ASCEND MENTAL HEALTH & WELLNESS
NOTICE OF PRIVACY PRACTICES
Effective Date: 8/19/2026
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Ascend Mental Health & Wellness (“Ascend,” “we,” “our,” or “the Practice”) is committed
to protecting the privacy and confidentiality of your health information.
This Notice explains how we may use and share your Protected Health Information
(“PHI”), the rights you have regarding that information, and our responsibilities for
protecting it.
You have rights regarding the health information we maintain about you.
Get a Copy of Your Health Record
You may ask to see or obtain an electronic or paper copy of your medical record and
other health information we maintain about you.
We will provide access within the time required by law and may charge a reasonable,
cost-based fee when permitted.
Certain information may be excluded from your right of access when permitted by law.
For example, HIPAA generally does not provide a right of access to psychotherapy
notes that meet the specific legal definition of psychotherapy notes and are maintained
separately from your medical record.
Ask Us to Correct Your Health Record
You may ask us to correct information in your health record that you believe is incorrect
or incomplete.
We may deny your request in certain circumstances permitted by law. If we deny your
request, we will explain the reason in writing and provide you with any additional rights
required by law.
Request Confidential Communications
You may ask us to contact you in a particular way or at a particular location.
For example, you may ask us to:
• use a particular telephone number;
• limit information left in voicemail;
• communicate through a particular email address; or
• send mail to a different address.
We will accommodate reasonable requests as required by law.
Please tell us if you have specific privacy concerns about how we communicate with
you.
Ask Us to Limit What We Use or Share
You may ask us not to use or disclose certain health information for treatment, payment,
or our health care operations.
We generally are not required to agree to every request. If we agree to a restriction, we
will follow it except when disclosure is otherwise permitted or required by law.
If you pay for a health care service in full out of pocket and ask us not to disclose
information about that service to your health plan for payment or health care operations,
we will honor that request when required by law.
Get a List of Certain Disclosures
You may ask for an accounting of certain disclosures we have made of your health
information during the six years before your request.
The accounting will include disclosures required by law to be included. Certain
disclosures, including many disclosures for treatment, payment, and health care
operations and disclosures you specifically authorized, generally are not included.
We will provide one accounting during a 12-month period without charge. We may
charge a reasonable, cost-based fee for additional requests during that period as
permitted by law.
Get a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you previously agreed
to receive it electronically.
The current Notice is also available through our website.
Choose Someone to Act for You
If another person has legal authority to act on your behalf regarding your health care or
health information, that person may exercise your applicable privacy rights.
We will verify the person’s identity and authority before allowing that person to act on
your behalf.
File a Privacy Complaint
If you believe your privacy rights have been violated, you may file a complaint with
Ascend by contacting our Privacy Officer:
Alexander Kamp, LCSW
Privacy Officer
Ascend Mental Health & Wellness
223 W Montauk Highway, Suite 102
Hampton Bays, NY 11946
Telephone: 631-594-3032
Email: alexk@ascendmhw.com
Website: ascendmhw.com
You may also file a complaint with the U.S. Department of Health and Human Services,
Office for Civil Rights.
We will not retaliate against you for filing a complaint or exercising your privacy rights.
For certain health information, you may tell us your preferences about what we share.
Family, Friends, and Others Involved in Your Care
You may tell us whether you want us to share relevant information with family members,
close friends, caregivers, or others involved in your care or payment for your care.
When you are present and able to make decisions, we will generally follow your wishes.
If you are unable to tell us your preference, such as during an emergency, we may
share information when permitted by law if, using professional judgment, we believe
doing so is in your best interest.
Being listed as your emergency contact does not automatically give someone
unrestricted access to your health information.
Marketing and Sale of Your Information
We will obtain your written authorization before using or disclosing your PHI for
marketing when authorization is required by law.
We will not sell your PHI without your written authorization when authorization is
required by law.
Fundraising
Ascend does not currently use patient PHI for fundraising.
If our practices change, we will comply with applicable notice, authorization, and opt-out
requirements.
HIPAA permits or requires us to use and disclose your health information in certain
circumstances without obtaining your written authorization.
The following are common examples.
