Notice of Privacy Practices of AIDS Care Service, Inc.

Note:AIDS Care Service is posting this notice on its web site to comply with federal legislation. 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.

Click here to download our HIPAA notice in Word.

Effective: April 13, 2003

If you have any questions or requests, please contact Kristen Bradsher at (336) 725-5552.

AIDS Care Service, Inc. has a legal duty to protect health information about you.

AIDS Care Service, Inc. is required to protect the privacy of health information about you and that can be identified with you, which we call “personal health information.” AIDS Care Service, Inc. must give you notice of our legal duties and privacy practices concerning personal health information. AIDS Care Service, Inc. is required to follow the procedures in this notice. We reserve the right to change the terms of this notice and to make new notice provisions effective for personal health information that AIDS Care Service, Inc. maintains.

  • AIDS Care Service, Inc. must protect personal health information that AIDS Care Service, Inc. has created or received about your past,present, or future health condition or care AIDS Care Service, Inc. provides to you, or payment for your health care.
  • AIDS Care Service, Inc. must notify you about how AIDS Care Service, Inc. protects personal health information about you.
  • AIDS Care Service, Inc. must explain how, when and why AIDS Care Service, Inc. uses and/or discloses personal health information about you.

AIDS Care Service, Inc. may use and disclose personal health information about you without your authorization for the following purposes:

  • to provide services to you.
  • to obtain payment for services.
  • for its operations.
  • under certain other circumstances.
    • When the use and/or disclosure is required by law.
    • When the use and/or disclosure is necessary for public health promotion
    • When the disclosure relates to victims of abuse, neglect or domestic violence.
    • When the use and/or disclosure is for health oversight activities.
    • When the disclosure is for law enforcement purposes.
    • When the use and/or disclosure relates to decedents.
    • When the use and/or disclosure relates to cadaveric organ, eye or tissue donation.
    • When the use and/or disclosure relates to medical research.
    • When the use and/or disclosure is to avert a serious threat to health or safety.
    • When the use and/or disclosure relates to specialized government functions.
    • When the use and/or disclosure relates to correctional institutions and in other law enforcement custodial situations.

You can object to certain uses and disclosures.

Unless you object, AIDS Care Service, Inc. may use or disclose personal health information about you in the following circumstances:

  • AIDS Care Service, Inc. may share your name and your condition with clergy and with people who ask for you by name.
  • AIDS Care Service, Inc. may share with a family member, relative, friend or other person identified by you, personal health information directly related to that person’s involvement in your care or payment for your care, or to notify such individuals of your location, general condition or death.
  • AIDS Care Service, Inc. may share with a public or private agency personal health information about you for disaster relief purposes. Even if you object, AIDS Care Service, Inc. may still share personal health information about you, if necessary for the emergency circumstances.

If you would like to object to our use or disclosure of personal health information about you in the above circumstances, please call our contact person listed on the cover page of this notice.

AIDS Care Service, Inc. may contact you to provide appointment reminders.

  • AIDS Care Service, Inc. may contact you with information about treatment, services, products or health care providers.
  • AIDS Care Service, Inc. may use and disclose personal health information to manage or coordinate services provided to you.

Written Authorization

Under any circumstances other than those listed above, AIDS Care Service, Inc. will ask for your written authorization before we use or disclose personal health information about you. If you sign such an authorization, you can later cancel your authorization in writing. If you cancel your authorization, AIDS Care Service, Inc. will not disclose personal health information about you after we receive your cancellation, except for disclosures which were being processed before we received your cancellation.

You have several rights regarding personal health information about you.

  • You have the right to request restrictions on uses and disclosures of personal health information about you.
  • You have the right to request different ways to communicate with you.
  • You have the right to see and copy personal health information about you.
  • You have the right to request amendment of personal health information about you.
  • You have the right to a listing of disclosures AIDS Care Service, Inc. has made. We are not required to include disclosures:
    • For your treatment
    • For billing and collection of payment for your treatment
    • For our health-related services
    • Requested by you, that you authorized, or which are made to individuals involved in your care
    • Allowed by law when the use or disclosure relates to certain specialized government functions or relates to correctional institutions and in other law enforcement custodial situations, and
    • Made as part of a limited set of information which does not contain certain information that would identify you.
  • You have the right to a copy of this notice.

You may file a complaint about our privacy practices.

If you think AIDS Care Service, Inc. has violated your privacy rights or you want to complain to us about our privacy practices, you can contact the person listed below:

Ms. Alice Gaspard
HIPAA Contact Person
P.O. Box 21373
Winston-Salem, NC 27120
(336) 725-5552
support@aol.com

You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. If you file a complaint, AIDS Care Service, Inc. will not take any action against you or change our treatment of you in any way.