Notice of Privacy Practices
This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
A federal regulation known as the “HIPAA Privacy Rule” requires that we provide a detailed notice, in writing of our privacy policies. We understand this notice is lengthy, however, the HIPAA Privacy Rule requires us to address many specific items in this notice.
I. OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
In this notice we describe the ways that we may use and disclose health information about our patients. The HIPAA privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “Protected Health Information” or “PHI.” We are required by law to:
- Maintain the privacy of PHI about you
- Give you notice of our legal duties and privacy practices with respect to “PHI”
- Comply with the terms of our Notice of Privacy Practices currently in effect
We reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you. If and when this Notice is changed, we will post a copy in our office in a prominent location and on our website. We will also provide you with a copy of the revised Notice upon your request to our Privacy Official identified at the end of this notice.
II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
The following categories describe the different ways we may use and disclose PHI for treatment, payment or health care operations. The examples included with each category do not list every type of use or disclosure that may fall within that category.
- Treatment: We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. We may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. For example, we may use and disclose PHI when you need a prescription, lab work, an x-ray or other health care services. In addition, we may use and disclose PHI about you when referring you to another health care provider. For example, if you are referred to another physician, we may disclose PHI to your new physician regarding whether you are allergic to any medications.
- We may also disclose PHI about you for the treatment activities of another health care provider. For example, we may send a report about your care from us to a physician that you are referred to so the physician may treat you.
- Payment: We may use and disclose PHI so we can bill and collect payment for the treatment and services provided to you. Before provided treatment or services, we may share details with our health plan concerning the services you are scheduled to receive. For example, we may ask for payment approval from your health plan before we provide care or services. We may use and disclose PHI to learn if your health plan will cover the cost of care and services we provide. We may use and disclose PHI to confirm you are receiving the appropriate amount of care to obtain payment for services. We may use and disclose PHI for billing, claims management and collection activities. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owned to us.We may also disclose PHI to another health care provider or to a company or health plan required to comply with the HIPAA Privacy Rule for the payment activities of that health care provider, company or health plan. For example, we may allow a health insurance company to review PHI for the insurance company’s activities to determine the insurance benefits to be paid for your care.
- Health Care Operations: We may use and disclose PHI in performing business activities that are called health care operations. Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs. We may use and disclose PHI about you in the following health care operations:
- Reviewing and improving the quality, efficiency and cost of care that we provide to our patients. For example, we may use PHI about you to develop ways to assist our physicians and staff in deciding how we can improve the medical treatment we provide to others
- Improving health care and lowering costs for groups of people who have similar health problems and helping to manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems, to give them information to insurance, about treatment alternatives, and education classes
- Reviewing and evaluating the skills, qualifications and performance of health care providers taking care of you and our other patients.
- Providing training programs for students, trainees, health care providers, or non-health care professionals (for example, billing personnel) to help them practice or improve their skills
- Cooperating with outside organizations that assess the quality of the care we provide
- Cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty. For example, we may use or disclose PHI so one of our nurses may become certified at having expertise in a specific field of nursing
- Cooperating with various people who review our activities. For example, PHI may be seen my doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in complying with the law and managing our business
- Assisting us in making plans for our agency’s future operations
- Resolving grievances within our agency
- Business planning and development, such as, cost-management analysis
- Business management and general administrative activities of our agency, including managing our activities related to complying with the HIPAA Privacy Rule and other legal documents
- Creating “de-identified” information that is not identifiable to any individual
If another health care provider, company or health plan that is required to comply with the HIPAA Privacy Rule has or once had a relationship with you, we may disclose PHI about you for certain health care operations to that health care provider or company. For example, such health care operations may include: reviewing and improving quality, efficiency and cost of care provided to you; reviewing and evaluating the skills, qualifications, and performance of health care providers; providing training programs for students, trainees, health care providers or non-health care providers or non-health care professionals; cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty; and assisting with legal compliance activities of that health care provider or company.
