PLEASE REVIEW CAREFULLY. This notice details the privacy practices of Heritage Case Management (HCM), including how health information about you may be used and disclosed and how you can get this information.

Purpose of this Notice
Heritage Case Management has always maintained the privacy of your personal information. The law now requires that we maintain the privacy of your personal information and that we give you this notice detailing our privacy practices, legal duties and your rights concerning your private health information. HCM is required to follow the practices described in this Notice as long as this Notice is in effect. This Notice will take effect on April 14, 2003 and will remain in effect until it is replaced. HCM reserves the right to revise or change this Notice at any time. If there is a significant change in HCM’s privacy practices you will receive a copy of that change. A copy of the current notice is available on this, the HCM website, www.heritagecasemgt.com. You may request additional copies of this Notice at any time.

If you have any questions regarding this Notice, please contact our HIPPA Privacy Officer, Ilene A. Peace at the telephone number or address listed below.

Uses and Disclosures of Your Health Information
HCM uses and discloses your personal health information for purposes of treatment/ services, payments and case management operations and requires your written authorization to do so. You may revoke any such authorization at any time.

For example:

Services: HCM may use or disclose your personal health information to a physician or other healthcare provider, which is providing treatment / services to you.

Payment: Your medical information may be used or disclosed to determine and remit proper payment for covered services.

Case Management Operations: HCM may use or disclose your personal health information in connection with the administration of your Plan of Support, including such operations as professional review, coordination of services, audit services and other administration activities.

Disclosures Required by Law: HCM may use or disclose your health information when it is required to do so by law.

Other Disclosures: HCM does not use or disclose your personal health information for marketing purposes nor does it sell your information for any purpose.

Your Rights Regarding Health Information About You
You have the following rights regarding the personal health information we maintain about you:

Right to Inspect and Copy: You have the right inspect and copy your health information which HCM maintains.

Right to Amend: If you feel your health information maintained by HCM is incorrect or incomplete, you may ask to amend the information by contacting the HCM HIPPA Privacy Officer. Your request may be denied if it does not include a reason to support the request.

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures" if any such disclosure was made for any purpose other than treatment/services, payment or case management operations. You must submit this request in writing to the HCM HIPPA Privacy Officer.

Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment/services, payment or case management services. This request must be submitted in writing to the HCM HIPPA Privacy Officer.

Right to Request Confidential Communications: You have the right to request that we communicate with you concerning your health information only in certain ways or at certain locations. You must submit this in writing to the HCM HIPPA Privacy Officer.

Complaint Procedure
If you believe your privacy rights have been violated by HCM, please file a written complaint to:

Ilene A. Peace, HIPAA Privacy Officer
Heritage Case Management
4 Chenell Drive, Suite 101
Concord, NH 03301

or with the Secretary of the Department of Health and Human Services.
You will not be penalized or retaliated against for filing a complaint.