Notice of Privacy Practices

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

Effective Date: April 14, 2003

Revision Date: February 1, 2008

I. Who Will Comply With This Notice?
This notice will be followed by PHC of Utah, Inc. d/b/a Highland Ridge Hospital, a subsidiary of Pioneer Behavioral Health.

II. Our Commitment Regarding Your Confidential Health Information
In order to provide you with the highest quality of care and to comply with various laws, we maintain a record of the services you receive from us. Your record contains personal information regarding your health care and payment for your health care. We understand that your health information is personal, and we are fully committed to protecting and enforcing your privacy rights.

This notice outlines our obligations with regard to using or disclosing your confidential health information and describes your rights to access such information.

By law, we are required to ensure that your confidential health information remains private. We also are required to provide you with a copy of this notice and comply with the terms of the notice that is currently in effect.

III. How We May Use or Disclose Your Confidential Health Information

A. For Treatment
We may use or disclose your confidential health information to provide you with health care treatment or services. For example, physicians, physician’s assistants, therapists, counselors, nurses, or other clinical staff members will record information in your medical record to diagnose your condition and determine the best course of treatment for you. Those individuals will work to provide you with the highest quality of care. We also may provide other health care professionals or subsequent health care providers with a copy of your medical records to assist them in treating you after you leave our care.

B. For Payment
We may use or disclose your confidential health information so that we may bill for services rendered and collect payment from you, an insurance company, or a third party, such as Medicare or Medicaid or an employee assistance program. For example, we may send a bill to your health plan, such as a health insurer, which may include information that identifies you, your diagnosis, treatments received, and supplies utilized. We also may tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine your eligibility to receive the treatment.

C. For Health Care Operations
We may use or disclose your confidential health information for the operations of our health care businesses. For example, clinicians, risk management staff, and members of our quality assurance teams may use your health information to evaluate the care and outcomes you received, as well as to assess the competency of our caregivers. Our health care operations are aimed at continually improving the quality and effectiveness of the health care and services we provide.

D. For Appointment Reminders and Treatment Alternatives
We may contact you for appointment reminders or to tell you about possible treatment options, alternatives, health-related benefits, or other services that may be of interest to you.
E. To Prevent a Threat to Health, Safety, or Welfare
We may disclose your confidential health information to the appropriate authorities if, in our professional or clinical judgment, we believe you are the victim of abuse, neglect, domestic violence, or other crimes, or to avert a threat to the health and safety of you or others.

F. To Our Business Associates
We receive some services through contracts with third-party business associates. For example, we may utilize outside vendors to provide medical transcription or billing collection services. When we use such services, we may disclose your confidential health information to the business associates so that they can perform the functions on our behalf. To protect your privacy rights, we contractually require that the business associates appropriately safeguard your confidential information.

G. For Use in a Facility Directory or Census Report
We may use your name, location in our facility, and general condition for an internal directory, census report, or similar patient-listing purposes.

H. For Communications With Your Family or Caregivers
Unless you provide us with a written objection, we may, in our best professional judgment, disclose your confidential health information to a family member or caregiver, if such information is relevant to that person’s direct involvement in your care or payment for your care. Such disclosures may be made to your family member, legal guardian, another relative, personal friend, or any other individual you identify to us.

I. For Research Purposes
We may disclose your confidential health information to researchers when an institutional review board has approved their research. The institutional review board will have reviewed the research proposal and established protocols to ensure the privacy of your health information.

J. In Lawsuits and Legal Disputes
If you are involved in a lawsuit or other legal dispute, we may disclose your confidential health information in response to an order of a court or tribunal. We may also disclose your confidential health information in response to a subpoena, warrant, discovery request, or other similar legal process by someone else involved in the matter, though we will attempt to obtain your written authorization prior to doing so.

K. To Funeral Directors or Coroners
We may disclose your confidential health information to funeral directors or coroners, consistent with applicable laws, in order to enable them to carry out their duties, such as identifying a deceased individual or determining a cause of death.

L. To the Food and Drug Administration (FDA)
We may disclose your confidential health information to the FDA, if such disclosure is related to adverse effects or events with respect to food, drugs, supplements, products or product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

M. To Workers’ Compensation Agencies
We may disclose your confidential health information, consistent with applicable laws, when necessary to comply with laws relating to workers’ compensation or other similar employment-related programs established by law.

N. For Health Oversight Activities
We may disclose your confidential health information to health oversight agencies for authorized activities, which may include audits, investigations, and inspections related to our licensure, insurance, and accreditation status. These activities monitor compliance with government programs, contractual agreements, licensure and accreditation standards, and laws and regulations.

