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.
This Notice of Privacy Practices describes how Four Square Clinicals (FSC) may use and disclose your protected health information (PHI) to carry out treatment, payment, and health care operations and for other purposes permitted or required by law. It also describes your rights to access and control your PHI. Certain records relating to substance use disorder (SUD) diagnosis, treatment, or referral may receive additional confidentiality protections under 42 CFR Part 2.
We are required by law to maintain the privacy and security of your PHI, provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect. We may change this Notice and make the revised Notice effective for PHI we already maintain as well as PHI we receive in the future. The current Notice will be available on our website and upon request. Effective Date: October 19, 2026.
1. Uses and Disclosures of Protected Health Information
Your PHI may be used and disclosed by your clinician, our workforce, and others involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed to support the operations of FSC. The examples below are not exhaustive.
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your health care and related services, including coordination with other health care providers. We may disclose PHI to clinicians, laboratories, pharmacies, hospitals, therapists, case managers, or other providers involved in your care when permitted by law. Additional restrictions may apply to records protected by 42 CFR Part 2.
Payment: We may use and disclose your PHI, as permitted by law, to obtain payment for services provided by FSC, including eligibility verification, prior authorization, claims submission, utilization review, and collection activities. Additional restrictions may apply to Part 2 records.
Health Care Operations: We may use or disclose PHI as needed to support our business and clinical operations, including quality assessment, staff review and training, licensing, credentialing, auditing, compliance, care coordination, and other activities permitted by law.
Business Associates: We may share PHI with third-party business associates that perform services for FSC, such as billing, health information technology, secure communications, transcription, scribing, or documentation support. When HIPAA requires it, we enter into a Business Associate Agreement or other appropriate written agreement requiring the business associate to safeguard PHI.
Artificial Intelligence and Technology-Assisted Documentation: FSC may use secure technology, including artificial intelligence-assisted documentation, electronic scribing, transcription, and similar documentation-support tools, to assist clinicians in preparing and maintaining clinical documentation. When these technologies create, receive, maintain, or transmit PHI on behalf of FSC, they are used subject to applicable privacy and security requirements, Business Associate Agreements when required, and additional confidentiality protections applicable to Part 2 records. Technology-assisted documentation supports, but does not replace, the professional judgment of the treating clinician. Clinicians remain responsible for reviewing and completing clinical documentation. If a technology uses ambient listening, audio capture, recording, or another function for which additional notice or consent is required, FSC will provide appropriate notice and obtain any required consent before use.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Agree or Object
Required By Law: We may use or disclose PHI to the extent required by law. Any use or disclosure will be limited to the relevant legal requirements. More protective federal or state confidentiality laws, including 42 CFR Part 2 when applicable, will govern when they impose additional restrictions.
Public Health: We may disclose PHI for public health activities and purposes to an authority authorized by law to collect or receive the information, including activities intended to prevent or control disease, injury, or disability.
Communicable Diseases: We may disclose PHI, when authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure, disciplinary actions, or other activities necessary for appropriate oversight of the health care system.
Abuse, Neglect, or Domestic Violence: We may disclose PHI to an authorized governmental or public health authority when permitted or required by law regarding suspected child abuse or neglect, abuse of a vulnerable adult, neglect, or domestic violence. Disclosures will be made consistent with applicable federal and state law.
Food and Drug Administration: We may disclose PHI to persons or organizations subject to FDA jurisdiction when required or permitted for activities related to the quality, safety, or effectiveness of FDA-regulated products or activities.
Legal Proceedings: We may disclose PHI in judicial or administrative proceedings when permitted or required by applicable law. Records protected by 42 CFR Part 2 generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you unless you provide the written consent required by Part 2 or a court order and subpoena or other legal process satisfying Part 2 requirements authorizes the use or disclosure.
Law Enforcement: We may disclose PHI for law enforcement purposes only when applicable legal requirements are met. Part 2 records receive additional protections and generally may not be used to initiate or substantiate a criminal charge against a patient or to conduct a criminal investigation of a patient except as specifically permitted by Part 2.
Coroners, Medical Examiners, Funeral Directors, and Organ Donation: We may disclose PHI as permitted by law for identification, determining cause of death, performance of authorized duties, funeral arrangements, or cadaveric organ, eye, or tissue donation.
Research: We may use or disclose PHI for research when the applicable HIPAA and other legal requirements have been satisfied, such as authorization by the individual or approval of an appropriate waiver. Part 2 records are subject to additional requirements.
Serious Threat to Health or Safety: Consistent with applicable federal and state law, we may disclose PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, to a person reasonably able to prevent or lessen the threat. Additional restrictions may apply to Part 2 records.
Military Activity and National Security: When applicable legal conditions are met, we may use or disclose PHI for certain military, veterans, national security, intelligence, and protective-service activities authorized by law.
Workers’ Compensation: We may disclose PHI as authorized by and to the extent necessary to comply with workers’ compensation or similar programs established by law.
