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.

This notice is solely for you protection. You do not need to take any action. We understand the importance of keeping your personal information confidential. This notice of our privacy practices describes generally how we may use and disclose this Personal Information to administer services to you, and other purposes that are permitted or required by law, and how we protect the security and confidentiality of your Personal Information. This notice also explains your rights regarding the information. This notice will become effective on April 14, 2003.

We are required by the federal privacy regulations to keep Personal Information about you private; give you this notice of our legal duties and privacy practices with respect to your Personal Information; and follow the terms of the notice that are currently in effect.

HOW WE MAY USE AND DISCLOSE PERSONAL INFORMATION

In providing services to you, we obtain personal information about you. In performing our duties, we may use and disclose this information in various ways. We have provided you with examples in certain categories, however not every use or disclosure in a category will be listed. Such uses and disclosures include:

· Payment. Aviva Family and Children's Services may use and disclose client information in order to bill and collect payment from a third party for services the client receives. For example, we may need to provide information about a client's diagnosis and treatment to the Los Angeles County Department of Mental Health in order to be reimbursed for services.

· Health Care Operations. Aviva Family and Children's Services may use and disclose client information for operations that are necessary for the business of the Agency and to ensure that all Aviva Family and Children's Services clients receive quality care. For example, Aviva Family and Children's Services may use client information to evaluate the performance of its programs in providing care.

· Treatment. Information about clients and their families may be used in consultations with members of the treatment team and other Agency staff in order to provide the highest quality of care and continuity of services. For example, a clinician in the Residential Program may need to share information about a client with a Therapeutic Behavioral Services Worker in order to assist the treatment team in identifying behavioral management interventions.

· Individuals Involved In Your Care. We may release information about you to a family member who is involved in your care. Unless there is a specific written request from you to the contrary, we may also tell your family member or guardian your condition and that you are being treated by the Agency. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family or guardian can be notified about your condition, status and location.

· As Required By Law. We will disclose information about you when required to do so by federal, state or local law.

· Public Health Activities. These activities generally include the following: To prevent or control disease, injury or disability; To report births and deaths; To report the abuse or neglect of children, elders and dependent adults; To report reactions to medications or problems with products; and To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

YOUR RIGHTS REGARDING PERSONAL INFORMATION

You have the following rights regarding your Personal Information:

· Right to Inspect and Copy. You have the right to inspect and copy Personal Information that we maintain. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request, as allowed by law.

· Right to Amend. If you feel that personal information we have about you is incorrect or incomplete, you may as us to amend the information that is contained in a "designated record set." You have the right to request an amendment for as long as we keep the information. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request or the current information is accurate and complete or if we did not create the information.

· Right to an Accounting of Disclosures. You have the right to request a list of our disclosures for purposes other than treatment, payment or operations. Your request must state a time period and may not include dates before April 14, 2003. If you request more than one list in a year, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

· Right to Request Restrictions. You have the right to request to restrict the way we use or disclose personal information regarding treatment, payment or operations. You also have the right to request the Personal Information we disclose about you to someone who is involved in your care , like a family member. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. In your request, you must tell us (1) what information you want to restrict; (2) whether you want to restrict our use, disclosure or both; and (3) to whom you want the restriction to apply.

· Right to Request Confidential Communications. You have the right to request that we communicate personal information to you in a certain way or at a certain location. Your request must specify how or where you wish to be contacted. We will comply with reasonable requests.

· Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice upon request.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint to Aviva Family and Children's Services at the address above. Please include your name, address and telephone number and we will respond. You may also contact the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

You may request any of the above described by contacting our Privacy Officer at (323) 876-0550 ext. 146 or submitting the request by mail to Aviva Family and Children's Services, Attn. Privacy Officer, 7120 Franklin Ave. Los Angeles, CA 90046