Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
If you have questions, contact the Ascend Clinical Compliance Officer at 650-780-5657.
With respect to your medical information, you have the right to:
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
We will provide a copy or a summary of your health information, usually within 30 days of your request.
We may charge a reasonable, cost-based fee.
You can ask us to correct health information about you that you think is incorrect or incomplete.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
You can ask for a list (accounting) dating back up to six years of (1) the times we’ve shared your health information, (2) who we shared it with, and (3) why it was shared.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures. We’ll provide one accounting a year at no cost. A fee will be charged for any additional requests made within 12 months.
You can request and receive a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
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 ensure the person has this authority and can act for you prior to any action being taken.
You can if you think we may have violated your rights. Use the information at the end of this Notice of Privacy Practices.
You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/privacy/hipaa/complaints/.
You will not be retaliated against for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information, if we believe it is in your best interest. We may also share your information, when needed, to lessen a serious and imminent threat to health or safety.
Share information with your family, close friends, or others involved in your care.
Share information in a disaster relief situation.
Contact you for fundraising efforts.
Sale of your information.
Sharing of psychotherapy notes.
We may contact you for fundraising efforts, but you can tell us not to contact you again. We must respect your request.
Our uses and disclosures
Ascend Clinical will typically use or share your health information in the following ways:
Ascend provides laboratory services to your primary provider.
Specifically, we provide the test results (your health information) to your provider.
We can use and share your health information to bill and get payment from health plans or other entities.
For example, we give information about you to your health insurance plan so it will pay for your services.
We can use and share your health information to run our healthcare operations.
For example, we use your test results to validate the accuracy of our testing equipment.
Other ways we use or share your health information
Ascend is allowed or required to share your information in other ways – usually in ways that contribute to the public health or safety. We have to meet many conditions in the law before we can share your information for these purposes. For more information, refer to http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
We can share health information about you for certain situations, such as preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; preventing or reducing a serious threat to anyone’s health or safety.
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services.
We will comply with any subpoenas.
We can use or share health information in the following circumstances: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; for special government functions such as military, national security, and presidential protective services.
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
We are required by law to maintain the privacy and security of your PHI.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI.
We must follow the duties and privacy practices described in this notice and give you a copy when requested.
We will not use or share your information other than as described here, unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information or to report a problem:
If you have questions about our Notice of Privacy Practices or would like a paper copy of it, please contact our Compliance Officer at the address below, or by calling 650.780.5657, or emailing firstname.lastname@example.org.
If you believe that your privacy rights have been violated, you may file a complaint, in writing, with Ascend Clinical. The written complaint should be sent to:
Attn: Compliance Officer
435 Oakmead Parkway
Sunnyvale, CA 94085
Additional information can be found at: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the terms of this notice
We can change the terms of this notice, and the changes will apply to all information we have about you.