This notice describes how medical information about your child may be used and disclosed, and how you can get access to this information. Please review it carefully.

This Notice tells you about the way's in which Sunny Hills Services, (SHS) may collect, use and disclose your child's protected health information to carry out payment and health care operations, and for other purposes that are permitted or required by law. It also sets out our legal obligations concerning your child's protected health information. Additionally, this Notice describes your rights to access and control protected health information.

What is Protected Health Information?
Protected Health Information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health plan, or a health care clearinghouse that can reasonably be used to identify your child and relates to your child's past, present or future physical or mental health condition, the provision of health care to your child, or the payment for that care.

Effective Date
This notice becomes effective April 14, 2003.

Our Responsibilities Regarding Protected Health Information
We are required by law to provide you with this Notice about your rights and our legal duties and privacy practices with respect to your child's protected health information (PHI). We must follow the terms of this Notice while it is in effect. Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than the federal standards. We reserve the right to change the provisions of our Notice and make the new provisions effective for all protected health information that we maintain. If we make a material change to our Notice, we will mail a revised Notice to the address that we have on record for you. If you have any questions or want additional information about the Notice or the policies and procedures described in the Notice, please address them to: Sunny Hills Services, Privacy Officer, 300 Sunny Hills Drive, San Anselmo, CA 94960, or ask your SHS clinician.

How We May Use and Disclose Protected Health Information
We may use and disclose your child's PHI for different purposes. The examples below are provided to illustrate the types of uses and disclosures we may make without your authorization for payment, health care operations, and treatment purposes.

Treatment. We may use and disclose PHI to provide, coordinate, or manage health care and any related services. This includes the coordination or management of our client's health care with a third party that has already obtained permission to have access to PHI. For example, we will disclose PHI, as necessary, to a therapist or dentist who provides care to our client. In addition, we may disclose PHI to another physician or health care provider (e.g., a specialist or laboratory), who, at the request of your child's physician, becomes involved in your child's care by providing assistance with health care diagnosis or treatment.

Payment. We may use or disclose PHI as necessary to obtain payment for health care services. This includes certain activities that your child's referring agency may undertake before it approves or pays for the health care services we provide. Examples of these activities include determining eligibility for additional services, reviewing services provided, and undertaking utilization review/quality assurance activities before payment of services is made.

Healthcare Operations. We may use or disclose PHI in order to support the business activities of SHS. These uses are necessary to run the agency and make sure all of our clients receive quality care. Examples of these activities may include quality assessment and improvement, reviewing employee performance, employee training, accreditation, licensing, and conducting or arranging for other business activities.

Other Permitted or Required Disclosures
As Required by Law. We must disclose PHI about your child when required to do so by law.

Health-Related Benefits and Services. We may use or disclose PHI, as necessary, to provide our client's parents/guardians, representatives, or referring agencies information about treatment alternatives or other health-related benefits and services that may be of interest to them.

Fundraising Activities. We may use or disclose demographic information and the dates of our clients receiving treatment, as necessary, in fundraising activities. We never allow our clients names to be used in publicity, nor may they be identified in any way. Clients may only be photographed, videotaped, or participate in live television transmissions for publicity purposes upon their approval and if SHS publicity release consent forms have been signed.

Appointment Reminders. We may use and disclose medical information to contact you and/or your child as a reminder that your child has an appointment for treatment.

Agency Directory. We may include certain limited information about your child in the internal SHS directory while he/she is a client at the agency. This information may include your child's name, program, birth date, and date of admittance.

Research Purposes. Under certain circumstances, we may disclose PHI about your child for research purposes, provided certain measures have been taken to protect your child's privacy. For example, a research project may involve comparing the health and recovery of all clients who received one medication to those who received another for the same condition.

Others Involved in Your Child's Healthcare. Unless you object, we may disclose PHI about your child to a friend or family member who is involved in your child's healthcare.

Emergencies. We may use or disclose your child's PHI in an emergency treatment situation. By way of example, we may provide PHI to a paramedic who is transporting your child in an ambulance. In case of a disaster situation, we may use or disclose information to an entity assisting in the disaster relief efforts, and to coordinate the uses and disclosures so that you and/or your family can be notified of your child's condition, status and location.

To Avert a Serious Threat to Health or Safety. We may disclose PHI, with some limitations, when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Public Health Activities. We may disclose PHI to public health agencies for reasons such as preventing or controlling disease, injury or disability.