O. To the U.S. Department of Health and Human Services (DHHS)
We must disclose your confidential health information to DHHS upon request, as necessary to determine our compliance with the government’s standards and regulations.

P. For Matters of Public Health
We may disclose your confidential health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. Such cases may include disclosures necessary to prevent or control diseases, to report possible abuse or neglect, or to notify individuals of product defects and recalls.

Q. To Correctional Institutions
If you are an inmate of a correctional institution or are under the custody of a law enforcement agency, we may disclose your confidential health information to the institution when necessary for your health or the health and safety of others.

R. For Law Enforcement Purposes
We may disclose your confidential health information for law enforcement purposes, including in response to a court order, subpoena, warrant, or other similar legal process, to identify or locate a suspect, fugitive, material witness, to report criminal conduct at our facility, or to report an injury or death we believe might have been a result of criminal activity.

S. To Authorities for Military, National Security or Intelligence Purposes
We may disclose your confidential health information, if required, to military authorities or federal officials for authorized activities related to military, intelligence, counter-intelligence, or other national security matters.

T. Other Uses and Disclosures Not Described Above
For all other uses and disclosures, the facility will obtain your prior written authorization. You have the right to revoke such authorizations, pursuant to the terms found on the facility’s authorization form.

IV. Your Rights
With respect to your confidential health information, you have the following rights:

A. Right to Inspect and Copy
You have the right to inspect and have copied your confidential health information. To inspect and copy your confidential health information, you must submit your request in writing to the facility’s Medical Records Department. If you request a copy of the information, we may charge a reasonable cost-based fee for the copying and mailing per your request. Subject to applicable laws, we may deny your request to inspect and copy if, in our professional judgment, we determine that it would be detrimental to your care or otherwise harmful to you or others or if denial is permissible under other applicable laws.

B. Right to Request an Amendment
If you feel your confidential health information is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing to the facility’s Medical Records Department. In addition, you must provide a reason that supports your request for an amendment. We may deny your request for an amendment if it is not in writing, does not include a reason to support the request, if it would be detrimental for your care or otherwise harmful to you or others, or if the information is correct and complete. The facility’s clinical supervisor will review all such requests.

C. Right to Accounting of Disclosures
You have the right to request a list of accounting for disclosures of your confidential health information that we made. To request this accounting of disclosures, you must submit your request in writing to the facility’s Medical Records Department. Your request must state a specific time period for when the disclosures were made. We will provide you with the accounting in the manner you designate in writing, or notify you of the reasons why we are unable to provide such accounting. Please be aware that we will not provide an accounting of all disclosures that were made, such as those disclosures made (a) prior to April 14, 2003; (b) for treatment purposes; (c) for payment purposes; (d) for health care operations; (e) pursuant to your written authorization; or, (f) as part of the facility’s directory or census reports.

D. Right to Request Restrictions
You have the right to request a restriction or limitation on the way we use or disclose your confidential health information. Your request must be submitted in writing to the facility’s Medical Records Department, and it must state the specific information you want restricted and how you want the restriction to occur. We are not required to agree to your request for restrictions if it is not feasible for us to comply, if we believe it will negatively impact the care we provide you, or if the restriction will prevent us from providing emergency treatment. If we do agree, we will comply with your request. The facility’s clinical supervisor will review all such requests.

E. Right to Request Confidential Communications
You have the right to request that we provide confidential communications to you. You may ask us to share information with you in a manner or location of your choice. For example, you could request that we send your information to an address other than your home address or that all communications be made via mail. To request confidential communications, you must make your request in writing to the facility’s Medical Records Department. You do not need to provide reasons for your request, and we will attempt to accommodate all reasonable requests.

F. Right to Obtain a Paper Copy of This Notice
You have the right to obtain a paper copy of this notice at any time. To obtain a copy, please submit a written request to the facility’s Medical Records Department. Please be aware that this notice is available and posted at all of our facilities and on the facilities’ web sites.

V. Changes to This Notice
We reserve the right to modify the provisions of this notice and to make the new notice effective for all confidential health information we maintain prior to the effective date of the new notice. If we modify this notice, we will post the new notice in our facilities and on our facilities’ web sites.

VI. Questions or Complaints

NoticeofPrivacyPractices

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

Acadia Healthcare will be referred to in this Notice of Privacy Practices (“Notice”) as “Acadia”. This Notice is given to you by an Acadia Facility to describe the ways in which Acadia may use and disclose your medical information (called “protected health information” or “PHI”) and to notify you of your rights with respect to PHI in the possession of Acadia. Acadia protects the privacy of PHI, which also is protected from disclosure by state and federal law. In certain circumstances, pursuant to this Notice, patient authorization or applicable laws and regulations, PHI can be used by Acadia or disclosed to other parties. Below are categories describing these uses and disclosures, along with some examples to help you better understand each category.

