The Autism Center of Nebraska
Notice of Privacy Practices

This Notice describes how health and services information about you may be used and disclosed and how you can get access to this information. You should read this Notice or have someone explain it to you before signing the acknowledgement. Please review it carefully.

I. Our Duty to Safeguard Your PHI.

Autism Center of Nebraska provides services and supports to people with developmental disabilities. Autism Center of Nebraska is closely affiliated with and directly involved in the administration and management of those services and supports. This corporation is Specialized Children's In Home Services, Inc (to be referred to as; SCIHS), located in Omaha, Nebraska. This corporation also has a duty to safeguard the information in the same manner as Autism Center of Nebraska. For purposes of this Notice, we refer to Autism Center of Nebraska we also mean Specialized Children’s In Home Services, Inc. (to be referred to as; SCIHS).

Individually identifiable information about your past, present or future physical or mental health or condition, the provision of health care to you or the payment for the health care is considered "Protected Health Information" or PHI. We are required to extend certain protections to your PHI, and to give you this Notice about our privacy practices that explains how, when and why we may use or disclose your PHI. You will receive this Notice no later than the first day on which you receive services. Except in specified circumstances, we will disclose only the minimum necessary PHI to accomplish the purpose for use or disclosure.

We are required to follow the privacy practices described in this Notice, although we reserve the right to change our privacy practices and the terms of this Notice at any time. The new notice provisions will be effective for all PHI we maintain. If we change our privacy practices, we will post a copy of the changed notice on our web site, with the effective date clearly displayed. You may also request a paper copy of the new notice from the Privacy Officer, whose address appears below.

II. How We May Use and Disclose Your PHI.

Autism Center of Nebraska collects PHI about you and stores it in files and/or on a computer, which we call a "record". Although the PHI is yours, the record is the property of Autism Center of Nebraska. CAN protect the privacy of your PHI, but the law permits us to use or disclose your PHI for the following purposes:

A) Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations:
The following are examples of the types of uses and disclosures of your PHI that Autism Center of Nebraska is permitted to make once you have signed our Acknowledgment form.

These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by us once you have signed the Acknowledgment.

• For treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and related services. This includes the coordination or management of your health care with staff members, volunteers, interns, and third parties that have authorization or your permission to have access of your PHI. For example, your PHI may be shared among members of your service planning team, your physician, and a laboratory or specialist involved in your treatment.
• For Payment: We may use or disclose your PHI order to bill and collect payment for our services. For example, we may release portions of your PHI to Medicaid agencies, a private insurance plan, or other state offices to get paid for services delivered to you. Release of your PHI to the county, state, or Medicaid agency might also be necessary to determine your eligibility for publicly funded services.
• For health care operations: We may also use or disclose your PHI in the course of the day to day operations with Autism Center of Nebraska. For example, we may use your PHI in evaluating the quality of services provided. We may also disclose your PHI to third party "business associates", including such parties as our attorney or our accountant for audit purposes. Our business associates are required to sign an agreement stating that they will keep all PHI confidential.

B. Other Uses and Disclosures Not Requiring Authorization: The law provides that we may use or disclose your PHI without authorization in the following circumstances:

• Reminders and information: We may contact you to provide appointment reminders or information about alternatives or other health-related benefits and services that may be of interest to you.
• When required by law: We may use 'or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or , disclosures. For example, we may disclose PHI when law requires that we report information about suspected abuse or neglect. We must also disclose PHI to authorities who monitor compliance with these privacy requirements.
• Legal proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process
• Law Enforcement: We may also disclose PHI for law enforcement purposes. These law enforcement purposes include: (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of your residence, and (6) medical emergency (not in your residence) and it is likely that a crime has occurred.
• For public health activities: We may disclose PHI when we are required to collect information about disease or injury or to report vital statistics to the public health authority.
• For health oversight activities: We may disclose your PHI to agencies responsible for audits, investigations, inspections, licensure, accreditation, and other oversight activities. We may also disclose your PHI to a person or company required by the food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required.
• Relating to decedents: We may disclose PHI relating to an individual's death to coroners, medical examiners or funeral directors and to organ procurement organizations relating to organ, eye, or tissue donations or transplants. We may disclose such information in reasonable anticipation of death.
• To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
• For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons, including the provision of protective services to the President or others so legally authorized.
• Workers Compensation: We may disclose your PHI as necessary to comply with worker's compensation laws.
• Fundraising: Autism Center of Nebraska may contact you to raise funds FOR THE AGENCY. As part of these fundraising activities, certain PHI may be disclosed to a "business associate" or to a foundation closely affiliated with Autism Center of Nebraska. The PHI disclosed may include demographic information and the dates of health care services provided and the dates of health care services provided to you. You do, however, have the right to "opt out" of receiving any fundraising materials. The Privacy Officer will provide you with a form to sign should you chose to "opt out".
• Uses and Disclosures Requiring That Yon Have an Opportunity To Object: We may use and disclose your PHI in the following described instances, for which you have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then Autism Center of Nebraska, may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
• Personal Involvement: We may disclose to a member of your family, a relative, a close friend, or other person you identify your PHI that directly relates to that person's involvement in your healthcare.
• Notifications: We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
• Disaster relief: we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts.

III. When We may Not Use or Disclose Your PHI without Authorization

In all instances not otherwise permitted by this Notice to release your PHI, we will ask you to sign an authorization form required by law. Your authorization can be revoked in writing at any time to stop future uses or disclosures except to the extent that we have already undertaken an action in reliance upon the authorization.

IV. YOUR RIGHTS REGARDING YOUR PHI you have the following rights relating to your PHI.

1. To request restrictions on uses or disclosures: You have the right to ask that we limit how we use or disclose your PHI for treatment, payment, or health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction.
2. To choose how we contact you: You may have the right to ask that we send you information at an alternative address or by an alternative means. We must agree to your request as long as it is reasonably easy for us to do so. For example, in most cases it will be impossible for us to hand deliver information or to overnight it via Federal Express or a similar mailing company.
3. To Inspect and Copy: You may inspect and obtain a copy of your PHI that is contained in a "designated record set" for as long as we maintain the PHI. A "designated record set" contains medical and billing records and any other records that Autism Center of Nebraska uses for making decisions concerning you. Under law, however, you may not inspect or copy the following: psychotherapy notes, information compiled in a reasonable anticipation of, or use in, a civil, criminai, or administrative action or proceeding; and PHI that is subject to law that prohibits access to PHI. If you want copies of your PHI, a charge for copying may be imposed, but may be waived, depending on your circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying.
4. To request amendment of your PHI: You have a right to request that we amend your PHI if it is incomplete or incorrect. We are not required to change your PHI. If we cannot amend your PHI in accordance with your request, we will provide you with information about the denial and how you can disagree with the denial.
5. To find out what disclosures have been made: You have the right to receive a report of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure for treatment, payment, and operations. The report also will not include any disclosures made for national operations. The report also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or disclosures made before April 14, 2003. Subject to the foregoing, your request can relate to disclosures going as far back as six years. We will respond to your request for a report within 60 days of receiving the request. There will be no charge for one such report made each year. There may be a reasonable charge for more frequent reports.
6. To receive this notice: You have a right to receive a paper copy of this Notice of Privacy Practices.
7. How to complain about our Privacy Practices: If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, including any decisions about your rights, you may file a complaint verbally or in writing with our Privacy Officer, whose address appears below. You also may file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We will take no retaliatory action against you if you make a complaint.

VI. Privacy Officer to contact for Information or to submit to a complaint:

If you have questions about this Notice or wish to make a complaint about our privacy practices, please contact: