NOTICE OF PRIVACY PRACTICES

Renaissance Community Homes Inc. & Renaissance House Inc

Effective Date: amended on September 20, 2006

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

This Notice tells you about your rights about your health care records. You get a copy of this Privacy Notice to keep for yourself. You can look at this copy any time to see what use is made of your health care records and who gets to see them. A new government rule requires that we give you this Privacy Notice, and that you sign a form that says we gave it to you.

This Privacy Notice is in six parts:

1.  What your health care records are, and our policy about protecting the privacy of those records.

2.   Who can see them without your written permission.

3.   Who can not see them unless you give a written OK.

4.   Your Rights about your health care records.

5.   Our duties about your health care records.

6.   Your right to complain if you think your privacy rights were violated.

1. Your health care records and our policy

Your records include your name, address, Social Security and other numbers like case numbers and insurance numbers. They also have information that tells about your condition now and in the past, and what treatment, services and tests you have had and what decisions doctors, clinicians, our staff and others have made. Our records include the Person Centered Plan developed with you in planning how we will help you reach your goals. We also keep records of what treatment or assistance we give you. Our policy has always been to keep your records safe. Your records are usually kept in a folder or notebook of papers with your name on it. Your records can also be stored in a computer.

2. Who can see your records without your written permission

We may use or share your health care records without your written permission for these

purposes:

For treatment or services we provide to you, for payment for those services, or for other

health business operations These are some examples of what that includes:

>    To write down what services or assistance we give you;

>    To coordinate our services with others who treat you;

>   To tell you about treatment alternatives;

>    To remind you of appointments;

>    To evaluate your care;

>    To arrange payment for your treatment or services given;

>    To have business associates, such as quality improvement inspectors, do their job.  For your personal reasons These are some examples of what that includes:

>          To communicate with your family;

>          To notify people who need to know how you are doing or what you need;

>          To be listed in a directory of people we serve;

>          For workers compensation if you are eligible;

>          To get an interpreter for you;

>          To notify a funeral director

For other reasons that might improve health or the way health care is given to you or to others   These are some examples of what that includes:

>    Authorized research projects;

>    Public health services, such as knowing when diseases are spreading;

>    Federal Food and Drug Administration activities, such as keeping track of how people taking a certain drug are feeling.

Other special uses These are some examples of what that includes:

>   Law enforcement requests;

>    Correctional institution requests;

>    Military service or national security requests;

>   Helping in an investigation or audit.

3. Who can not see your records without your written permission

We will not use or share your health information without your written permission except for the purposes described above. If you give your written permission to share information with any other person or agency and then change your mind, we will stop sharing with that person or agency as soon as you tell us in writing.

4. Your Rights

You have the right to confidential communications. If you want us to communicate medical information with you at some place different from where we would normally send it, tell us in writing where you want us to send the information. We will not ask you why you want confidential communication.

You have a right to see your records and to get a copy. With very few limited exceptions, such as psychotherapy notes, you may see or have a copy of your records. To do so, put your request in writing and give or send it to:  

Privacy Officer
Renaissance Community Homes Inc.
P.O. Box 16625 E. Main

Your request should say what information you want to see or copy. If you request a copy, we may charge a fee for the costs of copying and mailing. We will act on your request within 30 days, or we will tell you if we need more time. We may take up to 60 more days, but we will always tell you in writing why we need more time. We may deny your request if the information contains psychotherapy notes or is information prepared or collected by us in preparation for or for use in a civil or criminal or administrative action. If we deny your request, we will inform you why, and we will tell you how you can have our denial reviewed and we will tell you how to complain. If you request a review of our denial, we will arrange a review by a licensed health care professional of our choosing who was not directly involved in our decision to deny your request. We will comply with the results of that review.

You have the right to ask us to restrict others from seeing your record. For example, you may ask us not to share your information with a brother or sister. You may make that request in writing to our Privacy Officer:

Privacy Officer, Renaissance Community Homes Inc.,

You have the right to ask us to amend your record. If you think the information in your record that we keep is wrong or is not complete, you can ask that additional information be included to tell about what is wrong or what is missing. You must ask for that amendment in writing, telling us what information should be included and the reason it should be included. Give or send the request to our Privacy Officer:

Privacy Officer, Renaissance Community Homes Inc.,

We may deny your request. If so, we will inform you of the reason for the denial. The reason might be that what you requested is not part of the medical records we maintain, or that what your requested is not accurate or complete, or if your request was not in writing or was not complete, or for other similar reasons. If we deny your request, we will tell you why we are denying it. You have the right to submit a statement disagreeing with us. Your statement may not be longer than 2 pages. We may prepare a response to your statement. All of that information will then be added to your record. All of the information may also be shared with others in the future who receive your record. You also have the right to complain about our denial of your request.

You have the right to know who we have shared your record with. We will keep a record of anyone we have shared your record with. The record will not include those we do not need your permission to share it with. You may request a copy of these disclosures by making a written request to our Privacy Officer: Privacy Officer: Privacy Officer, Renaissance Community Homes Inc., P.O. Box 166, 25 E. Main, Milan, MI  48160.  We may charge you a fee for copying and mailing if you ask us to mail it. We will respond within 60 days of your request. We will not keep records for more than six years, and we will not begin that record before April 14,2003.

You have a right to a copy of this Notice. You can have a copy of this notice any time you want, just by asking any staff member.

5. Our duties about your health records

We are required by law to maintain the privacy of medical information about you and to provide the people we serve with this Privacy Notice about our privacy practices. We are required to follow the practices described in this Notice. We may change our Privacy Practices at any time, and we will always give you a new Notice if we do that.

6. Complaint procedure

If you believe your privacy rights have been violated you may file a complaint with us, or with the federal government. The complaints must be in writing. We will not take action against you if you file a complaint.

To file a complaint with our Privacy Officer, write to:

Privacy Officer,Renaissance Community Homes Inc.
P.O. Box 166,
25 E. Main
Milan, MI  48160

Or to complain to the federal government's Department of Health and Human Services, your written complaint must contain the following information:

Your name, address, home and work telephone numbers and email address if you have one.

Name, address and phone number of the person or agency you believe violated your health information privacy rights.

Briefly describe what happened.   How, why, and when do you believe your health information privacy rights were violated, or the Privacy Rule was otherwise violated? Include any other relevant information.

Sign and date your letter.

Send it to:

Office for Civil Rights
U.S. Dept. of Health & Human Services