We may also disclose PHI for the health care operations of an “organized health care arrangement” in which we participate. An example of an “organized health care arrangement” is the joint care provided by a hospital and the doctors who see patients at the hospital.
Communication from Our Office: We may contact you to provide information about treatment alternatives or other health related benefits and services that may be of interest to you.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION
Uses and Disclosures for Which You Have the Opportunity to Agree or Object: We may use and disclose PHI about you in some situations where you have the opportunity to agree or object. If you do not object, then we may make these types of uses and disclosures of PHI.
- Individuals Involved in Your Care or Payment for Your Care: We may disclose PHI about you to a family member, close friend, or any other person identified by you to act on your behalf if that information is directly relevant to the person’s involvement in your care or payment for your care. If you are present and able to consent or object (or if you are available in advance), then we may only use or disclose PHI if you do not object after you have been informed of your opportunity to object. If you are not present, or you are unable to consent or object, we may exercise professional judgement in determining whether the use or disclosure of PHI is in your best interest. We may also use and disclose PHI to notify such persons of your location, general condition, or death. We also may use professional judgement and experience with common practice to act on your behalf to pick up prescriptions, medical supplies, x-rays and other things containing PHI about you.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION AND OPPORTUNITY TO AGREE OR OBJECT
We may also use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.
Required by Law: We may use and disclose PHI as required by federal, state, or local law. Any disclosure complies with the law and is limited to the requirements of the law.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
Public Health Activities: We may use or disclose PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
- To prevent or control disease, injury or disability
- To report disease, injury, birth or death
- To report child abuse or neglect
- To report reactions to medications or problems with products or devices regulated by the Federal Food and Drug Administration or other activities related to quality, safety, or effectiveness of FDA regulated products or activities
- To locate and notify persons of recalls of products they may be using
- To notify a person who may have been exposed to a communicable disease in order to control who may be at risk of contracting or spreading the disease, or
- To report to your employer, under limited circumstances, information related primarily to workplace injuries or illness, or workplace medical surveillance.
Abuse, Neglect or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a person has been a victim of domestic violence, abuse or neglect.
Health Oversight Activities: We may disclose PHI to a health oversight agency for oversight activities including, for example, audits, investigations, inspections, licensure and disciplinary activities and other activities conducted by health oversight agencies to monitor the health care system, government health care programs, and compliance with certain laws.
Lawsuits and Other Legal Proceedings: We may use or disclose PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested.
Law Enforcement: Under certain conditions, we may disclose PHI to law enforcement officials for the following purposes where the disclosure is:
- About a suspected crime victim if, under certain circumstances, we are unable to obtain a person’s agreement because of incapacity or emergency
- To alert law enforcement of a death that we suspect was the result of criminal conduct
- Required by law
- In response to a court order, warrant, subpoena, summons, administrative agency request, or authorized process
- To identify or locate a suspect fugitive, material witness, or missing person
- About a crime or suspected crime committed at our office or,
- In response to a medical emergency not occurring at the office, if necessary, to report a crime, including the nature of the crime, the location of the crime or the victim, and the identity of the person who committed the crime.
Coroners, Medical Examiners, Funeral Directors: We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by law, so they may carry out their job functions.
Organ and Tissue Donation: If you are and organ donor, we may use or disclose PHI to organizations that help procure, locate, and transplant organs in order to facilitate an organ, eye, or tissue donation and transplantation.
Research: We may use and disclose PHI about you for research purposes under certain limited circumstances. We must obtain a written authorization to use and disclose PHI about you for research purposes except in situations where a research project meets specific, detailed, criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI.
To Avert a Serious Threat to Health or Safety: We may use or disclose PHI about you in limited circumstances when necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can only be made to a person who is able to help prevent the threat.
Specialized Government Functions: Under certain circumstances we may disclose PHI:
- For certain military and veteran activities, including determination of eligibility for veterans benefits and where deemed necessary by military command authorities
- For national security and intelligence activities
- To help provide protective services for the president and others
- For the health or safety of inmates and others at correctional institutions or other law enforcement custodial situations for the general safety and health related to correction facilities.
