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Client
Rights - Clinical (English)
Client
Rights - Non-Clinical (English) Client
Rights - Clinical (Spanish)
Client
Rights - Non-Clinical (Spanish)
HIPAA NOTICE
OF PRIVACY PRACTICES
Effective Date: 4-14-03
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.
If you have any questions about this Notice of Privacy Practices
("Notice"), please call the Privacy Officer at 520-622-7611.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health
is personal. We are committed to protecting medical information
about you. We create a record of the care and services you receive
at Arizona's Children Association ("AzCA"). We need this
record to provide you with quality care and to comply with legal
requirements. This notice applies to all medical information generated
by AzCA.
This notice will tell you about the ways in which we may use and
disclose health information about you. We also describe your rights
and certain obligations we have regarding the use and disclosure
of medical information.
THIS APPLIES TO THE FOLLOWING:
• Any behavioral health care professional authorized to enter
information into your Medical Record;
• All departments within AzCA;
• All members of the workforce of AzCA;
• All subcontractors which provide services to AzCA clients;
• All entities, sites and locations will follow the terms of
this Notice. Additionally, these entities, sites and locations may
share treatment information with each other for payment or operations
purposes described in this Notice.
Law requires us to:
• Make sure that medical information that identifies you is
kept private;
• Give you this Notice of our legal duties and privacy practices
with respect to medical information about you; and
• Follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and
disclose medical information. For each category of uses or disclosures
we will explain what we mean and try to give some examples. Not
every use or disclosure in a category will be listed. However, all
of the ways we are permitted to use and disclose information will
fall within one of the categories.
• For Treatment. We may use medical information
about you to provide you with medical treatment or services. We
may disclose medical information about you to doctors, nurses, technicians,
therapists, case managers or other AzCA personnel who are involved
in taking care of you. Many different staff members may share health
information about you in order to coordinate the different services
you need, such as prescriptions, lab work or x-rays. We also may
disclose medical information about you to people outside of AzCA
who may be involved in your medical care, such as family members,
clergy or others we use to provide services that are part of your
care.
• For Payment. We may use and disclose medical
information about you so that the treatment and services you receive
at AzCA may be billed to your payer and/or a third party. For example,
we may need to give your treatment information to the payer so that
we can receive payment. We may also give out your medical information
so that we can obtain prior approval for your treatment at AzCA.
• For Health Care Operations. We may use and
disclose medical information about you for our operations. These
uses and disclosures are necessary to run AzCA and make sure that
all of our clients receive quality care. For example, we may use
medical information to review our treatment and services and to
evaluate the performance of our staff in caring for you. We may
combine information about many clients to decide what additional
services we should offer, what services are not needed, and whether
certain new treatments are effective. We may remove information
that identifies you from this set of client information so others
may use it to study behavioral health care and behavioral health
care delivery without learning who the specific patients are.
• Appointment Reminders. We may use and disclose
information to contact you as a reminder that you have an appointment
for treatment at AzCA.
• Treatment Alternatives. We may use and disclose
medical information to tell you about, or recommend, possible treatment
options or alternatives that may be of interest to you.
• Health-Related Benefits and Services. We
may use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
• Research. Under certain circumstances, we
may use and disclose medical information about you for research
purposes. For example, a research project may involve comparing
the health and recovery of all clients who received one medication
to those who received another for the same condition. All research
projects, however, are subject to a special approval process. This
process evaluates a proposed research needs with clients need for
privacy of their medical information. Before we use or disclose
medical information for research, the project will have been approved
through this research approval process. We will always ask for your
specific authorization if the researcher will have access to you
name, address or other information that reveals who you are, or
will be involved in your care at AzCA.
• As Required By Law. We will disclose medical
information about you when required to do so by federal, state or
local law.
• To Avert a Serious Threat to Health or Safety.
We may use and disclose medical information about you when necessary
to prevent a serious threat to your health and safety or the health
and safety of the public or another person. (Any disclosure, however,
would be to someone able to protect public health and safety.)
• Public Health Responsibilities. We may disclose
medical information about you for public health activities. These
activities generally include the following:
• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report child abuse or neglect;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using;
• To notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease or condition;
• To notify the appropriate government authority if we believe
a client has been victim of abuse, neglect or domestic violence.
