NOTICE OF PRIVACY PRACTICES

January 1, 2018

Choice Empowers notice of privacy practices describes how identifiable health information about you may be used and disclosed and how you can get access to such information. The full notice of privacy practices is shared with anyone with whom Choice Empowers conducts business or provides support. Choice Empowers requires a signature for receipt of the notice of privacy practices and consent to receive updates to its privacy notice.

At Choice Empowers, we are committed to protecting your privacy and sharing information only with those who need to know and are allowed to see the information to assure quality services to you and promote your health and safety.

1. Who will follow this notice:

   All people who work for Choice Empowers in our programs and services and in our administrative offices will follow Choice Empowers privacy practices. This includes employees, persons Choice Empowers contracts with (contractors) who are authorized to enter information in your clinical record or need to review your record to provide services to you, and volunteers that Choice Empowers allows to assist you.

2. What information is protected:

   All information we create or keep that relates to your health or care and treatment, including your name, address, birth date, social security number, medical information, your individualized support/service plan, and other information about your care in our programs is deemed Protected Health Information (PHI).

Choice Empowers is required by law to:

• Maintain the privacy of your information.
• Give you a copy of our notice of privacy practices with our legal duties and practices concerning the protection of the health information we have about you.
• Follow the rules in the notice of privacy practices. Choice Empowers will use or share information about you only with your permission, except for the reasons explained in its privacy notice. We will inform you if we make changes to our privacy practices in the future.
• You have the right to receive a paper copy of our notice of privacy practices. Please contact our Privacy Officer at 585-880-2392.

CHOICE EMPOWERS SERVICES LLC reserves the right to change it’s notice of privacy practices. We reserve the right to make changes to the terms described in the notice and to make the new notice terms effective for all health information that Choice Empowers maintains. We will post the new notice with the effective date in our facilities and will provide copies of the notice to individuals and entities.

Complaints: If you believe your privacy rights have been violated:

• You may file a complaint with Choice Empowers at 585-880-2392 or info@choiceempowers.org
  If the situation is not rectified in an appropriate manner, you may contact the Secretary of Health and Human Services by writing them at 200 Independence Avenue, S.W., Washington, D.C. 20201. You may call them at 877-696-6775.
• Privacy Office Department of Public Welfare, Office of General Counsel, 3rd Floor West, Health & Welfare Building, Harrisburg, PA 17120.
• You may file a grievance with the Office of Civil Rights at 150 S. Independence Mall West Suite 372, Public Ledger Building Philadelphia, Pennsylvania 19106-9111. You may call them at Main Line 215-560-2496, Hotline 800-368-1019, TDD 215-861-4440.

All complaints must be submitted in writing. You will not be penalized for filing a complaint.