Treat You
We may use your health information and share appropriate information with other health
care professionals involved in your care.
For example, your Ascend therapist and psychiatric provider may communicate about
your treatment, or we may coordinate care with another provider involved in your
treatment when permitted by law.
Run Our Practice
We may use and disclose your health information for activities necessary to operate our
Practice.
For example, we may use appropriate information for clinical supervision, quality
improvement, credentialing, compliance, auditing, workforce training, and other health
care operations permitted by law.
Bill for Your Services
We may use and disclose health information to bill and obtain payment for services.
For example, we may provide necessary information to your insurance company for
eligibility verification, prior authorization, claims processing, medical-necessity review,
or payment.
Help With Public Health and Safety
We may disclose health information in certain circumstances involving public health or
safety when permitted or required by law.
This may include:
• reporting suspected abuse or neglect when required or permitted by law;
• certain public-health reporting;
• reporting certain adverse events; and
• preventing or reducing a serious threat to someone’s health or safety when
permitted by law.
Comply With the Law
We may use or disclose your health information when federal or state law requires us to
do so.
When another law provides greater protection for your information than HIPAA, we will
follow the applicable more protective requirement.
Health Oversight
We may disclose health information to authorized health oversight agencies for
activities permitted by law, including audits, investigations, inspections, licensing, and
regulatory activities.
Workers’ Compensation, Law Enforcement, and Government Requests
We may disclose health information for workers’ compensation and certain law-enforcement or governmental purposes when permitted or required by law.
Additional protections may apply to mental health, psychotherapy, or substance use
disorder information.
Lawsuits and Legal Proceedings
We may disclose health information in response to certain court orders, subpoenas, or
other lawful legal processes when the requirements for disclosure have been satisfied.
A subpoena does not necessarily permit unrestricted disclosure of your health
information.
Mental health records, psychotherapy notes, privileged communications, and certain
substance use disorder records may receive additional legal protection.
Research
We may use or disclose health information for research only when permitted by law and
when applicable legal requirements and privacy protections have been satisfied.
Medical Examiners and Funeral Directors
We may disclose health information to a coroner, medical examiner, or funeral director
when permitted or required by law.
Because Ascend provides behavioral health services, much of the information we
maintain concerns mental health evaluation and treatment.
Mental health information is protected by HIPAA and may also receive additional
protection under New York law. When applicable law provides greater confidentiality
protection than HIPAA, we will comply with the more protective requirement.
HIPAA also provides special protections for psychotherapy notes. Psychotherapy notes
are narrowly defined notes created by a mental health professional documenting or
analyzing the contents of counseling conversations that are maintained separately from
the patient’s medical record.
Ordinary progress notes, diagnoses, symptoms, treatment plans, medication
information, prognosis, and documentation of progress generally are not psychotherapy
notes merely because they concern psychotherapy.
We generally will obtain your written authorization before using or disclosing
psychotherapy notes when HIPAA requires authorization.
Ascend is a general outpatient mental health practice and is not a federally assisted
substance use disorder treatment program subject to 42 C.F.R. Part 2.
Ascend may provide mental health care to patients who have substance use disorders
and may recommend or refer patients to specialized substance use disorder treatment
or a higher level of care when clinically appropriate.
Ascend may also receive or maintain substance use disorder treatment records from
other health care providers that are protected by the federal confidentiality law known as
42 C.F.R. Part 2 (“Part 2”).
When Ascend maintains information that is protected by Part 2, additional confidentiality
protections apply to that information.
To the extent we maintain Part 2-protected records:
• we will use and disclose those records only as permitted by applicable law;
• Part 2-protected information generally may not be used or disclosed in a
civil, criminal, administrative, or legislative investigation or proceeding against you
unless you provide the required written consent or the use or disclosure is authorized by
an appropriate court order and subpoena as required by law; and
• we will honor the additional privacy rights applicable to Part 2-protected
records.
Receiving or maintaining Part 2-protected records does not mean that Ascend itself is a
Part 2 substance use disorder treatment program.
Ascend may communicate with you using Practice-approved methods, including
telephone, voicemail, email, text messaging, patient portal communications, and
telehealth.
We use reasonable safeguards to protect your information. However, electronic
communications may present privacy or security risks.
You may request reasonable confidential communication preferences, such as asking
us to contact you only through a particular telephone number or email address.
When available and appropriate, the patient portal is generally the preferred electronic
method for exchanging sensitive clinical information.
Electronic messages should not be relied upon for emergency assistance.
We are required by law to maintain the privacy and security of your Protected Health
Information.
We are responsible for:
• protecting the privacy and security of your health information;
• providing you with this Notice describing our legal duties and privacy
practices;
• following the duties and privacy practices described in the Notice currently
in effect; and
• notifying you if a breach occurs when notification is required by law.
We will not use or disclose your health information other than as described in this Notice
unless you authorize us to do so in writing or the use or disclosure is otherwise
permitted or required by law.
If you give us written authorization, you may revoke that authorization in writing as
permitted by law. Revocation will not affect uses or disclosures already made in reliance
on a valid authorization before we received the revocation.
We may change the terms of this Notice and make the revised Notice effective for
health information we already maintain as well as information we receive in the future.
If we materially change our privacy practices, we will revise this Notice as required by
law.
The current Notice will be available upon request, at our Practice location, and on our
website.
If you have questions about this Notice, want to exercise a privacy right, or wish to
make a privacy complaint, please contact:
Alexander Kamp, LCSW
Privacy Officer
Ascend Mental Health & Wellness
223 W Montauk Highway, Suite 102
Hampton Bays, NY 11946
Telephone: 631-594-3032
Email: alexk@ascendmhw.com
Website: ascendmhw.com
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
Information about filing a health-information privacy complaint is available through the
HHS Office for Civil Rights.
Ascend will not retaliate against you for filing a complaint or exercising your privacy
rights.
Effective Date: 8/19/2026
ASCEND MENTAL HEALTH & WELLNESS
223 W Montauk Highway, Suite 102
Hampton Bays, NY 11946
ascendmhw.com
NOTICE OF PRIVACY PRACTICES
Effective Date: 8/19/2026
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Ascend Mental Health & Wellness (“Ascend,” “we,” “our,” or “the Practice”) is committed
to protecting the privacy and confidentiality of your health information.
This Notice explains how we may use and share your Protected Health Information
(“PHI”), the rights you have regarding that information, and our responsibilities for
protecting it.
YOUR RIGHTS
You have rights regarding the health information we maintain about you.
Get a Copy of Your Health Record
You may ask to see or obtain an electronic or paper copy of your medical record and
other health information we maintain about you.
We will provide access within the time required by law and may charge a reasonable,
cost-based fee when permitted.
Certain information may be excluded from your right of access when permitted by law.
For example, HIPAA generally does not provide a right of access to psychotherapy
notes that meet the specific legal definition of psychotherapy notes and are maintained
separately from your medical record.
Ask Us to Correct Your Health Record
You may ask us to correct information in your health record that you believe is incorrect
or incomplete.
We may deny your request in certain circumstances permitted by law. If we deny your
request, we will explain the reason in writing and provide you with any additional rights
required by law.
Request Confidential Communications
You may ask us to contact you in a particular way or at a particular location.
For example, you may ask us to:
• use a particular telephone number;
• limit information left in voicemail;
• communicate through a particular email address; or
• send mail to a different address.
We will accommodate reasonable requests as required by law.
Please tell us if you have specific privacy concerns about how we communicate with
you.
Ask Us to Limit What We Use or Share
You may ask us not to use or disclose certain health information for treatment, payment,
or our health care operations.
We generally are not required to agree to every request. If we agree to a restriction, we
will follow it except when disclosure is otherwise permitted or required by law.
If you pay for a health care service in full out of pocket and ask us not to disclose
information about that service to your health plan for payment or health care operations,
we will honor that request when required by law.
Get a List of Certain Disclosures
You may ask for an accounting of certain disclosures we have made of your health
information during the six years before your request.
The accounting will include disclosures required by law to be included. Certain
disclosures, including many disclosures for treatment, payment, and health care
operations and disclosures you specifically authorized, generally are not included.
We will provide one accounting during a 12-month period without charge. We may
charge a reasonable, cost-based fee for additional requests during that period as
permitted by law.
Get a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you previously agreed
to receive it electronically.
The current Notice is also available through our website.
Choose Someone to Act for You
If another person has legal authority to act on your behalf regarding your health care or
health information, that person may exercise your applicable privacy rights.
We will verify the person’s identity and authority before allowing that person to act on
your behalf.
File a Privacy Complaint
If you believe your privacy rights have been violated, you may file a complaint with
Ascend by contacting our Privacy Officer:
Alexander Kamp, LCSW
Privacy Officer
Ascend Mental Health & Wellness
223 W Montauk Highway, Suite 102
Hampton Bays, NY 11946
Telephone: 631-594-3032
Email: alexk@ascendmhw.com
Website: ascendmhw.com
You may also file a complaint with the U.S. Department of Health and Human Services,
Office for Civil Rights.
We will not retaliate against you for filing a complaint or exercising your privacy rights.
YOUR CHOICES
For certain health information, you may tell us your preferences about what we share.
Family, Friends, and Others Involved in Your Care
You may tell us whether you want us to share relevant information with family members,
close friends, caregivers, or others involved in your care or payment for your care.
When you are present and able to make decisions, we will generally follow your wishes.
If you are unable to tell us your preference, such as during an emergency, we may
share information when permitted by law if, using professional judgment, we believe
doing so is in your best interest.
Being listed as your emergency contact does not automatically give someone
unrestricted access to your health information.
Marketing and Sale of Your Information
We will obtain your written authorization before using or disclosing your PHI for
marketing when authorization is required by law.
We will not sell your PHI without your written authorization when authorization is
required by law.
Fundraising
Ascend does not currently use patient PHI for fundraising.
If our practices change, we will comply with applicable notice, authorization, and opt-out
requirements.
HOW WE MAY USE AND SHARE YOUR INFORMATION
HIPAA permits or requires us to use and disclose your health information in certain
circumstances without obtaining your written authorization.
The following are common examples.
Treat You
We may use your health information and share appropriate information with other health
care professionals involved in your care.
For example, your Ascend therapist and psychiatric provider may communicate about
your treatment, or we may coordinate care with another provider involved in your
treatment when permitted by law.
Run Our Practice
We may use and disclose your health information for activities necessary to operate our
Practice.
For example, we may use appropriate information for clinical supervision, quality
improvement, credentialing, compliance, auditing, workforce training, and other health
care operations permitted by law.
Bill for Your Services
We may use and disclose health information to bill and obtain payment for services.
For example, we may provide necessary information to your insurance company for
eligibility verification, prior authorization, claims processing, medical-necessity review,
or payment.
Help With Public Health and Safety
We may disclose health information in certain circumstances involving public health or
safety when permitted or required by law.
This may include:
• reporting suspected abuse or neglect when required or permitted by law;
• certain public-health reporting;
• reporting certain adverse events; and
• preventing or reducing a serious threat to someone’s health or safety when
permitted by law.
Comply With the Law
We may use or disclose your health information when federal or state law requires us to
do so.
When another law provides greater protection for your information than HIPAA, we will
follow the applicable more protective requirement.
Health Oversight
We may disclose health information to authorized health oversight agencies for
activities permitted by law, including audits, investigations, inspections, licensing, and
regulatory activities.
Workers’ Compensation, Law Enforcement, and Government Requests
We may disclose health information for workers’ compensation and certain law-enforcement or governmental purposes when permitted or required by law.
Additional protections may apply to mental health, psychotherapy, or substance use
disorder information.
Lawsuits and Legal Proceedings
We may disclose health information in response to certain court orders, subpoenas, or
other lawful legal processes when the requirements for disclosure have been satisfied.
A subpoena does not necessarily permit unrestricted disclosure of your health
information.
Mental health records, psychotherapy notes, privileged communications, and certain
substance use disorder records may receive additional legal protection.
Research
We may use or disclose health information for research only when permitted by law and
when applicable legal requirements and privacy protections have been satisfied.
Medical Examiners and Funeral Directors
We may disclose health information to a coroner, medical examiner, or funeral director
when permitted or required by law.
MENTAL HEALTH INFORMATION
Because Ascend provides behavioral health services, much of the information we
maintain concerns mental health evaluation and treatment.
Mental health information is protected by HIPAA and may also receive additional
protection under New York law. When applicable law provides greater confidentiality
protection than HIPAA, we will comply with the more protective requirement.
HIPAA also provides special protections for psychotherapy notes. Psychotherapy notes
are narrowly defined notes created by a mental health professional documenting or
analyzing the contents of counseling conversations that are maintained separately from
the patient’s medical record.
Ordinary progress notes, diagnoses, symptoms, treatment plans, medication
information, prognosis, and documentation of progress generally are not psychotherapy
notes merely because they concern psychotherapy.
We generally will obtain your written authorization before using or disclosing
psychotherapy notes when HIPAA requires authorization.
SUBSTANCE USE DISORDER INFORMATION
Ascend is a general outpatient mental health practice and is not a federally assisted
substance use disorder treatment program subject to 42 C.F.R. Part 2.
Ascend may provide mental health care to patients who have substance use disorders
and may recommend or refer patients to specialized substance use disorder treatment
or a higher level of care when clinically appropriate.
Ascend may also receive or maintain substance use disorder treatment records from
other health care providers that are protected by the federal confidentiality law known as
42 C.F.R. Part 2 (“Part 2”).
When Ascend maintains information that is protected by Part 2, additional confidentiality
protections apply to that information.
To the extent we maintain Part 2-protected records:
• we will use and disclose those records only as permitted by applicable law;
• Part 2-protected information generally may not be used or disclosed in a
civil, criminal, administrative, or legislative investigation or proceeding against you
unless you provide the required written consent or the use or disclosure is authorized by
an appropriate court order and subpoena as required by law; and
• we will honor the additional privacy rights applicable to Part 2-protected
records.
Receiving or maintaining Part 2-protected records does not mean that Ascend itself is a
Part 2 substance use disorder treatment program.
ELECTRONIC COMMUNICATIONS
Ascend may communicate with you using Practice-approved methods, including
telephone, voicemail, email, text messaging, patient portal communications, and
telehealth.
We use reasonable safeguards to protect your information. However, electronic
communications may present privacy or security risks.
You may request reasonable confidential communication preferences, such as asking
us to contact you only through a particular telephone number or email address.
When available and appropriate, the patient portal is generally the preferred electronic
method for exchanging sensitive clinical information.
Electronic messages should not be relied upon for emergency assistance.
OUR RESPONSIBILITIES
We are required by law to maintain the privacy and security of your Protected Health
Information.
We are responsible for:
• protecting the privacy and security of your health information;
• providing you with this Notice describing our legal duties and privacy
practices;
• following the duties and privacy practices described in the Notice currently
in effect; and
• notifying you if a breach occurs when notification is required by law.
We will not use or disclose your health information other than as described in this Notice
unless you authorize us to do so in writing or the use or disclosure is otherwise
permitted or required by law.
If you give us written authorization, you may revoke that authorization in writing as
permitted by law. Revocation will not affect uses or disclosures already made in reliance
on a valid authorization before we received the revocation.
CHANGES TO THIS NOTICE
We may change the terms of this Notice and make the revised Notice effective for
health information we already maintain as well as information we receive in the future.
If we materially change our privacy practices, we will revise this Notice as required by
law.
The current Notice will be available upon request, at our Practice location, and on our
website.
QUESTIONS OR COMPLAINTS
If you have questions about this Notice, want to exercise a privacy right, or wish to
make a privacy complaint, please contact:
Alexander Kamp, LCSW
Privacy Officer
Ascend Mental Health & Wellness
223 W Montauk Highway, Suite 102
Hampton Bays, NY 11946
Telephone: 631-594-3032
Email: alexk@ascendmhw.com
Website: ascendmhw.com
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
Information about filing a health-information privacy complaint is available through the
HHS Office for Civil Rights.
Ascend will not retaliate against you for filing a complaint or exercising your privacy
rights.
Effective Date: 8/19/2026
ASCEND MENTAL HEALTH & WELLNESS
223 W Montauk Highway, Suite 102
Hampton Bays, NY 11946
ascendmhw.com