Effective Date:

Introduction: At A New Start II, LLC (ANS), we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This form takes effect on the date specified herein and applies to all protected health information as defined by federal regulations.

Who Will Follow This Notice: This notice describes A New Start II, LLC (ANS) practices and that of:

• Any health care professional authorized to enter information into your medical record maintained by A New Start II, LLC (ANS).
• All departments and units of A New Start II, LLC (ANS).
• Any member of a volunteer group we allow to help you while you are receiving services at A New Start II, LLC (ANS).
• All employees, staff and other A New Start II, LLC (ANS) personnel.

Our Responsibilities: A New Start II, LLC (ANS) is required to:

• Maintain the privacy of your health information as required by law.
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
• Abide by the terms of this notice.
• Notify you if we cannot accommodate a requested restriction or request.
• Accommodate your reasonable requests regarding methods to communicate health information with you.

How We May Use and Disclose Health Information:

• For Treatment: Information obtained by a nurse, physician, or other member of our healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.
• For Payment: We may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive.
• For Healthcare Operations: We may use and disclose health information about you for operational purposes. These uses and disclosures are necessary to run A New Start II, LLC (ANS) and ensure that all of our patients receive quality care.

Your Rights Regarding Health Information:

• Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care.
• Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
• Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures we have made of your health information.
• Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations.
• 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.
• Right to a Paper Copy of This Notice: You may ask us to give you a copy of this notice at any time.

Changes to This Notice: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in A New Start II, LLC (ANS).

Complaints: If you believe your privacy rights have been violated, you may file a complaint with A New Start II, LLC (ANS) or with the Secretary of the Department of Health and Human Services. To file a complaint with A New Start II, LLC (ANS), contact our Privacy Officer at A New Start II, LLC (ANS). All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Contact Information: If you have any questions about this notice, please contact our Privacy Officer at A New Start II, LLC (ANS). 

This form takes effect on the date specified herein.