Uses and Disclosures for Treatment, Payment, and Health Care Operations

Acadia may use or disclose your PHI for the purposes of treatment, payment and health care operations, described in more detail below, without obtaining written authorization from you.

FOR TREATMENT:

Acadia may use and disclose PHI in the course of providing, coordinating, or managing your medical treatment, including the disclosure of PHI for treatment activities at another healthcare facility. These types of uses and disclosures may take place between physicians, nurses, technicians, students, and other health care professionals who provide you health care services or are otherwise involved in your care. For example, if you are being treated by a primary care physician, that physician may need to use/disclose PHI to a specialist physician whom he or she consults regarding your condition, or to a nurse who is assisting in your care.

FOR PAYMENT:

Acadia may use and disclose PHI in order to collect payment for the health care services provided to you. For example, Acadia may need to give PHI to your health plan in order to be reimbursed for the services provided to you. Acadia may also disclose PHI to their business associates, such as billing companies, claims processing companies, and others that assist in processing health claims. Acadia may also disclose PHI to other health care providers and health plans for the payment activities of such providers or health plans.

FOR HEALTH CARE OPERATIONS:

Acadia may use and disclose PHI as part of their operations, including for quality assessment and improvement, such as evaluating the treatment and services you receive and the performance of our staff in caring for you. Other activities include hospital training, underwriting activities, compliance and risk management activities, planning and development, and management and administration. Acadia may disclose PHI to doctors, nurses, technicians, students, attorneys, consultants, accountants, and others for review and learning purposes. These disclosures help make sure that Acadia is complying with all applicable laws, and are continuing to provide health care to patients at a high level of quality. Acadia may also disclose PHI to other health care facilities plans for certain of their operations, including their quality assessment and improvement activities, credentialing and peer review activities, and health care fraud and abuse detection or compliance, provided that those other facilities and plans have, or have had in the past, a relationship with the patient who is the subject of the information.

FOR SHARING PHI AMONG ACADIA AND PROFESSIONAL STAFF:

Acadia works together with physicians and other care providers on their professional staff to provide medical services to you when you are a patient at an Acadia Facility. Acadia and members of their respective professional staff will share PHI with each other as needed to perform their treatment, payment and health care operations activities.

OTHER USES AND DISCLOSURES FOR WHICH AUTHORIZATION IS NOT REQUIRED:

In addition to using or disclosing PHI for treatment, payment and health care operations, Acadia may use and disclose PHI without your written authorization under the following circumstances:

AS REQUIRED BY LAW AND LAW ENFORCEMENT:

Acadia may use or disclose PHI when required by law, Acadia also may disclose PHI when ordered to in a judicial or administrative proceeding, in response to subpoenas or discovery requests, to identify or locate a suspect, fugitive, material witness, or missing person, when dealing with gunshot and other wounds, about criminal conduct, to report a crime, its location or victims, or the identify, description or location of a person who committed a crime, or for other law enforcement purposes.

FOR PUBLIC HEALTH ACTIVITIES AND PUBLIC HEALTH RISKS:

Acadia may disclose PHI to government officials in charge of collecting information about births and deaths, preventing and controlling disease, reports of child abuse or neglect and of other victims of abuse, neglect, or domestic violence, reactions to medications or product defects or problems, or to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.

FOR HEALTH OVERSIGHT ACTIVITIES:

Acadia may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws.

CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS:

Acadia may disclose PHI to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.

ORGAN, EYE, AND TISSUE DONATION:

Acadia may release PHI to organ procurement organizations to facilitate organ, eye, and tissue donation and transplantation.

RESEARCH:

Under certain circumstances, Acadia may use and disclose PHI for medical research purposes.

TO AVOID A SERIOUS THREAT TO HEALTH OR SAFETY:

Acadia may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.

TO AVOID A SERIOUS THREAT TO HEALTH OR SAFETY:

Acadia may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.

SPECIALIZED GOVERNMENT FUNCTIONS:

Acadia may use and disclose PHI of military personnel and veterans under certain circumstances, and may also disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of protective services to the President or other authorized persons or foreign heads of state or to conduct special investigations.

WORKERS’ COMPENSATION:

Acadia may disclose PHI to comply with workers’ compensation or other similar laws that provide benefits for work-related injuries or illnesses.

HEALTH-RELATED BENEFITS AND SERVICES; LIMITED MARKETING ACTIVITES:

Acadia may use and disclose PHI to inform you of treatment alternatives or other health-related benefits and services that may be of interest to you, such as disease management programs.

