Notice
of Privacy Practices
 | Make
certain that medical information that identifies you is kept private |
| Make certain that you are given notice of our legal duties and privacy practices with respect to your medical information |
| Make
certain that Pinal Hispanic Council and its provider network follow the
terms of the Notice of Privacy Practices that is currently in effect |
|
HOW
WE MAY USE OR DISCLOSE MEDICAL INFORMATION ABOUT YOU |
The
following describes different ways we use and disclose your medical information.
If you are receiving services for the evaluation or treatment of
substance abuse or Human Immunodeficiency Virus (HIV) conditions, specific rules
apply to the use and disclosure of information related to those services.
Please refer to the section entitled Substance Abuse Health Information
and HIV Information for those rules.
√ For
Treatment. We
may use your medical information to provide you with behavioral health treatment
or services. We may disclose your
medical information to psychiatrists, your primary care physician, nurses,
therapists, case managers or other behavioral health professionals who are
involved in your case. For example,
a psychiatrist treating you may need to know if you have allergies to certain
psychotropic medications. The
psychiatrist may need to contact your primary care physician to obtain that
information. Different departments
within Pinal Hispanic Council may also share your medical information to arrange
services you may need. Different
departments of your provider network may also share your medical information in
order to coordinate the services you need, such as medications, therapy, or case
management. If you are in jail,
Pinal Hispanic Council may share your medical information with necessary medical
personnel to coordinate your ongoing care.
√ For
Payment. We
may use and disclose your medical information so that the treatment and services
you receive may be billed and payment may be collected from appropriate payers,
such as an insurance company or a third party.
For example, we may need to give your network provider medical
information about treatment you received at the hospital so the hospital can
receive payment. Your network
provider may share your medical information with your insurance company or a
third party payer to check that you qualify for services, or to obtain approval
for the services requested.
√ For
Health Care Operations.
We may use and disclose your medical information for the business
activities of Pinal Hispanic Council and its network providers.
These uses and disclosures are necessary for administrative functioning
and to ensure our members receive quality care.
For example, one of our network may use your medical information to
review services and to evaluate our performance in caring for you.
We may combine medical information about many members to decide what
additional services Pinal Hispanic Council and its provider network should
offer, what services are needed, and whether certain new treatments are
effective. We may use and disclose
your medical information to assess Pinal Hispanic Council’s compliance with
the Arizona Department of Health Services, AHCCCS, or the Joint Commission on
Accreditation of Healthcare standards. For
example, this disclosure may be required to evaluate the quality of services we
provide or to resolve a specific treatment issue you have raised.
√ Individuals Involved in Your Care.
We may release your medical information to a family
member actively involved in your care and treatment as allowed under
SUBSTANCE ABUSE HEALTH INFORMATION. All medical information regarding substance abuse is kept strictly confidential and released only in conformance with the requirements of federal law (42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3) and regulation (42 C.F.R. part 2). Disclosure of any medical information referencing alcohol or substance abuse may only be made with your written authorization. A general authorization for the release of medical or other information is not sufficient for this purpose.
HIV INFORMATION. All medical information regarding HIV is kept strictly confidential and released only in conformance with the requirements of the state law (A.R.S. 36-664). Disclosure of any medical information referencing HIV status may only be made with your written authorization. A general authorization for the release of medical or other information is not sufficient for this purpose.
SPECIAL
CIRCUMSTANCES. Federal and state laws allow or require Pinal
Hispanic Council and its contracted provider network to disclose your medical
information in certain special circumstances that include, but are not limited
to, the situations described below.
√ Public
Health (Health and Safety for you and/or others). We may
disclose your medical information for public health activities.
We may use and disclose your medical information to a public health
authority, when necessary, to prevent a serious threat to your health and safety
or the health and safety of the public or another person.
These activities generally include the following:
§
To prevent or control disease, injury or disability
§
To report births or deaths
§
To report child abuse or neglect
§
To report reactions to medications
§
To notify people of recalls regarding medications they may be using
§
To notify a person who may have been exposed to a disease or may be at
risk for contracting a disease
§
To avert a serious threat to the health or safety of a person or the
public
§
To notify the appropriate government authority if we believe a member
has been the victim of abuse, neglect, or domestic violence.
We will make this disclosure when required or authorized by law.
√ Research.
Under certain limited circumstances, we may use and
disclose your medical information for research purposes.
For example, a research project may involve the care and recovery of all
members who receive one medication for the same condition.
All research projects are subject to a special approval process. We will
obtain your written authorization if the researcher will use or disclose your
medical information.
√ Health Oversight Activities.
We may disclose
your medical information to a health oversight agency for activities
authorized by law. These oversight
activities may include audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor the
behavioral health care system, government programs, and compliance with civil
right laws.
√ Lawsuits
and Disputes.
If you are involved in a lawsuit or legal action, we may disclose your
medical information in response to a valid court or administrative order, a
valid subpoena, a discovery request, or other lawful process that complies with
state law and Pinal Hispanic Council policies and procedures.
√ Law
Enforcement.
We may release your medical information is asked to do so by a law
enforcement official:
| In
response to a valid court order, subpoena, warrant, summons, or similar
lawful process that complies with state law and Pinal Hispanic Council
policies and procedures |
| 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 authorization |
| About
a death we believe may have been the result of criminal conduct |
| About
criminal conduct that occurs at Pinal Hispanic Council or at a provider
network |
| 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 your medical information to a coroner or medical examiner.
This may be necessary for identification or to determine a cause of
death. We may also release your
medical information to funeral directors as necessary to carry out their duties.
√ National Security and
Intelligence Activities. We
may release your medical information to authorized federal officials for
intelligence, counterintelligence, and other national security activities
authorized by law.
√ Protective Services for the President and Others.
We may disclose your medical information to authorized federal officials
so they may provide protection to the President or other authorized persons.
√ As
Required By Law.
We may disclose your medical information when required to do so by
federal, state, or local law.
|
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU |
√ Right to Access. You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy your medical information, contact the Pinal Hispanic Council Privacy Officer. If you request a copy of the information, you may receive one copy each year at no cost. For any additional copies during the same year, you may be charged a fee for the costs of copying, mailing, or other supplies associated with your request. Your request to inspect and copy your medical information may be denied in certain limited circumstances. If you are denied access to all, or any part, of your medical information, you may request that the denial be reviewed. Information regarding how to initiate the review process will be provided in writing at the time of any denial of access to your medical information.
√ Right
to Amend.
If you feel that your medical information is incorrect or incomplete, you
may ask us to amend the information. You
have the right to request an amendment for as long as your medical information
is kept by Pinal Hispanic Council. To
request an amendment, your request must be made in writing and submitted to the
Pinal Hispanic Council Privacy Officer. You
must provide a reason that supports your request.
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 kept by or for Pinal Hispanic
Council
§
Is not part of the medical information which you would be permitted to
inspect or copy; or
§
Is accurate and complete
√ Right to an Accounting of
Disclosures. You have the
right to request an accounting of disclosures of your medical information.
This is a list of disclosures we made of your medical information to
others outside of Pinal Hispanic Council. The
accounting does not include information disclosed as a part of treatment,
payment, or health care operations. The
accounting does not include disclosures that were authorized by you in writing.
To request this accounting, you must submit your request in writing to
the Pinal Hispanic Council Privacy Officer.
Your request must state a period of time for the accounting that may not
be longer that six years and may not include dates before
√ Right to Request
Restrictions. You have the
right to request a restriction on the medical information we use or disclose
about you. We are not required to
agree to your request. If we do not
agree, we will comply with your request, unless the information is needed to
provide you emergency treatment. To
request a restriction, you must make your request in writing to the Pinal
Hispanic Council Privacy Officer. In
your request, you must tell us what information you want to restrict, and to
whom you want the restriction to apply.
√ 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 if you believe that you will be otherwise
endangered. For example, you can ask
that we only contact you at a certain telephone number or address. To request
confidential communications, you must make your request in writing to the Pinal
Hispanic Council Privacy Officer. We
will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
√ Right to Paper Copy of this
Notice. You have the right
to a paper copy of this privacy notice. You
may ask us to give you a copy of this privacy notice at any time by requesting
it from the Pinal Hispanic Council Privacy Officer.
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CHANGES
TO THIS NOTICE |
Pinal
Hispanic Council and its provider network reserve the right to change this
notice. Pinal Hispanic Council
reserves the right to make the revised notice effective for your medical
information that Pinal Hispanic Council and its provider network already have
about you, as well as any information we will receive following the revision.
Pinal Hispanic Council will post the notice at all of its service sites.
The notice will contain the effective date at the bottom of each page.
Pinal Hispanic Council and its provider network will make you aware of
any revisions by posting the revised notice in all the above locations.
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COMPLAINTS |
If
you believe your privacy rights have been violated, you may file a complaint
with Pinal Hispanic Council, Pinal Gila Behavioral Health Association (PGBHA) or
with the Secretary of the Department of Health and Human Services.
To file a complaint with Pinal Hispanic Council, contact the Pinal
Hispanic Council Privacy Officer at (520) 466-7765.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
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OTHER
USES AND DISCLOSURES |
Other uses and disclosures of your medical information not covered by this notice will be made only with your written authorization. If you provide us with written authorization to use or disclose your medical information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, Pinal Hispanic Council will no longer use or disclose your medical information for the reasons covered by the authorization. Pinal Hispanic Council and its provider network are unable to take back any disclosures already based on your authorization.