Disclosures Required by HIPAA Privacy Rule: We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose PHI to you upon your request to access PHI or for an accounting of certain disclosures of PHI about you (those requests are described in Section III. of this Notice).
Workers’ Compensation: We may disclose PHI as authorized by workers’ compensation laws or similar programs that provide benefits for work related injuries or illness.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR AUTHORIZATION
All other uses and disclosures of PHI about you (e.g. marketing, sale of your information or psychotherapy notes) will only be made with your written authorization. If you have authorized us to use or disclose PHI about you, you may revoke your authorization at any time, except to the extent we have taken action based on authorization.
III. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
Under federal law, you have the following rights regarding PHI about you:
- Right to Request Restrictions: You have the right to request additional restrictions on the PHI that we may use for treatment, payment, and health care operations. You may also request additional restrictions on our disclosure of PHI to certain individuals involved in your care that otherwise are permitted by the Privacy Rule. We are not required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Official. In your request, please include: (1) the information you want to restrict (2) how you want to restrict information (for example, restricting use to this office only, restricting disclosure to persons outside this office or restricting both); and (3) to whom you want these restrictions to apply.
- Right to Receive Confidential Communications: You have the right to request to receive communications regarding PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. You must make your request in writing to our Privacy Official. You must specify how you would like to be contacted (for example, by regular mail to your post office box and not your home). We are required to accommodate reasonable requests.
- Right to Inspect and Copy: You have the right to request the opportunity to inspect and receive a copy of PHI about you in certain records that we maintain. This includes your medical and billing records but does not include psychotherapy notes or information gathered for civil, criminal or administrative proceeding. We may deny your request to inspect and copy PHI only in limited circumstances. To inspect and copy PHI, please contact our Privacy Official. If you request a copy of PHI regarding yourself, we may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request. We will provide records usually within 30 days of your request.
- Right to Amend: You have the right to request that we amend PHI about you as long as such information is kept by or for our office. To make this type of request, you must submit your request in writing to our Privacy Official. You must also give us a reason for your request. We may deny your request in certain cases, including if it is not in writing or no reason is given for the request. We will tell you why in writing within 60 days.
- Right to Receive an Accounting of Disclosures: You have the right to request an “accounting” of certain disclosures that we have made of PHI about you. This is a list of disclosures made by us during a specified period of up to six (6) years, other than disclosures made for treatment, payment and health care operations; for use in or related to a facility directory; pursuant to an authorization of you or your personal representative, or for certain notification purposes (including national security, intelligence, correctional and law enforcement purposes) and disclosure made prior to April 1, 2003. If you wish to make such a request, please contact our Privacy Official. The first list that you request in a 12-month period will be free, but we may charge you for reasonable costs of providing additional lists in the same 12-month period. We will communicate these costs to you, and you may choose to cancel your request at any time before costs are incurred.
- Right to a Copy of this notice: You have the right to receive a paper or electronic copy of this Notice at any time. You are entitled to a paper or electronic copy of this Notice, even if you previously agreed to receive this notice either via paper or electronically.
If you believe your privacy rights have been violated, you may file a complaint with us, or the Secretary of the United States Department of Health and Human Services for Civil Rights by sending a letter to: 200 Independence Avenue, S.W. Washington D.C. 20201, calling 1-877-696-6775 or visiting: www.hhs.gov/ocr/privacy/hipaa/complaints/. To file a complaint with our office, please contact our Privacy Official. We will not retaliate against you for filing a complaint.
If you have questions about this notice, please contact our Privacy Official.
VI. PRIVACY OFFICIAL CONTACT INFORMATION
You may contact our privacy official at the following address and telephone number:
Professional Health Care Network
7600 N. 16th Street, Suite 140
Phoenix, Arizona 85020
This notice, revised October 2019, was published and first effective April 1, 2003.