HIPAA Notice of Privacy Practices
Aspire Counseling Services® is required by law to maintain the privacy of your health information, give you a Notice of ACS’s legal duties and privacy practices with respect to it, and follow the terms of the current Notice. It will be followed by all employees associated with Aspire Counseling Services®.
Uses and Disclosure of Your Health Information:
The following categories describe some of the ways that ACS may use and disclose your health information.
Appointment reminders: ACS may use and disclose health information to remind you of your appointments for medical services.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION REQUIRED/PERMITTED BY LAW:
The following categories describe some of the ways that ACS may be allowed or required to use and disclose your health information.
Required by Law/Law Enforcement: ACS may use and disclose your health information if required by federal, state or local law, such as for workers compensation, and if requested by law enforcement officials for purposes such as responding to a court order or warrant or obtaining information about a victim of a crime if, under the circumstances, ACS cannot obtain the victim’s agreement.
Public Health and Safety: ACS may use and disclose your health information to prevent a serious threat to the health and safety of you, others, or the public and for public health activities, such as those intended to prevent or control.
Food & Drug Administration (FDA) and Health Oversight Agencies: AFC may disclose health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance to the FDA and manufacturers to enable product recalls, repairs, or replacements, and to health oversight agencies for activities authorized by law, such as audits.
Lawsuits/Disputes: If you are involved in a lawsuit/dispute and have not waived the physician-Client privilege, ACS may disclose your health information under a court/administrative order, subpoena, or discovery request after attempting to inform you of the request.
Coroners, Medical Examiners, and Funeral Directions: ACS may release your health information to coroners, medical examiners, or funeral directors to enable them to carry out their duties.
National Security/Intelligence Activities and Protective Services: ACS may release your health information to authorized national security agencies for the protection of authorized persons or to conduct special investigations.
Military/Veterans: ACS may disclose your health information to military authorities if you are an armed forces or reserves member.
If ACS wants to use and/or disclose your health information for a purpose not described in this Notice or required/permitted by law, ACS must obtain a specific authorization from you for that use and/or disclosure and you may revoke that authorization at any time.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION:
YOU have the rights described below in regards to the health information that ACS maintains about you. YOU must submit a written request to exercise any of these rights. YOU can contact the ACS’ office in regards to that request at (661) 396-7300.
Right to Inspect/Copy: YOU have the right to inspect and get a copy of health information used in decisions about your care. This right does not apply to psychotherapy notes and certain other information. By law, ACS may charge in advance $35.00 plus postage, payable prior to the requested records.
Right to Amend: If you feel health information ACS created is inaccurate or incomplete, you may request that ACS amend your information. ACS cannot delete or destroy any information already included in your medical record. YOU must provide a reason in support of your amendment request. ACS may deny your request if you ask to amend information that ACS did not create, unless that person or entity that created the information is not available to make the amendment; that is not part of the health information ACS maintains; that is not part of the information you are permitted by law to inspect and copy; or that is accurate and complete.
Right to Accounting of Disclosures: YOU have the right to request a free list of disclosures every 12 months. ACS is not required to list all disclosures, such as those authorized or made for treatment, payment, or operations. YOU must state a time period, which may not be longer than 6 years, or include dates before June 28, 2015. If you request more than one accounting in a 12-month period, ACS may charge you for the cost of the list. ACS will tell you the cost; and you may withdraw or modify your request before costs accrue.
Right to Request Restrictions: YOU have the right to request a restriction or limitation on your health information that ACS uses or discloses, unless use or disclosure is required by law. YOU have the right to request limits on the health information ACS discloses about you to someone involved in your care or payment for your care, like a family member or friend. YOU must specify the restriction and to whom it applies. ACS is not required to agree to every request. If ACS agrees, or is required to comply, ACS will comply with the request unless the information is needed in case of an emergency.
Right to Request Confidential Contacts: YOU have the right to request that ACS contact you about medical issues in a certain way or place, such as by mail. YOU must specify how or where your wish to be contacted; ACS will try to accommodate reasonable requests.
Right to Paper Copy of this Notice: YOU have the right to a paper copy of this Notice, which is posted and available at each location where medical services are provided.
CHANGES TO THIS NOTICE:
ACS reserves the right to change this Notice and to make the revised Notice effective for health information ACS created or received about you prior to the revision, as well as information that it receives in the future Revised Notices will be posted and available at each location where medical services are provided.
If you believe your privacy rights have been violated, you may file a complaint with ACS by contacting ACS’ office at (888) 585-7373
U.S. Department of Health and Human Services
Region IX – San Francisco (American Samoa, Arizona, California, Guam, Hawaii, Nevada)
Michael Leoz, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
Voice Phone: (415) 437-8310
FAX: (415) 437-8329
TDD: (800) 537-7697
YOU will not be retaliated against for filing a complaint.
CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE CLIENT RECORDS
The confidentiality of alcohol and drug abuse Client records maintained by this program is protected by Federal law and regulations. Generally, the program may not say to a person outside the program that the Client attends the program, or disclose any information identifying a Client as an alcohol or drug abuse unless:
Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.
Federal law and regulations do not protect any information about a crime committed by a Client either at the program or against any person who works for the program or about any threat to commit such a crime.
Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.
(See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR part 2 for Federal regulations)
(Approved by the Office of Management and Budget under control number 0930-0099)