We will only make this disclosure if you agree or when required
or authorized by law.*
• Health Oversight Activities. We may disclose
medical information to a health oversight agency for activities
authorized by law. These oversight activities include, for example,
audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
• Lawsuits and Disputes. If you are involved
in a lawsuit or a dispute, we may disclose medical information about
you in response to a court or administrative order. We may also
disclose medical information about you in response to a subpoena,
discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you about
the request of to obtain an order protecting the information requested.
• Law Enforcement. We may release medical
information if asked to do so by a law enforcement official:
• In response to a court order, subpoena, warrant, summons
or similar process;
• To identify or locate a suspect, fugitive, material witness,
or missing person;
• About the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person's agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at any AzCA locations; and
• In emergency circumstances to report a crime, the location
of the crime or victims, or the identity, description or location
of the person who committed the crime.*
• Coroners, Medical Examiners and Funeral Directors.
We may release medical information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person
or determine the cause of death. We may also release information
about clients to the funeral directors as necessary to carry out
their duties.
• National Security and Intelligence Agencies.
We may disclose medical information about you to authorized federal
officials for intelligence, counterintelligence, and national security
activities authorized by law.
• Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement official,
we may release medical information about you to the correctional
institution or law enforcement official. This release would be necessary
(1) for the institution to provide you with health care; (2) to
protect your health and safety or the health and safety of others;
or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain
about you:
• 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. Usually, this includes medical and
billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing to
AzCA's Medical Records Department.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information,
you may request that the denial be reviewed.
• 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. You have the right to request an
amendment for as long as the information is kept by or for AzCA.
To request an amendment, your request must be made in writing and
submitted to AzCA's Medical Records Department. In addition, you
must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing
or does not include a reason to support the request. In addition,
we may deny your request if you ask us to amend information that:
• Was not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
• Is not part of the medical information created or maintained
by or for AzCA;
• Is not part of the information which you would be permitted
to inspect and copy; or
• Is accurate and complete.
• Right to an Accounting of Disclosures. You
have the right to request an accounting of disclosures. This is
a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit
your request in writing to AzCA's Medical Records Department. Your
request must state a time period that may not be longer than six
years and may not include dates before April 14, 2003. Your request
should indicate in what form you want the list (for example, on
paper or electronically). The first list you request within a 12-month
period will be free.
• Right to Request Restrictions. You have
the right to request a restriction on the medical information we
use or disclose about you for treatment, payment or health care
operations. You also have the right to request a restriction on
the medical information we disclose about you to someone who in
involved in you care or the payment for your care, like a family
member or friend.
We are not required to agree to your request. If we do agree, we
will comply with your request unless the information is needed to
provide you emergency treatment.
To request restrictions, you must make your request in writing to
AzCA's Medical Records Department. In your request, you must tell
us (1) what information you want to restrict; (2) whether you want
to restrict our use, disclosure or both; and (3) to whom you want
the restrictions to apply, for example, disclosure to your spouse.
• 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. For example,
you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request
in writing to AzCA's Medical Records Department. We will not ask
you the reason for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to be
contacted.
• Right to a Paper Copy of This Notice. You
have the 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 medical
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
at every AzCA site. This Notice will contain on the first page,
in the top right-hand corner, the effective date. In addition, each
time you enroll with AzCA, or visit an AZCA site for treatment or
health care services as an inpatient or outpatient, we will offer
you a copy of the current Notice in effect.
COMPLAINTS
• If you believe your privacy rights have been violated, you
may file a written complaint with AzCA's Privacy Officer, Arizona's
Children Association, 2700 S. 8th Avenue, Tucson, AZ 85713.
• If we cannot resolve your concerns, you have the right to
file a written complaint with the Secretary of Health & Human
Services.
You will not be penalized for filling a complaint.
OTHER USES OF MEDICAL INFORMATION.
• Other uses and disclosures of medical information not coveredby
this Notice or the laws that apply to us will be made only with
your written authorization. If you provide us authorization to use
or disclose medical information about you, you may revoke that authorization
in writing, at any time. If you revoke your authorization, we will
no longer use or disclose medical information about you for the
reasons covered by your written authorization. You understand that
we are unable to take back any disclosures we have already made
with your authorization, and that we are required to retain our
records of the care that we provided to you.
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