We realize that your medical information is important to you and for that reason we are committed to protecting the privacy of your Protected Health Information (APHI@). PHI is medical or payment information that identifies you. As part of our efforts to protect your PHI, we are providing you with this Joint Notice of Privacy Practice (ANotice@). This Notice explains how, when, and why we will use and disclose your PHI. This Notice also explains the rights and obligations you have regarding the use and disclosure of your medical information. We are required by law to follow the privacy practice regulations and the provisions described in this Notice.

We reserve the right to make any changes to our privacy policies and this Notice at any time. Any changes to this Notice will only apply to current PHI. The Notice is posted on our web site at: www.tlcrehab.org. Additionally, you may request a copy of the Notice from TLC=s TLC=s Privacy Officer.

II HOW WE MAY USE AND DISCLOSE YOUR PHI WITHOUT AN AUTHORIZATION

For Treatment: We may use and disclose PHI about you to physicians, nurses, therapists, medical students, or others who are directly involved in your care. We may also disclose information to health care providers outside of TLC who may be involved in your medical care, such as physicians, therapists [Occupational Therapy, Physical Therapy, Speech Therapy, Vocational], medical equipment suppliers, pharmacies, and facilities [such as, hospitals, skilled nursing, assisted living]. We may also disclose information to family members/friends who are responsible for your direct care once you are discharged from our facility.

For example:

· The doctor who has taken your medical history and physical may share some of that information with the nurses and therapists so that proper care/therapy can be administered.

· If you have allergies to certain foods, the nurse may communicate that information to the kitchen staff so that they know what foods to prepare for you.

· A client=s name on the door of the client=s room is permitted.

· A client=s name on the wall in the residential lounge to help you find your room is permitted.

· A client=s name, appointment schedule, travel schedule and leaving/returning from Therapeutic Pass schedule in the TA office is permitted.

· A client=s name and photo in the TA and Administrative offices is permitted.

· A client=s name on the door of the TA office is permitted.

· A client=s name, as part of a Motivation Board (i.e. walking program) to increase self-esteem is permitted.

· A client=s name and bed number in the Admission=s office is permitted.

· A client=s name and therapy schedule in treatment areas is permitted.

· A client=s name and treatment schedule will be located in the Case Manager=s offices, Schedule box located on the desk of the Administrative Coordinator of Case Management and Clinical Programs and in the nursing office is permitted. NOTE: These schedules may also be carried by TLC staff in the course of providing services to you.

· A client=s name on adaptive equipment/wheelchairs/walkers/canes is permitted.

· A video/audio of your therapy may be utilized to evaluate your process.

· A client=s name and photo may be displayed in the Therapeutic Recreation Photo Box located in the hall in Building 2 and/or on the Activity Bulletin Board in Building 4. NOTE: These photos are obtained during therapeutic outings or during special events. We can not be held responsible for photos being taken by other clients/family of clients in which you may be inadvertently included.

· A rehabilitation team member may discuss your progress with other members of your treatment team in order to establish your treatment plan.

· A video of your graduation will be sent to you, your funding source, other members of the graduation ceremony and their funding source. If you do not want to be video taped you will be choosing not to participate in the Graduation ceremony. We can not be held responsible for videos being taken by other clients/family of clients in which you may be inadvertently included.

For Payment: We may use and disclose PHI about you in order to bill and collect payment for the treatment and services provided to you.

For example: Our billing department may have to give medical information to your insurance company so the insurance company will be able to process the claim and reimburse TLC for the services provided to you. We may also disclose information about treatments/services that are recommended to obtain prior approval and to determine if your funding source will cover the treatment/service.

For Health Care Operations: We may use and disclose your PHI in order to perform the functions of the facility.

For example:

· We may use information about you and other clients in order to evaluate how well our facility provides services to clients.

· We may use and disclose your information to doctors, nurses, and therapist for learning purposes.

· We may ask if we may disclose your name to prospective clients who may be viewing your room during tours.

· We may use information about you and other clients at the Board of Director=s Meeting to discuss issues, such as, liability, litigation, need of additional Programs/services, and approval to return funds for over-payment.

Individuals Involved in Your Care: We may release relevant PHI to any individual who will be involved in your care at discharge or while you are on a Therapeutic Pass. Such disclosure may be made in person, by telephone or videophone, or by email. When communicating by telephone, videophone, or email, we will take reasonable precautions to verify the identity of the person with whom we are communication.

