• Any health care professional authorized to enter information into your service record.
• All departments and programs of LSSI
• Any member of a volunteer group we allow to help you while you are a client of LSSI
• All employees, staff and other LSSI personnel

All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share health and service information with each other for treatment, payment or LSSI operation purposes described in this notice.

We understand that health information about you is personal. We are committed to protecting health and service information about you. We create a record of the care and services you receive at LSSI. We need this record to provide you with quality service and to comply with certain legal requirements.

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

The following categories describe different ways that we use and disclose health and service information:

• For Service Delivery. We may use health and service information about you to provide you with services. We may disclose health and service information about you to other staff members, student interns, or other LSSI personnel who are involved in providing services for you.
• For Payment. We may use and disclose health and service information about you so that the services you receive at LSSI may be billed to and payment may be collected from you or a third party.
• For Health Care Operations. We may use and disclose health and service information about you for LSSI operations. These uses and disclosures are necessary to run LSSI and make sure that all of our clients receive quality services.
• Appointment Reminders. We may use and disclose health and service information to contact you as a reminder that you have an appointment for services at LSSI.
• Service Alternatives. We may use and disclose health and serve information to tell you about or recommend possible service options or alternatives that may be of interest to you.
• Health-Related Benefits and Services. We may use and disclose health and service information to tell you about health-related benefits or services that may be of interest to you.
• As required by Law. We will disclose health and service information about you when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety. We may use and disclose health and service 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.
• Fundraising Activities. We may use and disclose service information to raise funds for Lutheran Social Services of Indiana.
• Health Oversight Activities. We may disclose health and service information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
• Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose health and service information about you in response to a court or administrative order.

You have the following rights regarding health and service information we maintain about you:

• Right to Inspect. You have the right to inspect health and service information that may be used to make decisions about your care. Usually, this includes service and billing records, but does not include psychotherapy notes. This request must be in writing.
• Right to an Accounting of Disclosures. You have a right to request an accounting of disclosures. This is a list of the disclosures we have made of health and service information about you. This request must be in writing.
• Right to Request Restrictions. You have the right to request a restriction or limitation on the health and service information we use or disclose about you for treatment, payment or health care operation. This request must be in writing. WE ARE NOT REQUIRED TO AGREE TO YOUR REQUEST.
• Right to Request Confidential Communications. You have the right to request that we communicate with you about health and service matters in a certain way or at a certain location. We will accommodate all reasonable requests. This request must be in writing.
• Right to a Paper Copy of This Notice. You have the right to request and receive a paper 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 health and service information we already have about you as well as any information we receive in the future.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with LSSI. To file a complaint with LSSI, contact the, Executive Director at (260) 426-3347. All Complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF HEALTH AND SERVICE INFORMATION
Other uses and disclosures of health and service information 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 disclose health and services information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health and service information about you for the reasons covered by your written authorization. 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.