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.
Ampersand Sexual Violence Resource Center is required by law to maintain the privacy of protected health information and to provide you with notice of its legal duties and privacy practices. Ampersand must abide by the terms of the notice currently in effect, but ASVRC reserves the right to change the terms.
If there is a change, Ampersand will provide you with a written, revised notice as soon as practicable by mail or hand delivery. As a client of Ampersand, information about you must be used and disclosed to other parties for purposes of treatment, payment, and health care operations. These uses and disclosures require your consent, and include, but are not limited to, a release of information contained in financial records and/or medical records, including information concerning psychiatric diagnosis and treatment records, medical history, treatment progress and/or any other related information to:
- Any hospital or other health care facility to which you may be admitted;
- Any physician or therapist providing you care;
- Any other individual or organization designated by you.
These disclosures will be made only with your written authorization. That authorization may be revoked, in writing, at any time.
Ampersand is permitted to use or disclose information about you without consent or authorization in the following circumstances:
- In emergency treatment situations;
- As required by law (including by statute, regulation or court order);
- Public health activities;
- Victims of abuse or neglect;
- Health oversight activities;
- Judicial and administrative proceedings;
- Law enforcement purposes;
- Decedents;
- Organ, eye, or tissue donation;
- Research;
- Serious threat to health or safety;
- Essential government functions;
- Workers’ compensation.
You have the right, subject to certain conditions, to:
- Request restrictions on certain uses and disclosures of information about you. However, Ampersand is not required to agree to the requested restriction;
- Receive confidential communication of protected health information;
- Inspect and copy protected health information;
- Amend protected health information;
- Receive an accounting of disclosures;
- Obtain a paper copy of this notice, if you had agreed to receive this notice electronically.
COMPLAINTS
You may complain to Ampersand and the Secretary of the U.S. Department of Health and Human Service if you believe that your privacy rights have been violated. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing with Ampersand and should state the specific incident(s) in terms of subject, date and other relevant matters. A complaint to the Secretary must comply with the standards set out in 45 CFR $160.306. For further information regarding filing a complaint with ASVRC contact the Executive Director at (859) 253-2615.