For Eligibility to our Program: We may disclose your PHI to your funding source(s) to obtain their approval for you to be admitted to our Program. We may disclose your PHI to the referring physician/facility so that they may be aware of your possible admission to our facility.

For Client Directory: Unless you express an objection, we are allowed to include your name and acknowledge that you are a client at TLC when asked.

· Phones calls for you that come through the main switchboard will be forwarded to the phone in the Residential lounge.

· Phone calls that come through the main switchboard requesting information about you will be forwarded to your Case Manager (for TideWay Program clients this is done through the Director of the Program).

· For phone calls that come directly to the phones in the Residential lounge, you or your legal guardian may request that staff not divulge your presence at TLC. This needs to be arranged through your Case Manager (for TideWay Program clients this is done through the Director of the Program). We can not be responsible if information about your being here at TLC is given out by another client who answers the phone.

For Law Enforcement: We may disclose your PHI when required by federal, state, local, judicial law enforcement or administrative proceedings. We may disclose your PHI for court hearings in response to a court order, subpoena, warrant, summons or similar process; to police or law enforcement authorities, or as required by law. We may disclose your PHI to a law enforcement agent in order to avoid the threat of harm to a person or yourself, about a victim of a crime, about a death we believe may be the result of a criminal conduct, or about criminal conduct on TLC property.

For Lawsuits or Disputes: We may disclose your PHI if you are involved in a lawsuit or dispute, in response to a court or administrative order, subpoena, discovery request, or other lawful process by someone else who is involved in the dispute after we can verify that efforts have been made to notify you about the request to obtain information.

Public Health Activities: We may disclose your PHI as required by federal, state, or local laws, such as, information to the Brain Injury Registry, Communicable Disease Center (CDC), abuse, neglect, domestic violence, notifying client(s) they may have been exposed to a communicable disease, and other activities that require reporting. We may also release your PHI when necessary to prevent a serious treat to your health and safety or the health or safety of others.

For Health Oversight Activities: We may use or disclose PHI to assist in oversight activities required by law such as licensure or administrative investigations of health care providers, criminal or civil investigations, or other activities that require the oversight of health care activities.

For Government Functions: We may disclose PHI about you to authorized federal officials for intelligence, counterintelligence, national security, or to protect the President; other authorized persons or foreign heads of state, or to conduct special investigations.

Armed Forces / Foreign Military Personnel: If you are a member of the armed forces/foreign military personnel, we may release your PHI as required by appropriate military/foreign command authorities.

For Worker=s Compensation Purposes: We may disclose PHI about you in order to comply with worker=s compensation laws.

For Research: Under certain circumstances, we may disclose your PHI for research purposes. For example, a research project the involves comparing the health and recovery of all clients who receive one medication to those who received another medication for the same condition. Most research projects, however, are subject to a special approval process. This process requires an evaluation of the proposed research project and its use of PHI, and balance these research needs with our client=s need for privacy. Before we use or disclose PHI for research, the project will have been approved through this special approval process. However, this special approval process is not required when we allow researchers who are preparing a research project to look at information about clients with specific criteria, so long as the PHI they review does not leave TLC. In certain circumstances we may provide PHI in order to conduct approved medical research or contact you regarding participation in research.

For appointment reminders or treatment alternatives: We may use PHI to provide appointment reminders or give you information about treatment alternatives or other health care services that may be of interest to you.

For contacting you regarding Follow-up, Fund Raising, and Marketing purposes: We may contact you after discharge to do Follow-up Services; to ask if PHI about you can be used in our Marketing efforts; or, ask if you would like to come and participate in any of out Fund Raising activities.

To Business Associates for Treatment, Payment, or Health Care Operations: We may disclose PHI to those third parties that perform certain services on your or our behalf. For example: pharmacies, pharmaceutical companies medical supply companies (including adaptive equipment), orthotic companies. To protect your PHI we have an agreement with the third party that requires them to safeguard your information.

III USES AND DISCLOSURES THAT YOU HAVE THE RIGHT TO RESTRICT

Disclosures to family, friends, or others: We may disclose PHI to a family member, friend or other individual who is involved in your care or payment of your services unless you object. If a family member or friend is responsible for payment of services for treatment, then we may disclose PHI to that family member or friend as it relates to payment of services. We may disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for the care of your general condition or your location.

