THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Who We Are
The services offered by the Employee Assistance Program (EAP) are provided by the staff of A.T.A.P. and a contracted network of consultants and their staffs, herein after referred to as “A.T.A.P.” This Notice describes the practices of all the entities and individuals who comprise A.T.A.P.

Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), also requires us to give you this Notice about our legal duties, our privacy practices, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. If we change our privacy practices, a revised Notice will be posted on our web site.

You may request a paper copy of this Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please call the number listed at the end of this Notice.

Understanding Your Protected Health Information/EAP Record
Each time you visit A.T.A.P., you may be reporting information about you and your physical and mental health. Typically, this is information about your past and/or present health or conditions and the counseling services provided to you by EAP or other treatment providers. Any health information we collect that could identify you is considered, in the law, Protected Health Information, or PHI. For EAP services, PHI usually consists of the reasons you contacted EAP, an assessment of your current situation and problems, a plan of action, and notes about contacts we have with you and/or treatment referrals we suggest, as well as how you are progressing toward problem resolution.

Uses and Disclosures of PHI by EAP
The law gives you the right to know about your PHI, specifically about how it is used and disclosed. When your PHI is read by persons in A.T.A.P., that is called, in the law, “use.” If this information is shared with, or released to persons outside of A.T.A.P., that is called, in the law, “disclosure.”

Uses with Your Consent
Prior to receiving services, you will be asked to sign a separate form, called a Statement of Understanding. One purpose of this form is to collect and use your PHI within A.T.A.P. EAP counseling services, defined below. We need information about you in order to provide you with proper care and services. Therefore, you must sign the consent form before we can provide EAP services to you.

The PHI that A.T.A.P. collects is used for:

Counseling – We may use your PHI to provide EAP assessment, counseling and referral services to you. For example, information that you provide over the phone when you call the EAP will be shared with the EAP Consultant with whom you meet. All of the information about the EAP services
provided to you is maintained in your individual EAP record.

Operations – We may use your PHI to review operations and general administrative activities of A.T.A.P. EAP, for quality improvement, case management, legal review, and grievance resolution related to client services.

Uses and Disclosures Not Requiring Consent or Authorization
The law allows us to use or disclose some of your PHI without your consent or authorization under certain conditions:

• Appointment reminders or changes in appointments: We may use/disclose your PHI to contact you as a reminder that you have an appointment. If you do not wish us to contact you for appointment reminders or changes in appointment times, please provide us with alternative instructions in writing.
• When disclosure is required by state, federal or local law: We may use/disclose your PHI when a law requires that we report information about suspected child or vulnerable adult, abuse or neglect, or in response to a court order. We must also disclose information to authorities that monitor compliance with these privacy requirements.
• To avoid harm: We may use or disclose limited PHI about you when necessary to prevent or lessen a serious threat to your health or safety, or the health and safety of the public or another person. If we reasonably believe you pose a serious threat of harm to yourself, we may contact family members or others who can help protect you. If you communicate a serious threat of bodily harm to another, we will be required to notify law enforcement and the potential victim.
• Judicial and administrative proceedings: We may disclose your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
• Law enforcement officials: We may disclose your PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or grand jury or administrative subpoena.

• Disclosures to relatives, close friends and other caregivers: We may use or disclose your PHI to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure and you do not object; or (3) reasonably infer that you do not object to the disclosure. If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information to a family member, other relative or a close personal friend, we would disclose only information that we believe is directly relevant to that person's involvement with your care.
• As required by law: We may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories.

Uses and Disclosures Requiring Your Authorization
If A.T.A.P. EAP needs to use or disclose your PHI for purposes other than those described above, we need your permission on a Release of Information form. If you give us authorization to disclose health information, you may revoke it in writing at any time; however, such revocation will not
affect information previously released.

Your Individual Rights
When PHI is disclosed, we keep records of: to whom the information was sent, when it was sent, what was sent, and the purpose for the disclosure. You have a right to receive an accounting of some of these disclosures, and may submit a written request of an accounting of such disclosures. Records are kept for a period of seven years.

You have the right to request in writing, restrictions on uses or disclosures of PHI; however, we are not required to agree to such a restriction. If we agree to a restriction, we will put this in writing, and will comply with the restriction unless the information is needed to provide emergency treatment to
you. We cannot agree to restrictions of disclosures that are permitted or required by law.

You have the right to look at, and get copies of, your EAP record, with limited exceptions, for as long as the record is maintained. You must submit your request in writing. We may deny access to EAP records under certain circumstances, but in some cases, you may have this decision reviewed. You have the right to request an amendment of your EAP record for as long as the record is maintained. Your request must explain why the information should be amended. Under certain circumstances, we may deny your request. Upon request, we will provide information about the procedures for record access and amendment.

For More Information or to Report a Problem
If you need more information or have questions or concerns about the privacy practices described above, please speak to your EAP Consultant or contact the EAP office. If you have a problem with how your PHI has been handled or if you believe your privacy rights have been violated, contact our
Clinical Director at the toll-free number above. You may also file a complaint in writing to the Secretary of the U.S. Department of Health and Human Services. Upon request, we will provide you with the address to file your complaint.

We support your right to the privacy of your health information. We will not penalize or in any way retaliate against you for filing a complaint with the Secretary or with A.T.A.P. EAP directly.