By law, Rochester Rehabilitation Center is required to protect the privacy of your personal medical information. We are also required to give you this notice to tell you how we may use and give out ("disclose") your personal medical information.

With your consent, we may use health information about you for:

• treatment (such as sending your medical record information to a specialist physician as part of a referral),
• to obtain payment for treatment (such as sending billing information to a health insurance plan), or administrative purposes, and
• to evaluate the quality of care that you receive (such as comparing client data to improve treatment methods.)

Subject to certain requirements, we may use or disclose identifiable health information about you without your permission ("authorization") for several other reasons:

• for public health purposes, or abuse or neglect reporting,
• auditing purposes,
• research studies,
• funeral arrangements and organ donation,
• workers' compensation purposes and emergencies
• when otherwise required by law, such as law enforcement

We may also contact you about appointment reminders or treatment alternatives or to raise funds. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later take back ("revoke") that authorization to stop any future uses or disclosures.

We may change our policies at any time. Before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area and on our Web site. You can also request a copy of our notice at any time. For more information about our privacy practices, contact the Privacy Officer listed below.

In most cases, you have the right to look at or get a copy of health information about you that we use to make decisions about the services that you receive. If you request copies, we will charge you ___cents per page. You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or healthcare operations.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

You have the right to request that your health information be communicated to you in a confidential manner, such as sending mail to an address other than your home. If this notice was sent to you electronically, you may obtain a paper copy of the notice.

You may request in writing that we not use or disclose your information for treatment, payment, or healthcare operations, or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider all of the above-mentioned requests, but are not legally required to accept them.

If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the Privacy Officer below. You may also send a written complaint to the U.S. Department of Health and Human Services. The Privacy Officer can provide you with the appropriate address upon request. Under no circumstance will you be retaliated against for filing a complaint.

We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice.

If you have any questions or complaints, contact: