Privacy Practices




We are required by federal law to maintain the privacy of your medical information and to give you our Notice of Privacy Practices (this “Notice”) that describes our privacy practices, our legal duties your rights concerning your medical information.

This Notice applies to and will be followed by all counseling staff, employees and other personnel of the Area Substance Abuse Council.


Except where such use or disclosure is otherwise prohibited by state or federal law, ASAC is permitted or required to use or disclose your medical information without your authorization (permission) in the following situations. Some, but not all, specific examples of the different types of disclosures have been listed.
Treatment. To provide you with treatment or services (e.g., provide information to counselors, technicians, students or personnel who are involved in your care).

Payment. To collect payment from you, an insurance company or a third party for the treatment and services you receive (e.g, submitting a claim to your insurance company).

Appointments and Service. To provide you with appointment reminders or to notify you of possible treatment alternatives or services.

Friends and Family. To a friend or family member involved in your care or payment for your care. Such disclosures will be made only if we have obtained your permission.

Health Care Providers. To another health care provider involved in your treatment in order for that provider to treat you, bill for its services and conduct certain of its healthcare operations. Such disclosure will be made only if we have obtained your permission.

Disaster Relief. To a public or private entity assisting in a disaster relief effort (e.g., to notify your family about your location, condition or death).

Public Health Activities. To public health authorities for public health activities as permitted or required by law (e.g., to report births, deaths, child abuse and neglect, immunizations and communicable diseases).

Abuse, Neglect and Domestic Violence. ASAC may notify the appropriate government authority if it believes you have been the victim of abuse, neglect or domestic violence. Unless such disclosure is required by law, ASAC will only make this disclosure if you agree or under other limited circumstances when such disclosure is authorized by law.

Healthy Safety Risks. Under certain circumstances, when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.

Workers’ Compensation. To persons (e.g., employers, insurance carriers, attorneys) in order to comply with workers’ compensation laws or other similar programs proving benefits for work-related injuries.

Health Oversight Activities. To a health oversight agency for activities authorized by law to monitor the health care system, government programs and compliance with civil rights laws (e.g., fraud and abuse investigations, inspections and licensure, or disciplinary actions).

Legal Proceedings. If you are involved in a lawsuit or dispute, in response to a court order.

Law Enforcement. To law enforcement authorities for law enforcement purposes in response to a court order or to report a crime that occurred on ASAC premises or against ASAC staff.

Deceased Individuals. To a coroner or medical examiner as necessary to carry out their duties (e.g., to identify a deceased person or determine the cause of death), or to funeral directors as authorized by law.

Correctional Institutions. To a correctional institution where you are an inmate or to a law enforcement official who has custody of you for certain limited purposes (e.g., to provide you with health care).

Research. For research-related activities that meet all privacy law requirements.

Limited Medical Information. Limited medical information to a third party for research purposes, public health activities and health care operations. The party to whom we disclose the information is required to keep it confidential.

Required by Law. When required to do so by federal, state or local law (e.g., to report child or dependent adult abuse).

Incidental Disclosures. Occasional incidental, unintended disclosure of your medical information which might occur during a permitted use or disclosure (e.g., information overheard during a discussion regarding your care with you or a member of your family). We will take reasonable steps to avoid these types of disclosures.

Business Associates. Some of the activities described above are performed through contracts with outside persons or organizations, such as legal services. It may be necessary for ASAC to provide some of your medical information to outside business associates who assist ASAC with these activities. ASAC requires that its business associates appropriately safeguard the privacy of your information.

You and Your Authorization. ASAC must also disclose your medical information to you, as described later in this Notice. Uses and disclosures of medical information not covered by this Notice or the laws that apply to use will be made only with your written permission. If you give us permission to use or disclose medical information about you, you may revoke (take back) that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons set forth in your written authorization. We are unable to take back any disclosures we have already made with your permission.


Access to Medical Information. You may request to inspect and copy much of the medical information we maintain about you, with some exceptions. This includes most medical and billing records, but does not include psychotherapy notes. We may charge a fee for the costs of copying, mailing, and other supplies associated with your request.

Request for Restrictions. You have the right to request a restriction on how we use or disclose your medical information for treatment, payment, or health care operations, or to certain family members or friends identified by you who are involved in your care or the payment of your care.

Amendment. You may request that we amend certain portions of your medical information if you believe that it is incorrect or incomplete. We may require you to give a reason to support your request. We are not required to make all requested amendments, but we will give each request careful consideration. If we deny your request, we will provide you with a written explanation of the reason(s) and your rights.

Accounting. You have the right to receive a list of certain disclosures of your medical information made by us or our business associates. You must state a time period for your request, which may not be longer than six years and may not include dates before April 14, 2003. The first list in any 12-month period will be provided to you for free; you may be charged a fee for each subsequent list you request within the same 12-month period.

Confidential Communications. You have the right to request that we communicate with you about medical matters in a different manner or at a different place. We will agree to your request if it is reasonable, and you specify an alternative means or location to contact you.

Paper Notice. You are entitled to receive a written copy of this Notice at any time.

How to Exercise These Rights. All requests to exercise these rights must be in writing. We will follow written policies to handle requests, and we will notify you of our decision or actions and your rights. Contact the ASAC Privacy Officer using the contact information at the end of this Notice for more information or to obtain request forms.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with ASAC using the contact information at the end of this Notice. You may also submit a complaint to the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.

Questions. If you have questions about this Notice, please contact your counselor or the Privacy Officer at the telephone number listed below.


ASAC is required to abide by the terms of this Notice currently in effect. ASAC reserves the right to change the terms of this Notice and make the new Notice provisions effective for all of your medial information that it maintains, including that which it created or received while the prior Notice was in effect. If ASAC makes a material change to its privacy practices, it will amend its Notice. We will post a copy of the current Notice in our facilities. The Notice will state the effective date.


Privacy Complaint Officer: Dedric Doolin
3601 16th Ave. SW
Cedar Rapids, IA 52404
(319) 390-4611

Effective Date: April 14, 2003

on October 23 • by