THIS NOTICE DESCRIBES HOW PSYCHIATRIC AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY ASCHER MEDICAL GROUP AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Disclosures for Treatment, Payment, and Health Care Operations
Ascher Medical Group, a private psychiatric medical practice (“Ascher,” “us” or “we”), may use or disclose your protected health information (PHI) for certain treatment, payment, and health care operations purposes without your authorization. In certain circumstances when we must share your PHI with non-physicians, we will only do so if the person or business receiving your PHI gives us written assurances that they will protect the confidentiality of your PHI.
Uses and Disclosures Requiring Authorization
Ascher may use or disclose the minimum necessary amount of your PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. In those instances when we are asked for information for purposes outside of treatment and payment operations, we will obtain an authorization from you before releasing this information. We will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes we have made about our conversation during a private, group, joint, or family counseling session, which we have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke or modify all such authorizations (of PHI or psychotherapy notes) at any time; however, the revocation or modification is not effective until we receive it.
Uses and Disclosures with Neither Consent nor Authorization
Ascher may use or disclose the minimum necessary amount of your PHI without your consent or authorization in the following circumstances:
Child Abuse: Whenever we, in our professional capacity, have knowledge of, or observe, a child we know or reasonably suspect has been the victim of child abuse or neglect, we may be legally required to immediately report such information to appropriate law enforcement agencies. Also, if we have knowledge of, or reasonably suspect, that mental suffering has been inflicted upon a child or that his or her emotional well-being is endangered in any other way, we may report this to law enforcement.
Elder and Dependent Adult Abuse: If we, in our professional capacity, have observed or have knowledge of an incident that reasonably appears to constitute physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if we are told by an elder or dependent adult that he or she has experienced abuse or if we reasonably suspect such abuse, we may be legally required to report the known or suspected abuse immediately to the adult protective services and/or law enforcement agencies as appropriate.
Health Oversight: If a complaint is filed against us with the California Medical Board or other relevant licensing boards, the Medical Board has the authority to subpoena your PHI from us relevant to that complaint.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and we receive a request for your PHI, we will not release your information without: 1) your written authorization or the authorization of your attorney or personal representative; 2) a court order; or 3) a subpoena duces tecum (a subpoena to produce records) where the party seeking your records provides us with a showing that you or your attorney have been served with a copy of the subpoena, affidavit and the appropriate notice, and you have not notified us that you are bringing a motion in the court to quash (block) or modify the subpoena. However, the above privilege does not apply when you are being evaluated for certain third parties (for example in connection with a workers’ compensation or disability claim) or where the evaluation is court ordered. We will inform you in advance if this is the case.
Serious Threat to Health or Safety: If you or your family member communicates to us that you pose a serious threat of physical violence against an identifiable victim, we must make reasonable efforts to communicate that information to the potential victim and law enforcement. If we have reasonable cause to believe that you are in a condition where you could be dangerous to yourself or others, we may release relevant information as necessary to prevent the threatened danger.
Workers’ Compensation: If you file a workers’ compensation claim, we may disclose PHI to your employer with the written consent of, and at the expense of your employer, so long as the requested information: 1) is relevant to your workers’ compensation claim; 2) is only used or disclosed in connection with the claim; and 3) only describes your functional limitations without any statement of medical cause.
Your Rights
Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of your PHI. However, we are not required to agree to all restrictions you request. An important exception is your right to request nondisclosure to an insurer in connection with services you are paying for out-of-pocket unless the disclosure is for treatment purposes or in the rare event disclosure is required by law.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are receiving treatment from Ascher.) Upon your request, we will send your PHI and other communications to an alternate address.
Right to Inspect and Copy – You have the right, upon reasonable notice, to inspect or obtain a copy of (or both inspect and obtain a copy of) your PHI and/or psychotherapy notes in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. We will provide you with access to records and will accommodate your request to receive the records in the form or format of your choice, so long as the records are readily reproducible in such format.
If you wish to receive hard (paper) copies of your records, we charge $.25 per page to cover our overhead in photocopying the records. We charge a flat rate based on the actual cost of our labor for production of your records in electronic format. We will inform you of this fee when you request such electronic records.
Right to Amend – You have the right to request an amendment of your PHI for as long as the PHI is maintained in the record. We may deny your request if your requested amendment is unreasonable, misleading, fraudulent or inaccurate.
Right to an Accounting – You have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (if any have occurred).
Right to Prohibit Sale of PHI – Unless you specifically authorize us, we will never sell your PHI for any purpose, including marketing or fundraising purposes. While we will never sell your PHI, we may use our contact records to send you occasional practice announcements, newsletters, health tips, or other marketing materials.
Right to a Paper Copy – You have the right to obtain a paper copy of this Notice upon request.
Our Legal Obligations
We are required by law to maintain the privacy of your PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
We must notify you if unsecured electronic PHI is breached. However, we always encrypt your PHI when it is in electronic format in our possession. We must also notify you if hard copies of your PHI are ever lost or otherwise breached.
We reserve the right to change and update this Notice, which we will provide to you. We are required to abide by any Notice of Privacy Practices currently in effect.
If you pass away while under our care, we are allowed to make relevant disclosures of PHI to your family after your death under essentially the same circumstances in which such disclosures are permitted before death.
If we revise this Notice, we will provide you with a copy. A copy of the Notice is also posted in our office and on our website.
Questions and Complaints
If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact us at: Ascher Medical Group, Attn: Privacy Officer, 1849 Sawtelle Blvd, Suite 610, Los Angeles, CA 90025. Tel (424) 273-9700. Fax (310) 928-9324.
If you believe that your privacy rights have been violated and wish to file a complaint with us, you may send your written complaint to Ascher Medical Group, Attn: Privacy Officer, 1849 Sawtelle Blvd, Suite 610, Los Angeles, CA 90025. Tel (424) 273-9700. Fax (310) 928-9324.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at (800) 368-1019 (TDD: 800-537-7697) or by sending a letter to:
Region IX, Office for Civil Rights
U.S. Department of Health and Human Services
90 7th St. Suite 4-100
San Francisco, CA 94103
You may also file a complaint online at: www.hhs.gov/ocr/privacy/hipaa/complaints/
We will never retaliate against you for exercising your right to file a complaint.
Effective Date: January 1, 2022