IV WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

With respect to your PHI, you have the following rights:

The Right to Request Restrictions on Uses and Disclosures of Your PHI: You have the right to ask that we limit how we use and disclose your PHI. We will review your request but are not legally required to accept it. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. In your request you must provide us with the following information:

· what information you want to limit

· whether you want to limit TLC=s use and/or disclosure of the information

· to whom you want the limits to apply (for example: your wife)

· your contact address

The Right to Choose How We Send PHI to You: You have the right to request how we communicate PHI to you. (For example: that we send information regarding your treatment, services, and PHI to an alternate address or phone you at work. We will accommodate all reasonable requests.

The Right to Inspect and Copy Your PHI: You have the right to inspect and copy your medical and billing records, except for Psychotherapy notes. Discuss this with your Case Manager (for TideWay Program clients this is done through the Director of the Program) or send your request in writing to:

· For Program Records: TLC Program Records Department, 1528 Postoffice St., Galveston, Texas 77550

· For Financial Records: TLC Admission/Billing Department, 1528 Postoffice St., Galveston, Texas 77550

We are allowed to charge you a fee for the costs of copying, mailing, or other costs associated with your request.

In certain situations we may deny your request and, if so, we will provide you with our reasons for the denial and notify you that you have the right to have the denial reviewed. The people conducting the review will not be the same people who denied your original request. If you are not satisfied with the decision made you may contact the Privacy Office or the Secretary for the Department of Health and Human Services as listed below.

The Right to Request and Amendment: If you believe that there is a mistake in your program record 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 your request and the reason for your request in writing to the Program Records= Department listed above. We will respond in writing within 60 days of receiving your request. If we deny your request, you may file a Complaint as described below.

We may deny your request for an amendment if the information:

· Was not created by us;

· Is not part of the program information kept by or for the facility;

· Is not part of the information which you would be permitted to inspect or copy; or

· Is correct and complete.

The Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures that we made about you for non-treatment, non-payment, and non-operations purposes. The information we will provide you will be from the past 6 years but will not include information before April 14, 2003. The first list that you request with in a 12-month period is free and any additional lists will be provided at a nominal fee. We will respond to your request within 60 days. The accounting of disclosures will include:

· the date of the disclosure

· the name of the entity or person who received the PHI and if known, the address

· a brief description of the PHI disclosed

· a brief statement of the purpose of the disclosure

The request should be made to: TLC Privacy Officer: 1528 Postoffice St., Galveston, Texas 77550

The Right to Receive a Paper Copy of This Notice: You have the right to get a paper copy of this notice. You may also obtain an electronic copy of this notice at our web site at www.tlcrehab.org.

V DISCLOSURES THAT REQUIRE AN AUTHORIZATION

Any uses or disclosures not described in the Notice or any uses or disclosures that are not related to treatment, payment, or health care operations require the completion of an authorization (permission) by you. If you provide us with authorization of your PHI, you may revoke (cancel) your authoritarian in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written permission. However, we are unable to take back any disclosures we have already made with your permission.

Alcohol and drug abuse information has special privacy protections: TLC will not disclose or provide any PHI relating to your substance abuse treatment unless:

· there is a client Authorization signed

· a court order requires disclosure of the information

· medical personnel need the information to meet a medical emergency

· qualified personnel use the information for the purposes of conducting scientific research, management audits, financial audits or program evaluation

· it is necessary to report a crime or a treat to commit a crime, or to report abuse or neglect as required by law.

VI COMPLAINTS

If you think that there has been a violation of your privacy rights or you disagree about a decision made regarding access to your records, you may file a complaint with:

· Current clients: contact your Case Manager. If you are not satisfied with the information they provide, you may contact the TLC Privacy Officer: 1528 Postoffice St., Galveston, Texas 77550, (409) 762-6661 ext. 427

· All other persons: contact the TLC Privacy Officer: 1528 Postoffice St., Galveston, Texas 77550, (409) 762-6661 ext. 427

You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Ave. S.W., Washington, D.C. 20201. If you choose to file a complaint about our privacy practices, we will take no retaliatory action against you.

VII CONTACT PERSON

If you have any questions regarding this notice or our privacy practices, please feel free to contact your Case Manager or the TLC Privacy Officer: 1528 Postoffice St., Galveston, Texas 77550

EFFECTIVE DATE: APRIL 14, 2003 Revision date: 03/07/06