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

General Information

Employee Assistance Program (“EAP”) services are confidential and information regarding your EAP participation is protected by federal laws including the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2; and the Health Insurance and Portability and Accountability Act of 1996 (“HIPAA”) and other local regulations. Under these laws, without your signed consent, COPE, Inc. (“COPE”) will not release information about your participation with the EAP or any of your health information, except in the specific situations listed below. We are required by law and professional ethics to release information, on a “need to know” basis, when:

• You say or do something that seriously threatens your health or safety, such as intent to harm yourself.
• You say or do something that seriously threatens the health or safety of someone else.
• There is reason to suspect abuse or neglect of children or other vulnerable persons.
• Disclosure is compelled by order of a court of competent jurisdiction.
• You present a clear and present danger to the safety or security of your community, workplace, or nation.

How COPE may use or disclose your personal health information

COPE maintains a confidential EAP Case record which relates your involvement with the EAP and contains “personal health information” as defined by federal regulations. This record is maintained for a period of six (6) years from the last date of client activity. Before COPE can use or disclose any information about you outside of COPE in a manner beyond the described exceptions, we must first obtain your specific written authorization allowing the disclosure. Any such written authorization may be revoked by you in writing. COPE is permitted to use or disclose your personal health information to you the client and, with a signed Authorization to Release Information form, to others (i.e., referral resources) to assist in the provision of EAP assistance. COPE will make reasonable efforts to limit disclosures to the minimum necessary to accomplish the intended purpose of the disclosure. Also, COPE is required to disclose information to the Secretary of the U.S. Department of Health and Human Services in order to demonstrate compliance with federal regulations if investigated.

Your Rights

1. You have the right to request restrictions on the uses/disclosures of your health information. COPE will agree to all reasonable requests, but is not required to agree all restrictions that you might request.

2. You have the right to confidential communication with COPE, including the right to request that we communicate with you by alternative means or at an alternative location. COPE will accommodate requests for alternative means/location of communication that are reasonable.

3. You have the right to inspect and to copy your health information, except to the extent that the information contains information that is determined harmful to you or others. If you wish to obtain a copy of your EAP record, your request must be in writing and must include the following:

• A statement indicating you are requesting a copy of your EAP record;
• A statement indicating you understand that if you release your record to your attorney as part of a legal action, that your record may subsequently be made available to the opposing attorney through the legal process of “discovery”;
• Your signature, and date signed.

COPE will provide your record within 30 to 60 days of the request.

4. You have the right to request that COPE amend your health information that is incorrect or incomplete. COPE is not required to change your health information and will provide you information about COPE’s response to your request.

5. You have the right to receive an accounting of disclosures of your health information made by COPE during the six years prior to the request.

6. You have the right to receive a paper copy of this notice upon request if you have received it electronically.

COPE’s Responsibilities

COPE is required by federal law, HIPAA, to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices. COPE is required by law to abide by the terms of this notice. COPE reserves the right to modify the terms of this notice and to make new notice provisions effective. COPE will post updated versions of this notice on its website at www.cope-inc.com any time that modifications are made. If you do not have access to the internet and would be interested in receiving a copy of future revisions, please contact us by mail or telephone to be placed on a mailing list solely for that purpose.

Complaints

COPE maintains compliance reports and will cooperate fully with external complaint investigations and compliance reviews. Complaints about this Notice of Privacy Practices, about disclosures of your personal health information, or requests for further information should be directed to:

Darrell Vail, Privacy Official
COPE, Inc.
1120 G Street NW
Suite 550
Washington, DC 20005
202.628.5100

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services by contacting:

Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Ave., SW
Washington, DC 20201

COPE will not retaliate against you in any way for filing a complaint with DHHS or with us.

Effective Date

This Notice of Privacy Practices is effective April 14, 2003.