Health Oversight Activities. We may disclose PHI to government oversight agencies for activities authorized by law. Oversight agencies include government agencies that oversee the health care system, and government benefit programs such as Medi-Cal.

Victims of Abuse, Neglect or Domestic Violence. We are required to disclose PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we will disclose PHI to the governmental entity or agency authorized to receive such information if we believe that our client has been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration. We are required to disclose 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; or to make repairs or replacements.

Judicial and Administrative Proceedings. We will disclose PHI in response to a court or administrative order. We may also disclose PHI in certain cases in response to a subpoena, discovery request or other lawful purposes.

Law Enforcement. We may disclose PHI under limited circumstances to a law enforcement official in response to a warrant or similar process; to identify or locate a suspect; or to provide information about the victim of a crime.

Special Government Functions. We may disclose information as required by military authorities or to authorized federal officials for national security and intelligence activities.

Worker's Compensation. We may disclose PHI to the extent necessary to comply with worker's compensation laws and other similar legally-established programs.

Other Uses or Disclosures with an Authorization
Other uses or disclosures of your child's PHI will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization at any time in writing, except to the extent that we have already taken action on the information disclosed or if we are permitted by law to use the information.

Your Rights Regarding Protected Health Information
The following is a description of your rights with respect to your child's PHI.

Right to Access Your Child's PHI. You have the right to review or obtain copies of your child's protected health information records, with some limited exceptions. Usually the records include admittance, billing, payment and case or medical management records. Your request must be made in writing. We may charge you a fee for the costs of producing, copying and mailing your requested information, but we will tell you the cost in advance. Under limited circumstances, we may deny your request to inspect and copy. If you are denied access, you may request that the denial be reviewed. The person(s) performing the review will not be the same one that denied your initial request. Under certain conditions, our denial will not be reviewable. If this event occurs, we will inform you in our denial that the decision is not reviewable.

Right to Request Restrictions on the Use and Disclosure of PHI. You have the right to request that we restrict or limit how we use or disclose your child's PHI for treatment, payment or health care operations. We may not agree to your request. If we do agree, we will honor your request unless the restricted health information is needed to provide your child with emergency treatment. You must request a restriction in writing. In your request, tell us (1) what information you want to limit; (2) whether you want to limit how we use or disclose your information, or both; and (3) to whom you want the restrictions to apply.

Right to Request Confidential Communications. You have the right to request that we communicate with you regarding your child's information in an alternative manner or at an alternative location if you believe that a normal disclosure of all or part of your child's PHI may endanger your child. Your request to receive confidential communications must be made in writing. Your request must clearly state that all or part of the communication from us could endanger your child. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Request an Amendment. If you believe that your child's PHI is incorrect or incomplete, you may request that we amend the information. Request the amendment in writing, and include the reason you are seeking a change. In certain cases, we may deny your request for an amendment. For example, we may deny your request if the information you want to amend was not created by us, or you ask to amend a record that is already complete and accurate. If we deny your request to amend, we will notify you in writing. You then have the right to submit to us a written statement of disagreement with our decision and we have the right to rebut the statement.

Right to an Accounting of Disclosures Made. You have the right to request an accounting of disclosures of your child's PHI made for reasons other than treatment, payment or health care operations. The list will exclude disclosures we may have made to you or with your authorization, for the agency directory, to family members or friends involved in your child's care, or for certain other purposes. You may request an accounting by submitting your request in writing. Your request may be for disclosures that occur after April 14, 2003.

Right to a Paper Copy of this Notice. You have the right at any time to request a paper copy of this Notice, even if you have previously agreed to receive an electronically copy.

Contact Information for Exercising Your Rights. To fulfill any of the above requests, please send a written request including the description of your request to: Sunny Hills Services, Privacy Officer, 300 Sunny Hills Drive, San Anselmo, CA 94960.

Changes to This Notice
We reserve the right to change the terms of this notice at any time, effective for PHI that we already have about your child as well as any information that we receive in the future. We will provide you with a copy of the new Notice whenever we make a material change to the privacy practices described in this Notice. The notice will show the effective date on the first page, under "Effective Date". Each time your child is registered or admitted to the agency for treatment we will offer a copy of the current notice in effect.

Complaints
If you believe that your child's privacy rights have been violated, you may file a complaint with us and/or with the Secretary of Health and Human Services. Please submit your complaint in writing to Sunny Hills Services, Privacy Officer, 300 Sunny Hills Drive, San Anselmo, CA 94960.

We support your right to protect the privacy of your child's PHI. We will not penalize or in any way retaliate against you for filing a complaint.