Correctional Institutions and Custodial Situations: If you are an inmate or otherwise in lawful custody, we may disclose PHI to a correctional institution or law enforcement official as permitted by HIPAA and other applicable law. Additional restrictions may apply to Part 2 records.
Uses and Disclosures Requiring Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted or required by law. Written authorization is generally required for most uses and disclosures of psychotherapy notes, certain uses or disclosures of SUD counseling notes protected by Part 2, most marketing uses, and a sale of PHI. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
Uses and Disclosures That Require an Opportunity to Agree or Object
Others Involved in Your Health Care or Payment for Your Care: Unless you object, we may disclose PHI directly relevant to the involvement of a family member, relative, close friend, caregiver, or another person you identify in your care or payment for care. If you are not present or cannot agree or object, we may use professional judgment to determine whether a disclosure is in your best interests. We may also use or disclose PHI to assist in disaster relief efforts as permitted by law. Part 2 records may be disclosed only as permitted by Part 2.
2. Special Protections for Substance Use Disorder Records - 42 CFR Part 2
Certain records relating to SUD diagnosis, treatment, or referral maintained by FSC may be protected by 42 CFR Part 2 in addition to HIPAA. When Part 2 applies, FSC will use and disclose those records only as permitted by Part 2 and other applicable law.
Treatment, Payment, and Health Care Operations: When permitted by Part 2 and based on a valid consent when required, Part 2 records may be used or disclosed for treatment, payment, and health care operations. Information disclosed pursuant to a valid Part 2 consent may be redisclosed as permitted by HIPAA unless otherwise prohibited by Part 2 or other applicable law.
Proceedings Against You: Part 2 records, or testimony describing the content of Part 2 records, generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you unless you provide the written consent required by Part 2 or an appropriate court order and subpoena or other legal process meeting Part 2 requirements authorizes the use or disclosure.
SUD Counseling Notes: Separate authorization may be required for certain uses and disclosures of SUD counseling notes, subject to exceptions permitted by law.
Breach Notification: Part 2 records are subject to applicable breach-notification requirements. FSC will notify affected individuals as required by law following a breach of unsecured PHI or Part 2 records.
Complaints Concerning Part 2 Records: You may file a complaint concerning the privacy of Part 2 records with FSC or the U.S. Department of Health and Human Services, Office for Civil Rights. FSC will not retaliate against you for filing a complaint.
3. Your Rights
Inspect and Obtain a Copy: You have the right to inspect and obtain an electronic or paper copy of health information maintained about you in a designated record set, subject to limitations permitted by law. We will provide access within the time required by law and may charge a reasonable, cost-based fee when permitted.
Request an Amendment: You may ask us to correct or amend PHI that you believe is incorrect or incomplete. We may deny certain requests as permitted by law and will provide a written explanation when required.
Request Restrictions: You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We generally are not required to agree to all requested restrictions. When you pay in full out of pocket for a health care item or service, you may ask us not to disclose information about that item or service to your health plan for payment or health care operations, and we will honor the request when required by law.
Confidential Communications: You may request that we contact you in a specific way or at a specific location. We will accommodate reasonable requests as required by law and will not require you to explain the reason for the request.
Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI made during the period allowed by law. The accounting does not include every type of disclosure; exclusions and limitations established by law apply.
Copy of This Notice: You have the right to obtain a paper or electronic copy of this Notice upon request, even if you previously agreed to receive it electronically.
Choose Someone to Act for You: If you have given someone medical power of attorney or another person is legally authorized to act on your behalf, that person may exercise your privacy rights as permitted by law. We may verify the person’s authority before acting.
4. Our Responsibilities
FSC is required by law to maintain the privacy and security of your PHI; follow the duties and privacy practices described in the Notice currently in effect; provide you with a copy of this Notice; and notify affected individuals when a breach requires notification under applicable law. FSC will apply the additional confidentiality requirements of 42 CFR Part 2 when those requirements apply to your records.
We will not use or disclose your PHI in a manner materially inconsistent with this Notice unless the use or disclosure is authorized by you or otherwise permitted or required by law.
5. Complaints
You may complain to FSC or to the U.S. Department of Health and Human Services, Office for Civil Rights, if you believe your privacy rights have been violated. You may file a complaint with FSC by contacting our Privacy Officer. FSC will not retaliate against you for filing a complaint.
Attn: Privacy Officer
Four Square Clinicals (FSC)
100 N Arlington Ave, Suite 340A
Reno, NV 89501
Phone: 775-238-3082
Email: info@fsclinicals.com
Website: www.fsclinicals.com
You may request a paper copy of this Notice at any FSC office or obtain the current version from our website. The current Notice applies to the FSC locations and health care services covered by this Notice.
NOTICE REGARDING STATE LAW
Federal and state laws may provide privacy protections that are more restrictive than HIPAA. FSC will comply with applicable federal and state confidentiality laws, including laws governing mental health information, substance use disorder records, and other specially protected health information.
Effective Date: October 19, 2026