The admission
assessment includes a face-to-face interview with both the parents and the
adolescent and, if needed, collection of a urine drug screen. Interviewing both
the adolescent and the parents, either together or separately at the discretion
of the ASAP Intake Coordinator, is considered critical to the process of
information gathering and the breakdown of denial.
The
face-to-face interview is designed to ensure that a good match exists between
the needs of the prospective client and the services provided by the ASAP
Program. The clinician conducting the admission interview determines whether
the client is abusing or dependent on a mind-altering drug and examines the
possible presence of additional diagnoses. The DSM-IV is utilized to make
diagnostic decisions, and the ASAM Patient Placement Criteria are utilized to
make optimal decisions regarding appropriate level of care. The face-to-face
interview provides the clinician with a wealth of information about the client,
including drug use symptoms, a social history, a family history, personal
assets and liabilities, possible diagnoses, family resources, and practical
information regarding appropriate treatment.
The ASAP
Intake process is individualized, and the decision to require additional
information before granting or denying admittance to the ASAP Program is
reserved by the Intake Coordinator. Urine drug testing may be required at the
time of admission interview to provide information about the adolescent's drugs
of choice and drug use pattern. (Urine drug testing is also used later during
treatment as a monitoring tool to measure honesty and treatment compliance.)
All this admission information is integrated by the ASAP Intake counselor, who
will recommend the individualized treatment approach most likely to succeed for
each adolescent and family. If admission to the ASAP Program is not made, a
referral to another professional organization will be provided.
Acceptance
into ASAP can be considered when a definitive diagnoses of substance abuse or
dependence is made and the following conditions are met:
- Age 12-18 (exceptions may be considered)
- Medically stable, with detoxification
completed
- Current treatment for secondary diagnoses (if
any) may be required
- Commitment by the family to full participation
- Not currently psychotic, suicidal or at risk
to harm self or others
Notice of Policies and
Practices to Protect the Privacy of Your Health Information
THIS NOTICE
DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
I.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
ASAP may use or disclose your protected health information (PHI), for
treatment, payment, and health care operations purposes with your consent. To
help clarify these terms, here are some definitions:
•
“PHI” refers to information in your health record that could
identify you.
• “Treatment, Payment and Health Care Operations”
– Treatment is when ASAP provides, coordinates or manages your health
care and other services related to your health care. An example of treatment
would be when ASAP consults with another health care provider, such as your
family physician or another mental health professional.
– Payment is when ASAP obtains reimbursement for your healthcare.
Examples of payment are when ASAP discloses your PHI to your health insurer to
obtain reimbursement for your health care or to determine eligibility or
coverage.
– Health Care Operations are activities that relate to the performance
and operation of ASAP’s practice. Examples of
health care operations are quality assessment and improvement activities,
business-related matters such as audits and administrative services, and case
management and care coordination.
• “Use” applies only to activities within ASAP’s
practice such as sharing, employing, applying, utilizing, examining, and
analyzing information that identifies you.
• “Disclosure” applies to activities outside of ASAP’s practice such as releasing, transferring, or
providing access to information about you to other parties.
II.
Uses and Disclosures Requiring Authorization
ASAP may use or disclose PHI for purposes outside of treatment, payment, or
health care operations when your appropriate authorization is obtained. An
“authorization” is written permission above and beyond the general
consent that permits only specific disclosures. In those instances when ASAP is
asked for information for purposes outside of treatment, payment or health care
operations, ASAP will obtain an authorization from you before releasing this
information. ASAP will also need to obtain an authorization
before releasing your Psychotherapy Notes. “Psychotherapy
Notes” are notes ASAP may have made about conversations during a private,
group, joint, or family counseling session, which have kept separate from the
rest of your medical record. These notes are given a greater degree of
protection than PHI.
You may
revoke all such authorizations (of PHI or Psychotherapy Notes) at any time,
provided each revocation is in writing. You may not revoke an authorization to
the extent that (1) ASAP has relied on that authorization; or (2) if the
authorization was obtained as a condition of obtaining insurance coverage, law
provides the insurer the right to contest the claim under the policy.
III.
Uses and Disclosures with Neither Consent nor Authorization
ASAP may use or disclose PHI without your consent or authorization in the
following circumstances:
• Child Abuse – ASAP is required to report PHI to the appropriate
authorities when staff have reasonable grounds to believe that a minor is or
has been the victim of neglect or physical and/or sexual abuse.
