THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Your health record contains personal information about you and your health. State and federal law protects the confidentiality of this information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. The confidentiality of alcohol and drug abuse patient records is specifically protected by Federal law and regulations. AdCare Hospital of Worcester, Inc. ("AdCare Hospital") is required to comply with these additional restrictions. This includes a prohibition, with very few exceptions, on informing anyone outside the program that you attend the program or disclosing any information that identifies you as a patient of our facility. The violation of Federal laws or regulations by this program is illegal. If you suspect a violation you may file a report to the appropriate authorities in accordance with Federal regulations.

How We May Use and Disclose Health Information About You

• For Treatment. We may use medical and clinical information about you to provide you with treatment or services.
• For Payment. With your authorization, we may use and disclose medical information about you so that we can receive payment for the treatment services provided to you.
• For Health Care Operations. We may use and disclose your protected health information ("PHI") for certain purposes in connection with the operation of our program.
• Without Authorization. Applicable law also permits us to disclose information about you without your authorization in a limited number of other situations, such as with a court order. These situations are explained on the following pages.
• With Authorization. We must obtain written authorization from you for other uses and disclosures of your PHI.

Your Rights Regarding Your PHI. You have the following rights regarding PHI we maintain about you:

• Right of Access to Inspect and Copy. You have the right, which may be restricted in certain circumstances, to inspect and copy PHI that may be used to make decisions about your care. We may charge a reasonable, cost-based fee for copies.
• Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment.
• Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures that we make of your PHI.
• Right to Request Restrictions. You have the right to request a restriction or limitation on the use of your PHI for treatment, payment, or health care operations. We are not required to agree to your request.
• Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
• Right to a Copy of this Notice. You have the right to a copy of this notice.
• Complaints. You have the right to file a complaint in writing to us or to the Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.

If you have any questions about this Notice of Privacy Practices,
please contact our Privacy Officer:

Jeffrey W. Hillis, Vice President of Administration
AdCare Hospital of Worcester, Inc.
107 Lincoln Street
Worcester, MA 01605
Tel.: (508) 799-9000 x3123
E-mail: jhillis@adcare.com

For the remainder of this Notice of Privacy Practices, click here.