Notice of Privacy Practices
We are required to:
- Maintain the privacy of your health information;
- Provide you with this notice of our legal duties and information practices with respect to information we collect and maintain about you;
- Notify you if we learn there has been a breach of your unsecured information; and
- Abide by the terms of this notice.
You have several rights regarding your health information. Those include the right to:
- Request that we not use or disclose your health information in certain ways;
- Request to receive communications in an alternative manner or location;
- Access and obtain a copy of your health information;
- Request an amendment to your health information; and
- Request an accounting of disclosures of your health information.
Entities Covered Under This Notice
Each time you visit a medical provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment and a plan for future care or treatment. This information, often referred to as your health record or medical record, serves the following purposes;
- Basis for planning your care and treatment
- Communication among health professionals involved in your care
- Legal document describing the care you received
- Proof that services billed were provided
- A tool to educate health professionals
- A source of data for medical research
- A source of information for public health officials who oversee the delivery of health care
- A tool to measure and improve the care we give
Understanding what is in your record and how your health information is used helps you to:
- Ensure its accuracy
- Understand who, what, where and why others may access your health information
- Make informed decisions when authorizing disclosure to others.
How We Will Use or Disclose Your Health Information
For Treatment. We will use and disclose your personal health information in providing you with treatment and services. We may disclose your personal health information to personnel who may be involved in your care, such as physicians, nurses, nurse aides, physical therapists, dietary and admissions personnel. For example, a nurse caring for you will report any change in your condition to your physician. We may also disclose personal health information to health care professionals who may be involved in your care after you are no longer in our care.
For Payment. We may use and disclose your personal health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your personal health information to your representative, an insurance or managed care company, Medicare, Medicaid or another third-party payer. For example, we may contact Medicare or your health plan to obtain payment, to confirm your coverage or to request prior approval for a proposed treatment or service.
For Health Care Operations. We may use and disclose your personal health information for our regular health care operations. These uses, and disclosures are necessary to manage our operations and to monitor our quality of care. For example, we may use personal health information to evaluate our services, including the performance of our staff. In addition, the entities covered by this Notice may disclose your personal health information to one another to develop treatment protocols.
Business Associates. Outside people and entities provide some services for us. Examples of these “business associates” include our accountants, consultants, and attorneys. We may disclose your health information to our business associates so that they can perform the job we’ve asked them to do. We require the business associates to safeguard your information so that it is protected.
Notification. We may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your care, of your location and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number that they/you have provided us, e.g. on an answering machine.
Communication with Family. We may disclose to a family member, or other relative, close friend or any other person involved in your health care, health information relevant to that person’s involvement in your care or payment related to your care.
Research. We may disclose information to researchers when certain conditions have been met.
Transfer of Information at Death. We may disclose health information to funeral directors, medical examiners, and coroners to carry out their duties, consistent with applicable law.
Organ Procurement Organizations. Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.
Food and Drug Administration (FDA). We may disclose to the FDA, or to a person or entity subject to jurisdiction of the FDA, health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recall, repairs or replacement.
Worker’s Compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Public Health. We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Correctional Institution. Should you be an inmate of a correctional institution, we may disclose to the institution or its agents, health information necessary for your health and the health and safety of other individuals.
Law Enforcement. In some circumstances, we may need to disclose health information to law enforcement officials. For example, we may disclose your health information in response to a search warrant or a grand jury subpoena, or to assist law enforcement officials in identifying or locating an individual, to report deaths that may have resulted from criminal conduct, and to report criminal conduct at one of our offices. We may also disclose health information necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Reports. Federal law allows a member of our work force or a business associate to release your health information to an appropriate health oversight agency, public health authority or attorney, if the work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
Health Oversight Agencies. We may disclose your health information to a government agency that oversees our operations or its personnel, such as the state Department of Health Services, the federal or state agencies that oversee Medicare and Medicaid, and professional licensing boards that license and investigate medical and nursing professionals. These agencies need health information to monitor our operations and its personnel’s compliance with state and federal laws.
Military, Veterans, National Security and Other Government Purposes. We may disclose health information about members of the armed forces, as required by military command authorities or to the Department of Veterans Affairs. If requested to do so, we will also provide information to federal officials for intelligence and national security purposes or for presidential protective services.
Judicial Proceedings. We may be ordered to disclose health information by a judge in a court or administrative proceeding or in response to a subpoena.
Electronic Disclosure. Your personal health information is also subject to electronic disclosure. We will obtain your authorization for any electronic disclosure that is not authorized or required by state or federal law.
