Federal law requires that we provide you with this notice.  The word "you" as used below applies
to a patient in the Aichhorn Residential Treatment Facility.  If the patient is a minor, a guardian
may take any action described below on his/her behalf.

We attempt to respect the privacy of all medical information at all times.  However, in order to
assure safe operation of a continuous care facility like the Residential Treatment Center, numerous
staff working at various times and in various areas must have access to this information.  This is
essential for your care.  We may, at our discretion, and to the extent possible, attempt to limit
access to certain sensitive information to a restricted group of staff members, but we cannot
guarantee any such restriction of information within the treatment facility.

After you leave the facility, we may attempt to contact you to gather information on the long-term
effectiveness of the treatment you receive here, and to invite your further comments and
suggestions.

We must also disclose information about your condition and about your treatment to people and
agencies outside of the August Aichhorn Center for certain purposes.  We attempt to limit such
disclosures as much as possible.  However, in order to receive the funding that makes our whole
operation possible, we must, for example, disclose information to Medicaid in order to bill for
treatment services, and all of the records of your treatment are therefore subject to audit by
Medicaid authorities.  All operations of the facility, including clinical information about your
condition and treatment, are also subject to review by accreditation agencies, and by the New York
State Office of Mental Health, the New York State Health Department, the New York State
Commission on Quality of Care for the Mentally Disabled, and the U.S. Department of Health and
Human Services.  In your own interest, we must also disclose information about your condition and
treatment if you require other medical treatment in another facility (for example, in a hospital
emergency department).  We may also be required to provide information about your condition and
treatment to the police in an emergency (for instance if you are taken into custody), or to courts or
law enforcement agencies in response to a subpoena.  In non-emergency situations, we will inform
you if such a disclosure is requested, and afford you an opportunity to object to this disclosure.

Finally, if you are a minor, we must also ordinarily disclose information about your treatment and
condition to your guardian.

We may use information from your clinical record to compile various reports on general matters
such as average length of stay, frequency of various diagnoses, use of particular medications, and
adverse or positive treatment outcomes, and these reports may be published or disseminated
publicly.  However, these reports will not contain any information that would personally identify
you, or indicate you are or were a patient in this program.  We will not publish or disseminate any
material relating to your record or your treatment that would permit you to be individually
identified as being or having been a patient here, without your specific, written consent.

You have the right to a copy of this notice, and you have the right to request restrictions on the use
and disclosure of information about you.  You may also review records we make about your
treatment, and you may obtain copies of these records at a charge of $.75 per page (unless we
determine that such a review would involve an increased danger to your health; you may contest
such a determination if it is made).  We will provide you, on request, with an accounting of
disclosures of information about you other than routine billing and treatment operations.  If you
believe that information in your record is incorrect, you have the right to request a correction.  If
we do not make the change you request, you have the right to have your objection included in the
record.

We are responsible for insuring that the practices and procedures outlined above are observed.  If
you have any questions, concerns, or complaints about disclosure of information or any other
aspect of the privacy policies outlined above, please address them to the Administrative Director,
who is the agency Privacy Officer.   You should be assured that any question or complaint that you
raise will not result in any change in your treatment here.

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