Your health information is personal and private, and we must protect it. This notice tells you how the law requires or permits us it use and disclose your health information. It also tells you what your rights are and what we must do to use and disclose your health information. All Social Science Services, Inc. employees, staff, volunteers and others who have access to client health information will follow this notice. This includes other entities that form an Organized Health Care Arrangement (OHCA) and are listed at the end of this notice.

We must by law: maintain the privacy and security of your health information (also known as “protected health

information” or “PHI”), provide you this Notice of our legal duties and privacy practices regarding you PHI, follow the duties and privacy practices described in this Notice, and notify you promptly if a breach occurs that may have compromised the privacy or security of

your information

Change to this Notice: We have the right to make changes to this Notice and to apply those changes to your PHI. If we make changes, you have the right to receive a copy of them in writing. To obtain copy, you may ask your service provider or any Social Science Services, Inc staff person.

HOW THE LAW PERMITS US TO USE AND DISCLOSE INFORMATION ABOUT YOU:

We may use or give out your health information (PHI) for treatment, payment or health care operations. These are some examples: for Treatment: Health care professionals, such as doctors and therapists working on your case, may talk privately to determine the best care for you. They may look at health care services you had before or may have later on; for Payment: We need to use and disclose information about you to make sure that the services we have given you. For example, Insurance companies ask that our bills have descriptions of the treatment and services we gave you to get payment.; for Health Care Operations: We may use and disclose information about you to make sure that the services you get meet certain state and federal regulations. For example, we may use your protected health information to review services you have received to make sure you are getting the right care.

SOCIAL SCIENCE SERVICES, INC & DISCLOSURES

To Other Government Agencies Providing Benefits or Services: We may disclose information about you to other government agencies that are providing you benefits or services. The information we release about you must be necessary for you to receive those benefits or to Keep Your Informed: we may call or write to let you know about your appointments. We may also send you information about other treatments that may be of interest to you. For research: We may release your PHI to researchers for a research project that has gone through a special approval process. Researchers must protect the PHI they receive. As Required by Law: we will disclose your PHI when required to do so by federal or state law. To Prevent Serious Threat to Health or Safety: we may use and disclose medical 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. For Workers’ Compensation: we may disclose your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. For Public Health Activities: we may release your PHI for public health activities, such as to stop or control disease, stop injury or disability, and report abuse or neglect of children, elders and dependent adults. For Health Oversight Activities: we may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. For Lawsuits and Other Legal Actions: if you have a lawsuit or legal action, we may release you PHI in response to a court order. For Law Enforcement: we may release your PHI if asked to do so by a law enforcement officials. In response to a court order, subpoena, warrant, summons or similar process. To identify or locate a suspect, fugitive, material witness, or missing person; About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; About a death we believe may be the result of criminal conduct; o About criminal conduct at the hospital; and In emergency circumstances to report a crime; the location of the crime or victims; or the

identity, description or location of the person who committed the crime. Coroners, Medical Examiners and Funeral Directors:

We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also PHI about patients of the hospital to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Protective Services for the President and Others: we may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Protective Services for Elective Constitution Officers: We may release your PHI to government law enforcement agencies as needed for the protection of Federal and State elective constitutional officers and their families. For Protective Services for Senate or Assembly Committee: We may release your PHI to the Senate Committee on Rules or the Assembly Committee on Rules for the purpose of legislative investigation authorized by the committee. Inmates: If you are currently incarcerated, we may release your PHI to the Youth Authority or Adult Correctional Agency as necessary to the administration of justice.

For Multidisciplinary Personnel Teams: We may disclose health information to a multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child’s parents, or elder abuse and neglect. 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. We may release medical information about foreign military personnel to the appropriate foreign military authority.

Disaster Relief: We may disclose your Health Information to disaster relief organizations that seek your Health Information to coordinate your care, or notify family of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever it is practical to do so. Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose PHI about you, you may revoke that permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your PHI for the purposes covered by your written

authorization, except if we have already acted in reliance on your permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

YOUR RIGHTS ABOUT YOUR PROTECTED HEALTH INFORMATION (PHI)

Right to See and Copy: Federal regulations say that you have the right to ask to see and copy you PHI. However, psychiatric and drug and alcohol treatment information is covered by other laws, your request to see and copy your PHI may be denied.

Social Science Services, Inc. will approve or deny your request. If approved, we may charge a reasonable cost-based fee of copying and sending out your PHI. We may also ask if a summary instead of a complete record may be given to you. The information will usually be provided within (30) days. If your request is denied, you may appeal and ask another therapist to review your request. Right to Ask for an Amendment: If you believe that the information we have about you is incorrect or incomplete, you may request changes to be made to your PHI as long as we maintain this information. While we accept requests for changes, we are not required to agree to the changes. We may deny your request to change you PHI if it came from another health care provider, if it is

part of the PHI that you were not permitted to see and copy, or if your PHI is found to be accurate and complete. Right to Know to Whom We Released Your PHI: You have the right to ask us to you know whom we may have released your PHI. Under federal guidelines, we must maintain a list of anyone who was given your PHI not used for treatment, payment and health care operations or as required by law mentioned above. To get this list, you must ask your service provider in writing for it. You cannot ask for a list during a time period over six years ago. We will provide one accounting per year for free but will charge you a reasonable cost-based fee if there is a second request within a 12-month period. We will let you know the cost, and you may choose to stop or change your request before it costs you anything. Right to Ask Us to Limit PHI: You have the right to ask us to limit the PHI that the law lets us use or release about you for treatment, payment or health care operations. We don’t have to agree to your request. If we do agree, we will comply with your request unless the PHI is needed to provide you emergency treatment. To request limits, you must ask your service provider in writing. You must tell us (1) what PHI you want to limit; (2) whether you want to limit its use, disclosure or both; and (3) to whom you want the limits to apply. Right to Ask for Privacy: You have the right to ask us to tell you about appointments or other matters related to your treatment in a specific way or at a specific location. For example, you can ask that we contact you at a certain phone number or by mail. To request that certain information be kept private, you must ask your service provider in writing. You must tell us how and where you wish to be contacted. Right to Ask Us Not to Use your PHI: If your health care item or service has been paid in full out of pocket, you have a right to ask that your mental health information not be disclosed to a health plan for the purposes of carrying out payment or health care options. There is an exception if the disclosure to the health plan is required by law. Right to a Paper Copy of This Notice: You may ask us for a copy of this Notice at any time. You may ask any staff person for a copy.

Right to choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

Complaints: If you believe your privacy rights have been violated, you may submit a complaint with us or with the State.

Filing a complaint will not affect your right to further treatment or future treatment.

To file a complaint with State, contact:

Department of Health Care Services

P.O. Box 997413, MSOOIO

Sacramento, Ca 95899-7413

916-445-4646; 877-735-2929 TTY/TDD

FAX: 916-440-7680

To file a complaint with Social Science Services, Inc.:

Privacy Officer

Daniel Chagolla

HIPPA Compliance Officer 18612 Santa Ana Ave

Bloomington, Ca 92316

909-421-7120 Extension 115

FAX: 909-421-7128