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.

PRIVACY AND YOU
Your health information is personal and private. Seniors•At•Home, a program of Jewish Family and Children's Services ("JFCS"), is required by law to protect the privacy of the health information we have about you. We are also required by law to provide you with this Notice of our legal duties and tell you how we may use and give out ("disclose") your health information.

JFCS must follow the terms of this Notice. We have the right to make a change in our privacy practices and apply it to all personal health information we have. Before we make any important changes, however, we will revise this Notice and promptly send it to you. We will also post the revised Notice on our Web site.

HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
In general, information disclosed by you to JFCS is confidential and will not be released to an outside agency or individual without your permission or consent (known as authorization). There are, however, specific situations in which JFCS needs to use or share your health information for purposes of treatment, payment, and health care operations. In these situations, the privacy rules allow us to do so without your permission. JFCS generally will not use or give out any more of your health information than is necessary. Here are some examples of how we may use and share your health information:

• Treatment includes providing, coordinating, or managing your health care needs. Treatment can also include consultation and referrals between providers. For example, if JFCS is providing homecare services to you and our nurse needs to talk with your physician, JFCS can disclose your physical health information to coordinate your care. But, if JFCS is providing mental health services to you, your JFCS health care provider cannot disclose your mental health information, such as to an outside psychiatrist, without your written authorization.
• Payment includes activities by JFCS, other plans or providers to obtain or provide payment for the health care services you received. For example, JFCS can disclose your health information to your insurance company to get paid for health care services that we have provided.
• Health care operations include activities by JFCS to evaluate and improve the quality of our health care services. For example, JFCS may use your health information to evaluate the performance of the health care provider who provided services to you.

JFCS may also disclose your health information without your permission in certain other situations. For example, there are situations in which JFCS staff and volunteers are required by state law to disclose client information, specifically to report suspected elder and child abuse or neglect and homicidal threats against others or suicidal intentions. These situations are described more fully in the section below. In addition, information disclosing your location, general condition, or death may be given to a family member, close friend, or other person you identify who is involved in your care or is paying for your health care treatment. You will, however, generally be given a chance to object (although exceptions may be made if you're incapacitated). JFCS may also contact you to provide appointment reminders or for fundraising purposes. JFCS is a community-based, not for profit social service agency that depends extensively on charitable support. We may use limited information about you such as your name, address and demographic information to inform you of opportunities to support JFCS and its services and programs.

OTHER USES FOR YOUR INFORMATION
JFCS is allowed to use or disclose your health information without your permission for the following activities:

• To federal, state or local agencies or law enforcement when required by law, such as to report information about victims of abuse or neglect or homicidal threats (see above).
• For public health activities, such as providing information to the county coroner.
• For government health care oversight activities, such as providing information as part of a government investigation of a health care provider.
• For judicial and administrative proceedings, such as in response to a court order.
• For research studies that meet all privacy law requirements.
• To avoid a serious and imminent threat to health or safety.
• To comply with workers' compensation laws.
• To comply with government laws regulating disclosures about individuals who are members of the military, disclosures for national security purposes, and disclosures to correctional institutions about inmates.
• To the Department of Health and Human Services (HHS) to determine JFCS' compliance with the privacy law.

WHEN WRITTEN PERMISSION IS NEEDED
The ways in which JFCS may use or share your health information without your permission are limited. If JFCS ever wants to use or give out your health information for any purpose not listed above, we will get a written authorization from you. If you give us a written authorization to use or share your health information for other purposes, you may take back ("revoke") your authorization in writing at any time. However, you can't revoke your authorization if we have already acted based on your permission.

YOUR PRIVACY RIGHTS

• By law, you have the following rights:
  
• You have a right to ask JFCS not to use or share your health information in the ways described above. If you want to exercise this right, you must ask us in writing. We will do our best, but may not be able to agree to your request.
• You have the right to ask JFCS to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. box instead of your home).
• You have the right to look at and get a copy of your personal health information. However, you do not have a right to inspect or receive copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings.
• You have a right to ask that the information in your records be changed if you believe that it is incorrect or that information is missing, and we agree. If we disagree, you may have a statement of your disagreement added to your health information.
• When we share your health information for reasons other than treatment, payment, or health care operations, you have the right to request a list of with whom we shared your information, when, for what reasons, and what information was shared.
• You have a right to request a paper copy of this Notice.

COMPLAINTS
If you believe your privacy rights have been violated, you may complain to JFCS by calling or writing:
Gayle Zahler, Associate Executive Director
Jewish Family and Children's Services
2150 Post Street
San Francisco, CA 94115
(415) 449-1200
gaylez@jfcs.org

We will review your claim and take corrective action as needed. You also have the right to file a complaint with the Department of Health and Human Services (HHS) within 180 days of your discovery of the incident leading to your complaint. You can contact HHS by calling or writing:

Secretary of the U.S. Department of Health and Human Services
Office for Civil Rights
Attention: Regional Manager
50 United Nations Plaza, Room 322
San Francisco, CA 94102
(866-627-7748) or (866-788-4989 TTY)

You will not be retaliated against for filing a complaint.

QUESTIONS
If you have any questions about this Notice and want further information, please contact Gayle Zahler, Associate Executive Director, Jewish Family and Children's Services, 415-449-1200.