DISCLOSURES TO YOU OR FOR HIPAA COMPLIANCE INVESTIGATIONS:

Acadia may disclose your PHI to you or to your personal representative, and are required to do so in certain circumstances described below in connection with your rights of access to your PHI and to an accounting of certain disclosures of your PHI. Acadia must disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (the “Secretary”) when requested by the Secretary in order to investigate compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)

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Uses and Disclosures to Which You May Object

You may object to the following uses and disclosures of PHI that Acadia may make:

PATIENT DIRECTORIES:

Your information may be included in a patient directory that is available only to those individuals whom you have identified as contacts during your hospital stay. You will receive a unique patient code that can be provided to these contacts.

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Other Uses and Disclosures of PHI for Which Authorization Is Required:

Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which you have the limited right to revoke in writing.

REGULATORY REQUIREMENTS:

Acadia is required by law to maintain the privacy of your PHI, to provide individuals with notice of their legal duties and privacy practices with respect to PHI, and to abide by the terms described in this Notice. Acadia reserves the right to change the terms of this Notice and of its privacy policies, and to make the new terms applicable to all of the PHI it maintains. Before Acadia makes an important change to its privacy policies, they will promptly revise this Notice and post a new Notice in registration and admitting areas. You have the following rights regarding your PHI:

You may request the Acadia restrict the use and disclosure of your PHI.

Acadia is not required to agree to any restrictions you request, but if the entity does so it will be bound by the restrictions to which it agrees except in emergency situations.

You have the right to request that communications of PHI to you from Acadia be made by particular means or at particular locations.

For instance, you might request that communications be made at your work address, or by e-mail rather than regular mail. Your requests must be in writing and sent to the Privacy Officer. Acadia will accommodate your reasonable requests without requiring you to provide a reason.

Generally, you have the right to inspect and copy your PHI in the possession of Acadia if you make a request in writing to the applicable Acadia Hospital’s Medical Records Department.

Within thirty (30) days of receiving your request (unless extended by an additional thirty (30) days), Acadia will inform you of the extent to which your request has or has not been granted. In some cases, Acadia may provide you a summary of the PHI you request if you agree in advance to such a summary and any associated fees. If you request copies of your PHI or agree to a summary of your PHI, Acadia may impose a reasonable fee to cover copying, postage, and related costs. If Acadia denies access to your PHI, it will explain the basis for denial and your opportunity to have the denial reviewed by a licensed health care professional (not involved in the initial denial decision) designated as a reviewing official. If Acadia does not maintain the PHI you request, if it knows where that PHI is located it will tell you how to redirect your request.

If you believe that your PHI maintained by Acadia contains an error or needs to be updated, you have the right to request that the entity correct or supplement your PHI.

Your request must be made in writing to the local Medical Records Department and it must explain why you are requesting an amendment to your PHI. Within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Acadia will inform you of the extent to which your request has or has not been granted. Acadia generally can deny your request if your request relates to PHI: (i) not created by Acadia; (ii) that is not part of the records Acadia maintains; (iii) that is not subject to being inspected by you; or (iv) that is accurate and complete. If your request is denied, Acadia will give you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) submit a request that any future disclosures of the relevant PHI be made with a copy of your request and Acadia’s denial attached, if you do not file a statement of disagreement; and (iii) complain about the denial.

You generally have the right to request and receive a list of disclosures of your PHI Acadia has made during the six (6) years prior to your request (but not before April 14, 2003).

The list will not include disclosures (i) for which you have provided a written authorization; (ii) for treatment, payment, and health care operations; (iii) made to you; (iv) for an Acadia patient directory or to persons involved in your health care; (v) for national security or intelligence purposes; (vi) to correctional institutions or law enforcement officials; or (vii) of a limited data set. You should submit any such request to the Privacy Officer, and within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Acadia will respond to you regarding the status of your request. The entity will provide the list to you at not charge, but if you make more than one request in a year you will be charged $25.00 for each additional request.

You have the right to receive a paper copy of this notice upon request even if you have agreed to receive this notice electronically.

You can view a copy of this notice on Acadia’s website, www.acadiahealthcare.com. To obtain a paper copy of this notice, please contact the Privacy Officer.

You may complain to Acadia if you believe your privacy rights with respect to your PHI have been violated by contacting Acadia’s Privacy Officer and submitting a written complaint. Acadia will not penalize you or retaliate against you for filing a complaint regarding their privacy practices. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Avenue, S.E., Washington, DC 20201.

If you have any questions about this notice, please contact Acadia Healthcare’s Compliance Hotline toll-free 866-544-9713, or email to corporatecompliance@acadiahealthcare.com or write to 830 Crescent Centre Dr. Suite 610, Franklin, TN 37067