This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information", or PHI, is information kept by Monadnock Family Services (MFS) about your mental health condition and the services you receive. If you are the parent or guardian of a minor child in treatment, all of the information in this notice pertains to PHI regarding that child. Most but not all services within MFS gather, create or maintain such information about you. We must abide by the terms of this notice. We may change the terms of our notice at any time. Any new notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices or you may see it on our website at www.mfs.org.

In most instances when we need to share PHI with a third party we will seek your written permission. There are times when MFS is permitted or required by law to use and disclose your health information without specific consent from you, as described in each category listed below. For each category, we will explain what we mean in general and give you an example of what might happen.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your mental health care and any related services among your MFS providers. This includes sharing information with a third party that has already obtained your permission to have access to your PHI. In addition, we may disclose your health information from time-to-time to a specialist, pharmacy, laboratory, or other provider who is assisting the MFS treatment team in your care.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may require before it will pay for the services we recommend for you. For example, obtaining approval for a hospital stay may require that PHI about your mental health condition be disclosed to your health plan to obtain approval for the hospital admission.

Healthcare Operations: We may use your health information to evaluate and manage your services. These activities include, but are not limited to, quality assessment activities, scheduling, employee evaluation, training of graduate students, and government licensing and approval. For example, we may call you by name in the waiting room when your provider is ready to see you. We may disclose your PHI, as necessary, to contact you to remind you of your appointment. We will share your health information with other "business associates" that perform other professional services for MFS (e.g. legal or accounting services). We have written agreements with those other professionals that will protect the privacy of your mental health information. We may use some of your personal information to send you surveys to ask your opinions about the quality of our services. If you do not want to receive the surveys, please contact our Privacy Officer and ask that they not be sent to you. We may use your PHI in an approved research project, but, generally, only with consent from you will we provide a researcher with information that can identify who you are.

As Required By Law: We may disclose your mental health information if we are required to do so by law. The use or disclosure will be limited to that information which is required to comply with the law. You will be notified, as required by law, of any such disclosures.

Your family or other persons with whom you live: We may disclose information to a family member or other person you live with or who provides you with direct care, as it relates to that person’s involvement in your care.

Emergencies: We may disclose your health information to public safety or medical personnel in a medical emergency or to an authorized public or private entity to assist in disaster relief efforts and to coordinate disclosures to family or other individuals involved in your care.

Public Health: We may disclose your health information to a public health authority for the purpose of controlling disease.

Communicable Diseases: We may disclose your health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.

Abuse or Neglect: We may disclose your health information to the authority that is authorized by law to receive reports of child abuse or neglect or adult abuse or neglect consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems.

Legal Proceedings: We may disclose health information in the course of any judicial or administrative proceeding, in response to a court order, or other lawful process.

Law Enforcement: We may disclose health information to law enforcement officials as required by law. This may include, for example, information pertaining to victims of a crime, certain types of injuries or activities, or if a crime occurs on MFS premises.

Coroners, Medical Examiner: We may disclose protected health information to a Medical Examiner in determining the cause or manner of death.

Criminal Activity: As required or permitted by law, we may disclose your health information to law enforcement in connection with a serious threat of violence, substantial damage to real property, drug seeking activity, gunshot wounds and other criminal conduct.

Military Activity and National Security: When the appropriate conditions apply, we may use or disclose health information of individuals who are in the Armed Forces, veterans or members of a foreign military service. We may also disclose your information to authorized federal officials conducting national security and intelligence activities, including for the provision of protective services to the President .

Workers’ Compensation: Your PHI may be disclosed if you apply for worker’s compensation benefits.

Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility as required and permitted by law.

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. You may ask to see or to obtain a copy of your health information that is included in certain records that MFS maintains. We may deny your request in certain limited circumstances. If you request copies, we may charge you to copy and mail the records.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose your health information in the ways that we normally do. While we will consider all such requests, we are not required to agree to a requested restriction. With this in mind, please discuss any restriction you wish to request with your provider.

You have the right to request special communication You may ask to receive communications of confidential information from MFS in a certain way. For example, you can ask that we only contact you at work, or by mail. While we will consider all such requests, we are not required to agree to a requested restriction.

You may ask to amend your protected health information. This means you may request that we add information to your medical record if you feel that information we have about you is wrong or not complete. If we deny your request, you have the right appeal that decision.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice. The right to receive this information is subject to certain exceptions, restrictions and limitations. You are entitled to get this list for free once in a 12 month period. For additional lists, you will be charged

You have the right to obtain a paper copy of this notice from us, upon request.

If you wish to make any of the requests listed above under "Your Rights", you must send your request in writing or call the Privacy Officer c/o Monadnock Family Services Quality Assurance Office, 64 Main Street, Keene, NH 03431. The phone number is (603) 357-6878.

You may ask questions or complain to MFS or to the Secretary of Health and Human Services if you believe we have violated your privacy rights. You may file a complaint with us by notifying our privacy officer of your complaint. We will not take action against you for filing a complaint.

You may contact our Privacy Officer at (603) 357-6878 or by mail c/o Monadnock Family Services Quality Assurance Office, 64 Main Street, Keene, NH 03431 for further information about the complaint process.