THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY. Your health information is contained in a medical record that is the physical property and responsibility of Diversified Family Services.

Diversified Family Services (dFs) reserves the right to change the terms of this Notice, our privacy practices, and to make the new provisions effective for all protected health information we maintain. You may contact our office at the address or phone number above to obtain a revised Notice of Privacy Practices.

Uses and Disclosures of Your Health Information
Treatment. In order to provide service to you we collect information about you from: you or your authorized representative, your supports coordinator or caseworker, and other members of your treatment team. This information is gathered on intake or other forms, in interviews, in service plan meetings and by phone conversations. Also information related to your treatment may be obtained from a health care provider, such as a doctor, pharmacist, nurse, dentist or other person providing services to you, and will be recorded in your medical record. This information is necessary to provide proper assessment and services.
Individuals Involved in Your Care. At admission you will be asked which family member(s) or advocates are involved in your care. If you do not specifically inform us of individuals who are to be excluded from involvement in your care, we will assume that we have your permission to release health information to them. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort (such as the Red Cross) so that your family can be notified about your condition, status and location.
Payment. We may use and disclose health or other protected information about you to others for purposes of receiving payment for the treatment & services you receive. The information on the bill may include information which identifies you and the treatment or services provided to you.
Operations. We may use and disclose information about you for administrative and operational purposes. Members of risk management or quality improvement teams may use information about you to assess the care and outcomes for services you receive. We may also use and disclose medical information to evaluate the performance of our staff and your satisfaction with our services. This information is used internally to monitor and improve the services we provide. We may also share information with licensing and accreditation bodies which review client records as part of their review processes like the Office of Mental Retardation and Office of Children and Youth.
Appointment Reminders. We may use health information about you to provide appointment or prescription reminders.
Organized Health Care Arrangement. We participate in an organized health care arrangement with Omnicare and its affiliate NCS for the provision of pharmacy services to our clients.
Business Associates. We provide some service through contracts with business associates such as consultants, attorneys and accountants. When such services are contracted, we may disclose information about you to our business associates so that they can perform the tasks which we have assigned to them. To protect your health information, we require the business associate to appropriately safeguard health information about you.
Required by Law. We may use and disclose health information about you as required by federal, state or local law. For example we may disclose information to public health authorities or other legal authorities to prevent or control disease, injury or disability or for other health oversight activities. We may use or disclose health information about you to avert a serious threat to your health or safety or any other person pursuant to applicable law. We may use or disclose health information about you to medical examiners, coroners, or funeral directors to allow them to perform their lawful duties. We may use or disclose health information for purposes of notifying the FDA of adverse events with respect to food, products, or to enable product recalls. We may use or disclose information about you to comply with laws and regulations related to workers compensation.
Information Not Personally Identifiable. We may use or disclose health information about you in ways that do not personally identify you or reveal who you are.
Future Communications. We may communicate with you via newsletters or mailings regarding activities in which we are participating.
Fund Raising. We may communicate with you via newsletters or mailings regarding fund raising activities for which we are engaging to benefit our own or other nonprofit entities.

Your Health Information Rights – You have the following rights with respect to health information about you:
Right to a Copy of Notice of Privacy Practices. You have a right to a paper copy of our Notice at any time. To obtain a copy of our current Notice, please contact the office.
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health information. Your request must be in writing. Please be aware that we are not required to agree to your request for restrictions. For more information about this right request dFs Policy & Procedure (P&P), Client’s Rights to Request Restriction, Uses, and Disclosure of Protected Health Information.
Right to Inspect and Copy. You have the right to inspect and/or obtain a copy of health information that we maintain in certain groups of records that are used to make decisions about your treatment. Your request must be in writing. If you request a copy of your health information, we will charge you a fee to cover the costs of copying and mailing the information. In certain very limited circumstances, we may deny your request. If you are denied access to your health information, we will explain our reasons in writing. For more information about this right request dFs P&P, Client’s Right of Access to Protected Health Information.
Right to Amend. If you feel that health information about you that we maintain in certain groups of records is inaccurate or incomplete you have the right to request that we amend the information. For more about this right request dFs P&P, Client’s Right to Request Correction / Amendment of Protected Health Information.
Right to Request Alternative Method of Contact. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Your request must be in writing. We will agree to the extent that it is reasonable for us to do so. For more about this right request dFs P&P, Client’s Rights to Request Restriction, Uses and Disclosure of Protected Health Information.
Right to Revoke Authorization. You have the right to revoke your authorization to use or disclose health information, except to the extent that action has already been taken in reliance upon your authorization. Your request must be in writing.
Right to an Accounting of Disclosures. You have the right to request an accounting or listing of certain disclosures of your health information. The time period covered by the accounting is limited. Your request must be in writing. For more about this right request dFs P&P, Release of Medical Information and dFs P&P Client’s Right to Accounting of Uses and Disclosures of Protected Health Information.

Complaints. If you think your privacy rights have been violated, you may complain to dFs and to the Department of Health and Human Services. You may make a complaint to us by contacting the dFs Privacy Officer at the address or phone listed in the letterhead.

Our Duties dFs is required to:
• maintain the privacy of protected health information
• provide you with this Notice of our legal duties and privacy practices with respect to your health information
• abide by the terms of the Notice currently in effect
• obtain your written authorization to use or disclose your health information for reasons other than those identified in this Notice
• comply with Pennsylvania laws if they provide greater rights over your health information or for more restrictions than herein described
• for judicial or administrative proceedings pursuant to legal authority
• to report information related to victims of abuse, neglect, or domestic violence
• to assist law enforcement officials in their law enforcement duties

Contact Information
If you have any questions, requests, or concerns about your dFs health information rights or our uses and disclosures of information please contact: Privacy Officer adavidsons@diversifiedfamily.org or Andrea Davidson at 724-346-2123.