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.

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC) AND TO DISCUSS IT WITH ACCESS’ PRIVACY OFFICER AT Compliance@achn.net OR 1.833.221.9955 IF YOU HAVE ANY QUESTIONS.

Access Community Health Network (ACCESS) is committed to maintaining the privacy and confidentiality of your health information and will follow the privacy practices described in this notice.

This notice will be followed by ACCESS health centers, its employees, physicians, other health care professionals, residents, students, and contractors.

HOW ACCESS MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT, PAYMENT, OR HEALTH CARE OPERATIONS

ACCESS may use and disclose (share) your health information for treatment, payment, and health care operation purposes.

Treatment. ACCESS may use and share your health information with other professionals who are treating you. For example, sharing information with other health care providers involved in your care, or for consultative and referring treatment purposes. Note, however, that we will ask you for written permission to disclose sensitive information.

Payment. ACCESS may use and share your health information to bill and get payment from health plans and other entities. For example, sharing your health information with your health insurance to obtain prior approval for services or to get paid for services provided.

Health care operations. ACCESS may use and share your health information to run our health network, improve your care, and contact you when necessary. For example, using your health information for quality assessment and improvement activities, for education and training activities, for contacting you for appointment reminders and satisfaction surveys. ACCESS may use Artificial Intelligence (AI) tools to record the conversation with your provider to assist them in writing their notes, summarize the assessment and plan, or for diagnostic purposes to help provide better care for you. However, AI does not replace your provider’s clinical judgment.

Substance Use Disorder (SUD) records. We will obtain your written consent for treatment, payment, and health care operations. We may ask you to sign a single consent for all future uses and disclosures for treatment, payment, and health care operations purposes. A single consent may be revoked at any time; however, it will not apply to actions taken while the consent was effective. Records shared with your consent may be further shared by the recipient without your permission to the extent the HIPAA rules permit it. However, your information can be shared
without consent in a bona fide emergency when you are unable to consent because of the emergency.

HOW ACCESS MAY USE OR DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR WRITTEN AUTHORIZATION

ACCESS is also allowed and sometimes required to use or share your information in other ways. ACCESS will have to meet many conditions in the law before sharing your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Public health and safety. For the purpose of preventing disease, helping with product recalls, reporting adverse reactions to medication to the Food and Drug Administration (FDA). SUD records will be de-identified prior to disclosure if we do not obtain your permission.

Victims of abuse, neglect or violence. For the purpose of reporting suspected abuse, neglect, or violence; related to children and the elderly.

Research purposes. Your medical information may be used for research purposes in accordance with state and federal law. This may include preparing for a research study, analyzing records as part of a project with Institutional Review Board (IRB) approval of a waiver of authorization, or studies involving decedent information.

Comply with the law. ACCESS will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law. 

Organ and tissue donation requests. To organ procurement organizations for the purposes of organ, eye or tissue donation and transplantation.

Coroner or medical examiner. For the purpose of identifying a deceased person, determining a cause of death, or other duties authorized by law.

Funeral director requests. As required by law, as needed to do their job.

Workers’ compensation. For workers’ compensation claims.

Law enforcement. We may share your information when needed to lessen a serious and imminent threat to health or safety of a particular person or the general public, or to report a crime that occurred on our premises.

Other governmental requests. With health oversight agencies for activities authorized by law. For special government functions such as military, national security, and presidential protective services.

Judicial and administrative proceedings. We can share health information about you in response to a court or administrative order, or in response to a subpoena. Substance use disorder treatment records, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual unless based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.

Other sensitive information. The use and disclosure of certain sensitive information may also be further restricted by other federal or state laws. This includes information related to alcohol and substance use disorder, genetics, mental health, and HIV/AIDS.

Business associates. With our business associates who provide services for or on our behalf. All our business associates are required to protect the privacy and security of your health information just as we do.

YOUR CHOICE ABOUT WHAT WE SHARE
For certain health information, you can tell us your choices about what we share.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends or others involved in your care or payment of care.
• Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may proceed and share your information if we believe it is in your best interest. We do not create or manage a Facility Directory.

In these cases, we will never share your information unless you give us written authorization:

• Marketing purposes
• Sale of your information
• Sharing of psychotherapy or counseling notes

Fundraising. ACCESS does not contact patients for fundraising efforts.

For SUD records, with your consent, we may also use and share your information in the following ways:

• To whomever you name in a consent to share your information.
• To prevent multiple enrollments in withdrawal management or maintenance treatment programs.
• To report participation in treatment required by the criminal justice system.
• To report prescribed substance use disorder treatment medications to a state prescription drug monitoring program when required by law.

Information sharing through our electronic medical record. ACCESS uses an electronic medical record software called Epic, which allows ACCESS to electronically exchange health information with other health care providers including, but not limited to, CareEverywhere® and Carequality®. You have the right to opt-out of the electronic exchange of your health information by contacting the Privacy Officer as described in this notice.

NO OTHER USES OR DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION
ACCESS may not make any other uses and disclosures of your health information without your written authorization. You may revoke your authorization at any time if you provide ACCESS with written notice.

YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and how to exercise them.

Request restrictions. You may request restrictions on how we use and disclosure your health information for purposes of treatment, payment, and our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

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.

Request confidential communication. You may request 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.

Access, inspect and copy. You may request to inspect and obtain an electronic or paper copy of your medical record and other information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request.

Request an amendment. You can ask us to correct your health information 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.
Request an accounting. You have the right to request a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and any other disclosures including those you have asked ACCESS to make. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another within twelve (12) months. For SUD records, an accounting will include disclosures up to the past three years from the date of the request, and will include disclosures for treatment, payment, and health care operations if the disclosure was made through an electronic health record.

Request a copy of this privacy notice. You have the right to get a copy of this notice electronically via email. If you have agreed to receive this notice via email, you also have the right to request a paper copy of this notice at any time.

Choose someone to act for you. 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 make sure this person has the authority and can act for you before we take any action.

How to file a complaint. If you feel ACCESS has violated the privacy or security of your information, or your rights concerning your information, please contact us at the information listed at the end of this notice. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mail: U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, SW, Washington, DC 20201; by telephone at 1.877.696.6775; or visit www.hhs.gov/ocr/privacy/hipaa/complaints/. ACCESS will not retaliate against you for filing a complaint.

OUR RESPONSIBILITIES
ACCESS is required by law to maintain the privacy and security of your protected health information.

ACCESS will notify you if a breach occurs that may have compromised the privacy or security of your information.

ACCESS must follow the duties and privacy practices described in this notice and give you a printed copy of this notice.

ACCESS will not use or share your information other than as described here unless you provide authorization 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.

ACCESS will not use or share your information other than as described here unless you provide authorization 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.

ACCESS reserves the right to change the terms of this notice, and the changes will apply to all information ACCESS has about you. The new notice will be posted in the health center, provided upon request, and will be available on ACCESS’ public website, www.achn.net.

CONTACT INFORMATION
If you wish to exercise your rights as listed in the notice, or have any questions, please contact ACCESS’ Privacy Officer via email at compliance@achn.net, through the Compliance Hotline at 1.833.221.9955, or submit a report online at achn.navexone.com.

This notice is effective as of 6/1/2026