Marketing. We may use your health information to provide you with certain refill reminders, for treatment, case management or care coordination, to direct or recommend alternative treatments, therapies, health care providers, or settings of care, or to describe a health-related product or service provided by us. We will obtain your authorization prior to using or disclosing your information for purposes of marketing items and services to you and where we are paid to make a communication. We will not obtain your authorization for face-to-face marketing communications or if it provides you with a promotional gift of nominal value.
Charitable Contributions. We may contact you in the future to raise donations for us or our programs. You have the right to opt out of receiving such communications. If you do not want to be contacted for fundraising, please call (844) 399-5338 or e-mail email@example.com.
Required by Law. Federal, state, or local laws sometimes require us to disclose your health information. For instance, we are required to report child abuse or neglect and must provide information to law enforcement officials in domestic violence cases.
Information with Additional Protection. Certain types of medical information have additional protection under state law. In some circumstances, we will require your consent to disclose information about communicable disease and HIV/AIDS, drug and alcohol abuse treatment, genetic testing, and mental health treatment. In addition, records belonging to patients of Arizona’s Department of Developmental Disabilities may be subject to additional protections.
Psychotherapy Notes. We will not use or disclose your psychotherapy notes without your authorization, unless the use is by the person who wrote the notes for purposes of treatment, for training of medical or counseling professionals, or for us to defend ourselves in a legal proceeding brought by you. In addition, any other disclosure or use of psychotherapy notes must be to the Department of Health and Human Services; required by law; for the health oversight of the practitioner that wrote the notes; to the coroner or medical examiner; or to avert a serious threat to the health or safety of a person or the public.
Other Uses and Disclosures. If we wish to use or disclose your health information for a purpose that is not discussed in this Notice, we will seek your permission. For example, we must obtain your permission to sell your health information. Whenever you provide permission to use of disclosure your health information, you may take back your permission at any time, unless we have already acted on your permission. To revoke your permission, please write to the applicable agency office: Attention Privacy Officer.
Your Health Information Rights
You have the following rights regarding your personal health information:
Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment or health care operations. You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment of your care. Your request should be submitted in writing to the address listed below.
We are generally not required to agree to your requested restriction. However, we must agree to your request to not share your health information with your health insurer about a service which you (or someone other than your insurer) has paid us in full and where the disclosure is for the purpose of carrying out payment or health care operations and where the disclosure is not otherwise required by law. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.
Right of Access to Personal Health Information. You have the right to inspect and obtain a copy of your medical records or billing records or other written information that may be used to make decisions about your care, subject to some limited exceptions. Such records will be provided to you in the time frames established by law. If permitted by law, we may charge a reasonable fee for our costs in copying and mailing your requested information. If you are requesting records from an office in Colorado, we will deliver the medical records in electronic format if you or your personal representative requests electronic format, the original medical records are stored in electronic format, and the medical records are readily producible in electronic format. Your request should be submitted in writing to the address listed below.
We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to personal health information, in some cases you will have the right to request a review of the denial.
Right to Request Amendments. If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information. Such requests must be made in writing to the address listed below and must provide a reason to support the amendment.
We may deny your request for amendment in certain circumstances. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of the disclosures we make of your personal health information. This is the listing of certain disclosures of your personal health information made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions.
To request an accounting of disclosures, you must submit a request in writing to the mailing address listed below, stating a time period beginning within six years from the date of your request. An accounting will include, if requested; the disclosure date; the name of the person or entity that received the information and the address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or a copy of the authorization request; or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs. Requests should be submitted to the address listed below.
Right to Receive a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice, even if you have agreed to receive this notice electronically. You may request a paper copy of this notice at any time by contacting us at the telephone number and addresses listed below.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.
Right to be Notified in the Event of a Breach. In the event we determine that the confidentiality of your unsecured health information has been breached, you have the right to be notified.
Right to Revoke Authorization. You may revoke an authorization to use or disclose health information, except to the extent that action has already been taken. This request must be made in writing to the applicable address listed below.
For More Information or to Report a Problem.
If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the Office of Civil Rights in the U. S. Department of Health and Human Services. To file a complaint with us or to obtain information about how to exercise any of your rights, you may contact the Corporate Privacy Officer by phone at (844) 399-5338, by email at firstname.lastname@example.org, or by mail at:
Attention: Privacy Officer
7025 North Scottsdale Road, Suite 200
Scottsdale, AZ 85253
To file a complaint with the Office of Civil Rights you may submit a complaint online at: https://www.hhs.gov/hipaa/filing-a-complaint/index.html You may also submit a complaint to the OCR via email at OCRComplaint@hhs.gov. We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.
Effective Date: 04.01.2021