As a person receiving services from Gateway Community Industries Inc. (GCI) treatment, residential or vocational programs you are entitled to privacy of your health related information. The information compiled by GCI will be kept secure and inaccessible to anyone other than designated program staff. The information will not be given to others without your consent.

Pursuant to your written authorization GCI will disclose health-related information for the following:

• evaluating your eligibility and need for more appropriate services
• meeting the needs of your treatment plan
• approved research projects

GCI will release health-related information without your written authorization to responsible federal, state or local authorities when we become aware that there is:

• physical or psychological abuse to children or adults
• prenatal exposure to controlled substances
• disclosure that you intend to hurt yourself or others
• when required for enforcement of HIPAA
• coroner or medical examiner
• or for treatment ( To provide you with treatment and services. We may disclose health/clinical information about you to: doctors, nurses, psychologists, social workers and service coordinators) payment (To bill and collect payment from either: you, a third party, an insurance company, Medicare or Medicaid, or other government agencies) and healthcare operations (For quality improvement to review our treatment and services; to conduct fiscal audits).

With regard to your health information, you have the right to:

• inspect or receive a copy of your health information (excluding psychotherapy notes) within the timelines and policies set forth by GCI
• receive an accounting of disclosures
• amend or correct your protected health information according to the guidelines set forth by GCI
• request in writing restrictions of uses and disclosures although it should be noted that GCI is not required to agree to the requested restrictions
• receive confidential information in an alternative manner (i.e. TTY machines )
• receive a copy of the Notice of Privacy Practices upon request
• file a complaint with the privacy officer.

Should you have questions regarding the privacy policy and procedures of Gateway Community Industries you should contact the designated Compliance Officer, Bill Harper, Associate Executive Director at (845) 331-1261 or address communication to him at Gateway Community Industries PO Box 5002 Kingston, NY 12402.

Effective date: April 14, 2003

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