Notice of Privacy Practices

Effective Date: September 29, 2026

Kalamazoo ASD Assessment is committed to protecting the privacy of your health information. We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices regarding your PHI, and to abide by the terms of the notice currently in effect.

This notice applies to all records of your care generated or maintained by Kalamazoo ASD Assessment. It describes how we may use and disclose your PHI, your rights regarding your health information, and our obligations concerning the use and disclosure of your PHI.

How We May Use and Disclose Your Protected Health Information

The following categories describe the ways we may use and disclose your PHI without your written authorization.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your care. For example, we may share your assessment results with another healthcare provider involved in your treatment.

Payment

We may use and disclose your PHI to obtain payment for services we provide. For example, we may share information with your health plan to obtain authorization for services or to confirm coverage.

Healthcare Operations

We may use and disclose your PHI for our internal operations. This may include quality assessment and improvement activities, case management and care coordination, professional competency review, training, accreditation activities, and compliance reviews.

Business Associates

We may disclose your PHI to business associates who perform functions on our behalf or provide us with services, such as billing, electronic health records, or practice management. Our business associates are required by contract and law to protect the privacy of your information and are not allowed to use or disclose your PHI other than as specified in their agreements with us.

Public Health and Safety

We may use or disclose your PHI when permitted or required by law for public health activities, including reporting disease, injuries, vital events, or the conduct of public health surveillance, investigations, or interventions.

Serious and Imminent Threats

We may use or disclose your PHI when, in our professional judgment, the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law and standards of ethical conduct.

Legal and Regulatory Requirements

We may disclose your PHI when required to do so by federal, state, or local law. This includes, but is not limited to:

• Judicial and administrative proceedings, such as in response to a court order or subpoena
• Law enforcement purposes, as permitted or required by law
• Health oversight activities, such as audits, investigations, or inspections conducted by government agencies
• Coroners, medical examiners, and funeral directors as required by law
• Specialized government functions, including military, veterans affairs, national security, and intelligence activities as required by law
• Workers' compensation programs as authorized or required by law
• Reporting abuse, neglect, or domestic violence as required or permitted by law

Uses and Disclosures Requiring Your Written Authorization

Certain uses and disclosures of your PHI require your written authorization before we may proceed. You may revoke an authorization at any time by submitting a written request, except to the extent that we have already taken action in reliance on the authorization.

Psychotherapy Notes

Most uses and disclosures of psychotherapy notes, where applicable, require your written authorization. Psychotherapy notes are notes recorded by a mental health professional documenting or analyzing the contents of a counseling session, which are maintained separately from the rest of your medical record. Certain limited exceptions exist under HIPAA (such as use by the originator for treatment, use for training, or use for defense in legal proceedings brought by the patient).

Marketing

We will not use or disclose your PHI for marketing purposes without your written authorization, except in limited circumstances permitted by law, such as face-to-face communications and promotional gifts of nominal value.

Sale of Protected Health Information

We will not sell your PHI without your written authorization, except in limited circumstances permitted by law.

Other Uses and Disclosures

Any uses and disclosures of your PHI not described in this notice will be made only with your written authorization. You may revoke any authorization in writing at any time, subject to any actions already taken in reliance on the authorization.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI. To exercise any of these rights, please contact us using the information at the end of this notice.

Right to Access and Obtain Copies

You have the right to inspect and obtain a copy of your health records maintained by us, with limited exceptions. We may charge a reasonable, cost-based fee for copies. If you request an electronic copy and we maintain your records electronically, we will provide the copy in the electronic form you request if readily producible, or in a mutually agreed-upon readable electronic form.

Right to Request Corrections

If you believe that the health information we have about you is incorrect or incomplete, you may request that we amend it. We may deny your request under certain circumstances. If we deny your request, we will provide you with a written explanation and inform you of your right to submit a statement of disagreement.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you may ask that we contact you only at a particular phone number. We will accommodate reasonable requests.

Right to Request Restrictions

You have the right to request that we restrict how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request, except that we must agree to restrict disclosures to a health plan for payment or healthcare operations purposes when you have paid for the service in full out of pocket. Even when we agree to a restriction, we may disclose your PHI if you need emergency treatment.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures of your PHI that we have made. This accounting does not include disclosures made for treatment, payment, or healthcare operations, or disclosures made with your authorization, among other exceptions. The first accounting in any twelve-month period is provided at no charge. We may charge a reasonable fee for additional requests within the same period.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this notice at any time, even if you have previously agreed to receive it electronically. You may request a paper copy by contacting us using the information at the end of this notice.

Right to Choose Someone to Act on Your Behalf

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 verify that the person has this authority before we take any action.

Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be retaliated against for filing a complaint. See the "Complaints" section below for contact information.

Breach Notification

If a breach of your unsecured PHI occurs, we are required by law to notify you. We will provide notification without unreasonable delay and in no case later than 60 days after discovery of the breach. The notification will include a description of the breach, the types of information involved, the steps you should take to protect yourself, what we are doing to investigate and mitigate the breach, and how to contact us for additional information.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We are required to follow the terms of this notice currently in effect.
• We are required to notify affected individuals following a breach of unsecured protected health information as required by law.
• We will not use or disclose your PHI without your authorization except as described in this notice.
• We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI we maintain. If we make a material change to this notice, we will make the revised notice available upon request and will post it on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Kalamazoo ASD Assessment using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr.

We will not retaliate against you for filing a complaint.

Contact Information

For questions about this notice, to exercise any of your rights, or to file a complaint, please contact us:

For information about how this website collects and handles information online, please see our Website Privacy Policy.