• Adult and Domestic Abuse – If ASAP has the responsibility for the
care of an incapacitated or vulnerable adult, staff are required to disclose
PHI when they have a reasonable basis to believe that abuse or neglect of the
adult has occurred or that exploitation of the adult's property has occurred.
• Health Oversight Activities – If an
• Judicial and Administrative Proceedings – If you are involved in
a court proceeding and a request is made for information about the professional
services ASAP provided you and/or the records thereof, such information is
privileged under state law, and ASAP will not release information without the
written authorization of you or your legally appointed representative or a
court order. The privilege does not apply when you are being evaluated for a
third party or where the evaluation is court ordered. You will be informed in
advance if this is the case.
• Serious Threat to Health or Safety – If you communicate to ASAP
an explicit threat of imminent serious physical harm or death to a clearly
identified or identifiable victim(s) and ASAP staff believe you have the intent
and ability to carry out such a threat, ASAP has a duty to take reasonable
precautions to prevent the harm from occurring, including disclosing
information to the potential victim and the police and in order to initiate
hospitalization procedures. If ASAP believes there is an imminent risk that you
will inflict serious harm on yourself, ASAP may disclose information in order
to protect you.
• Worker’s Compensation – ASAP may disclose PHI as authorized
by and to the extent necessary to comply with laws relating to worker’s
compensation or other similar programs, established by law, that provide
benefits for work-related injuries or illness without regard to fault.
IV.
Patient’s Rights and Provider’s Duties
Patient’s Rights:
• Right to Request Restrictions – You have the right to request
restrictions on certain uses and disclosures of protected health information.
However, ASAP is not required to agree to a restriction you request.
• Right to Receive Confidential Communications by Alternative Means and
at Alternative Locations – You have the right to request and receive
confidential communications of PHI by alternative means and at alternative
locations. On your request, ASAP will send your bills to
another address.)
• Right to Inspect and Copy – You have the right to inspect or
obtain a copy (or both) of PHI in ASAP mental health and billing records used
to make decisions about you for as long as the PHI is maintained in the record.
ASAP may deny your access to PHI under certain circumstances, but in some cases
you may have this decision reviewed. On your request, ASAP
will discuss with you the details of the request and denial process.
• Right to Amend – You have the right to request an amendment of
PHI for as long as the PHI is maintained in the record. ASAP may deny your
request. On your request, ASAP will discuss with you the
details of the amendment process.
• Right to an Accounting – You generally have the right to receive
an accounting of disclosures of PHI. On your request, ASAP
will discuss with you the details of the accounting process.
• Right to a Paper Copy – You have the right to obtain a paper copy
of the notice upon request, even if you have agreed to receive the notice
electronically.
Provider’s Duties:
• ASAP is required by law to maintain the privacy of PHI and to provide
you with a notice of its legal duties and privacy practices with respect to
PHI.
• ASAP reserves the right to change the privacy policies and practices
described in this notice. Unless ASAP notify you of such changes, however, ASAP
is required to abide by the terms currently in effect.
• If ASAP revises its policies and procedures, ASAP may notify you by US
mail.
V. Complaints
If you are concerned that ASAP have violated your privacy rights, or you
disagree with a decision ASAP made about access to your records, you may
contact ASAP staff at 602-953-2727 for further information
You may also send a written complaint to the Secretary of the U.S. Department
of Health and Human Services.
VI.
Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect on 4-14-2003.
ASAP will limit the uses or disclosures that ASAP staff will
make as follows: what is reasonably necessary to accomplish the purpose for
which the request is made.
ASAP reserves the right to change the terms of this notice and to make the new
notice provisions effective for all PHI that ASAP
maintains. ASAP may provide you with a revised notice by US mail.
Your signature below acknowledges that you have received this HIPPA notice from
ASAP.
Parents,
professionals, educators and interested others are encouraged to contact the
ASAP location nearest you for further information regarding services, fees, or
to schedule an admission. Please call (602) 434-0249.
THIS WEBSITE IS AN INFORMATIONAL SITE ONLY. PLEASE CONTACT
ASAP BY PHONE: (602) 434-0249
CLICK HERE TO SEE OUR PRIVACY POLICY