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Notice of Privacy Practices

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.

Who We Are:

This Notice describes the privacy practices of The Antioch Group Inc. and our clinicians, support staff, interns, volunteers, and other subcontracted personnel. It also applies to all business associates with whom we may share information.

We understand that your health care information is confidential, and we are committed to maintaining its privacy. Federal law requires that we provide you with this Notice of our legal duties and privacy practices with respect to your health care information. We are required to abide by the terms of this Notice when we use or disclose your health care information.

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

The Antioch Group may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your written authorization. To help clarify the terms in this Notice, below are definitions:

II. Other Uses and Disclosures Requiring Authorization

The Antioch Group may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when information is requested from your clinician for purposes outside of treatment, payment, or health care operations, he or she will obtain an authorization from you before releasing this information. Your clinician will also need to obtain an authorization before releasing his or her Clinical Therapy Notes made regarding conversation during your counseling session, kept separate from the rest of your record. These Clinical Therapy Notes are given a greater degreeof protection than PHI, based on the Illinois Mental Health and Developmental Disabilities Confidentiality Act.

You may revoke all authorizations of PHI or Clinical Therapy Notes at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that, (1) your clinician has relied on that authorization; or (2) the authorization was obtained as a condition of obtaining insurance coverage, as law provides insurers the right to contest claims under the policy.

III. Uses and Disclosures without Authorization

The Antioch Group may use or disclose PHI without your consent or authorization in the following circumstances:

IV. Patient’s Rights and The Antioch Group’s Duties

Patient’s rights:

The Antioch Group’s duties:

V. Questions and Complaints

If you have questions about this notice, disagree with a decision your clinician makes about access to your records, or have other concerns about your privacy rights, you may contact:

Steven A. Hamon, Ph.D.
The Antioch Group Inc.
6615 N. Big Hollow Rd.
Peoria, IL 61615
(309) 692-6622
office@antiochgroup.com

If you believe that your privacy rights have been violated and wish to file a complaint with The Antioch Group, you may send your written complaint to our Privacy Officer, above.

In both cases above, you also may send a written complaint to the U.S. Department of Health and Human Services. Our Privacy Officer can provide you with the appropriate address upon request.

You have specific rights under the Privacy Rule. The Antioch Group will not retaliate against you for exercising your right to file a complaint.

VI. Effective Date, Restrictions, and Changes to Privacy Policy

The Antioch Group reserves the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect.

The effective date of the original Notice is April 14, 2003. This revised Notice becomes effective on August 1, 2007.