Synergy Services, Inc.

Notice of Privacy Practices

OUR PLEDGE REGARDING YOUR PERSONAL INFORMATION

The Mission of Synergy Services is to eliminate family violence, abuse and neglect by providing quality services for persons of all ages.  We seek to empower the individual, strengthen the family and develop our community thought crisis intervention, shelter, counseling, advocacy and education.

We keep all of the information about you confidential unless other wise stated by law.   This notice applies to all of the records of your care generated by Synergy Services, Inc.

This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of your information.

Law to requires us to:

Make sure that information that identifies you is kept private and;

Give you this notice of our legal duties and privacy practices with respect to medical information about you; and

Follow the terms of this notice that is currently in effect.

The following categories describe different ways that we use and disclose medical information. Not every use or disclosure is listed.  However, all the ways we are permitted to use and disclose information will fall within one of these categories.

For Treatment We may use personal information about you to provide you with service                s.  We may disclose information about to other persons that are involved in your care.

For Payment We may use and disclose information about you for payment.

Treatment Alternatives We may use and disclose information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

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

To Avert a Serious Threat to Health or Safety We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any discloser, however, would only be to someone able to help prevent the thereat.

Military and Veterans If you are a member of the armed forces, we may release medical information about you as required by military command authorities.

Worker’s Compensation We may release information about you for workers’ compensation or similar programs.

Public Health Risks We may disclose medical information about you for public health activities such as:

To prevent or control disease, injury or disability;

To report the abuse or neglect of children, elders and dependent adults;

To notify the appropriate government authority if we believe a client has been the victim of abuse, neglect or domestic violence.  We will only make this disclosure if you agree or when required by law.

Health Oversight Activities We may disclose medical information to a health oversight agency for activities authorized by law.

Lawsuits, Disputes and Law Enforcement If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court of administrator order.  We may also disclose information about you in response to a subpoena, discovery request, or other lawful process.

National Security and Intelligence Activities We may release information about you to authorized federal officials for intelligence, counter intelligence and other national security activities authorized by law.

YOUR RIGHTS REGARDING YOUR PERSONAL INFORMATION.

You have the following rights regarding medical information we maintain about you.

Right to Inspect and Copy

You have the right to inspect and copy information that is in your file.  To Inspect and copy your file that we used to make decisions about you, you must submit your request in writing to Medical Records Synergy Services, Inc. 400. E. Sixth St. Parkville, MO 64152.

We may deny your request to inspect and copy in certain very limited circumstances. You will be notified of this denial.

Right to Amend If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information, you have the right to request an

amendment for as long as the information is kept by Synergy Services.

To request an amendment, your request must be made in writing and submitted to Medical Records Synergy Services, Inc. 400. E. Sixth St. Parkville, MO 64152.  In addition, you must provide a reason that supports your request

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request.

Right to Request Restrictions You have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment or health care operations.  You also have the right to request a limit on the information we disclose about you.  We are not required to agree to your request 

To request restrictions, you must make your request in writing to  Medical Records Synergy Services, Inc. 400. E. Sixth St. Parkville, MO 64152.

In your request, you must tell us

What information you want to limit; and/or

Whether you want to limit our use; and/or

To whom you want the limits to apply.

Right to a Withdraw Consent or Authorization to Release Information  You have the right to revoke authorization to release information.  The revocation will be in effect on the day received and does not cover any disclosers before that date.  To withdraw consent or authorization write to Medical Records Synergy Services, Inc. 400. E. Sixth St. Parkville, MO 64152.

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.

Changes to this Notice We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for the information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice.

Complaints If you believe your privacy rights have been violated; you may file a complaint with  Synergy Services or with the Secretary of the Department of Health and Human Services.  To file a complaint with Synergy Services contact Robin Winner, Executive Director, Synergy Services, Inc. 400. E. Sixth St. Parkville, MO 64152. All complaints must be in writing.