Assertive Comprehensive Care, Inc.
Notice of Privacy Practices
Effective Date: [colocar fecha]

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.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information (“PHI”). We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. 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 by notifying us in writing.

How We May Use and Disclose Your Information

We may use and disclose your PHI for purposes of treatment, payment, and health care operations. Examples include:

For Treatment
We may use your health information to provide, coordinate, or manage your care. For example, your providers may review your symptoms, diagnosis, medications, treatment plan, and progress notes to support your care.

For Payment
We may use and disclose your information to bill and collect payment from you, your insurance company, or another third party.

For Health Care Operations
We may use your information to run our practice, improve quality of care, train staff, conduct audits, and manage administrative activities.

Other Uses and Disclosures Permitted or Required by Law

We may also use or disclose your information when required or permitted by law, including:

• public health and safety activities
• health oversight activities
• judicial and administrative proceedings
• law enforcement purposes
• workers’ compensation
• to avert a serious threat to health or safety
• as required by federal or state law

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization for uses and disclosures not otherwise permitted by law, including most uses of psychotherapy notes where applicable and certain disclosures for marketing or sale of information, if applicable.

Your Rights

You have the right to:

• get a copy of your medical record, with limited exceptions
• request a correction to your medical record
• request confidential communications
• ask us to limit certain uses or disclosures, although we are not always required to agree
• get a list of certain disclosures we have made
• get a paper copy of this notice at any time, even if you agreed to receive it electronically
• choose someone to act for you, when legally authorized
• file a complaint if you believe your privacy rights have been violated

Complaints

You may file a complaint with us if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to This Notice

We reserve the right to change this notice and make the new notice apply to all protected health information we maintain. The updated notice will be available in our office and on our website.

Contact Information

Assertive Comprehensive Care, Inc.
Phone: (305) 204-1209
Fax: (305) 402-0959
Address: 12550 NW 1st St., North Miami, FL 33181
Email: jac-pmhnp@assertivecare.net