Notice of Privacy Practices
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.
Effective Date: 06/01/2026
Our Pledge Regarding Your Health Information
Ascend Psychiatry ("we," "us," or "our") understands that information about you and your health is personal. We are committed to protecting the privacy of your health information. This Notice of Privacy Practices ("Notice") describes how we may use and disclose your protected health information ("PHI") to carry out treatment, payment, or health care operations, and for other purposes permitted or required by law. It also describes your rights regarding your PHI.
We are required by law to:
Maintain the privacy of your PHI;
Provide you with this Notice of our legal duties and privacy practices with respect to your PHI;
Notify you following a breach of unsecured PHI; and
Follow the terms of the Notice currently in effect.
How We May Use and Disclose Your Protected Health Information
The following describes the ways we may use and disclose your PHI. Not every permitted use or disclosure is listed, but every category of use or disclosure we may make is described below.
For Treatment
We may use and disclose your PHI to provide, coordinate, or manage your psychiatric care and related services. For example, we may share information with other healthcare providers involved in your care, such as your primary care physician, therapist, pharmacist, or a hospital where you receive care.
For Payment
We may use and disclose your PHI so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company, or a third party. For example, we may share information with your health plan to obtain prior authorization for services or to receive reimbursement.
For Health Care Operations
We may use and disclose your PHI for activities necessary to run our practice and to make sure all of our patients receive quality care. For example, we may use your PHI to review the quality of our services, train staff, conduct compliance and risk management activities, or arrange for legal and auditing services.
Appointment Reminders and Health-Related Communications
We may contact you to remind you of appointments, to provide test results, or to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may use phone, voicemail, text message, email, or postal mail.
Business Associates
We contract with outside individuals and companies to perform services on our behalf (for example, electronic health record vendors, billing services, IT support, and secure messaging providers). These "business associates" may receive PHI to perform their services. We require them by written contract to safeguard your PHI to the same standards we follow.
Individuals Involved in Your Care or Payment for Your Care
Unless you object, we may disclose to a family member, other relative, close personal friend, or any other person you identify, PHI directly relevant to that person's involvement in your care or payment for your care. We may also disclose your PHI to notify a person responsible for your care of your location, general condition, or death.
Required by Law
We will disclose your PHI when required to do so by federal, state, or local law.
Public Health and Safety
We may disclose your PHI for public health activities, including reporting disease, injury, vital events, and conducting public health surveillance, investigations, and interventions.
We may disclose your PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of you, another person, or the public.
Victims of Abuse, Neglect, or Domestic Violence
We may disclose your PHI to a government authority authorized to receive reports of abuse, neglect, or domestic violence, as required or permitted by law.
Health Oversight Activities
We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure, and disciplinary actions.
Judicial and Administrative Proceedings
We may disclose your PHI in the course of a judicial or administrative proceeding in response to a court order, subpoena, discovery request, or other lawful process, subject to additional protections that apply to mental health and substance use records under Wisconsin law and 42 C.F.R. Part 2 where applicable.
Law Enforcement
We may disclose your PHI to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person; responding to a court order or subpoena; or reporting certain crimes, in each case as permitted or required by law.
Coroners, Medical Examiners, and Funeral Directors
We may disclose PHI to a coroner, medical examiner, or funeral director as authorized by law.
Workers' Compensation
We may disclose your PHI as authorized by and to the extent necessary to comply with laws relating to workers' compensation or similar programs.
Specialized Government Functions
If you are a member of the armed forces, we may disclose your PHI as required by military command authorities. We may also disclose PHI for national security and intelligence purposes, protection of public officials, and to correctional institutions if you are an inmate.
Research
We may use or disclose your PHI for research purposes only when the research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI, or as otherwise permitted by law.
Uses and Disclosures That Require Your Written Authorization
The following uses and disclosures will be made only with your written authorization. You may revoke your authorization at any time in writing, except to the extent we have already taken action in reliance on it.
Psychotherapy notes: Most uses and disclosures of psychotherapy notes (notes recorded by a mental health professional documenting or analyzing the contents of a counseling session and kept separate from the rest of your medical record) require your written authorization.
Marketing: Most uses and disclosures of your PHI for marketing purposes require your written authorization.
Sale of PHI: Disclosures that constitute a sale of your PHI require your written authorization.
Other uses and disclosures: Any other uses and disclosures not described in this Notice will be made only with your written authorization.
Special Protections for Mental Health and Substance Use Records
Wisconsin mental health treatment records: Wisconsin law (Wis. Stat. § 51.30) provides additional protections for treatment records related to mental illness, developmental disability, alcoholism, or drug dependence. We will not release these records except with your informed written consent or as specifically permitted by Wisconsin law.
Federal substance use disorder records (42 C.F.R. Part 2): If we provide substance use disorder treatment that is subject to 42 C.F.R. Part 2, additional federal restrictions apply to the disclosure of records identifying you as receiving such treatment. These records generally cannot be disclosed without your written consent or a specific court order, except in narrow circumstances such as medical emergencies, qualified research and audits, or to report a crime committed on our premises or against our staff.
Your Rights Regarding Your Protected Health Information
You have the following rights regarding your PHI. To exercise any of these rights, please submit a written request to our Privacy Officer using the contact information at the end of this Notice.
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that we use to make decisions about your care. We may charge a reasonable, cost-based fee for copies as permitted by law. We may deny your request in certain limited circumstances; if we do, you may request a review of our denial as required by law.
Access to psychotherapy notes and to information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative proceeding may be restricted as permitted by law.
Right to Request Amendment
If you believe PHI we have about you is incorrect or incomplete, you have the right to ask us to amend the information. Your request must be in writing and must include a reason supporting your request. We may deny your request in certain circumstances. If we deny your request, we will provide a written explanation, and you may submit a written statement of disagreement that will be included with your record.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures," which is a list of certain disclosures of your PHI we have made in the six years prior to your request. The list will not include disclosures made for treatment, payment, or health care operations, certain disclosures you authorized, or other disclosures excluded by law. The first accounting in any 12-month period is free; we may charge a reasonable, cost-based fee for additional requests.
Right to Request Restrictions
You have the right to request a restriction on certain uses and disclosures of your PHI for treatment, payment, or health care operations, or to family members or others involved in your care. We are not required to agree to your request, except that we must agree to your request to restrict disclosure of PHI to a health plan if the disclosure is for payment or health care operations and the PHI pertains solely to a service for which you (or someone other than the health plan on your behalf) have paid us in full.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location (for example, by mail at a specific address, or only by phone at work). We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may obtain a copy by asking us in person, calling our office, or downloading it from https://www.ascendpsychiatrysc.com.
Right to Be Notified of a Breach
You have the right to be notified in the event of a breach of unsecured PHI in accordance with applicable law.
Right to 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 PHI. We will verify that the person has this authority before taking any action.
Our Duties
We are required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices, to abide by the terms of the Notice currently in effect, and to notify you if a breach of your unsecured PHI occurs.
Changes to This Notice
We reserve the right to change the terms of this Notice at any time and to make the new Notice provisions effective for all PHI we maintain. The current Notice will be posted in our office and on our website at https://www.ascendpsychiatrysc.com. You may obtain a copy of the current Notice from our office at any time.
Complaints
If you believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer or with the Secretary of the United States Department of Health and Human Services. To file a complaint with us, contact:
Privacy Officer: Neha Thapa
Ascend Psychiatry
812 Cormier Rd., Suite 203, Green Bay, WI 54304
Phone: (920) 709-9964
Fax: (920) 214-9647
Email: info@ascendpsychiatrysc.com
To file a complaint with the federal government, contact:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/ocr/
You will not be retaliated against for filing a complaint.
Contact and Acknowledgment
If you have any questions about this Notice or would like additional information, please contact our Privacy Officer at the address and telephone number listed above.