Notice of Privacy Practices
(THIS NOTICE DESCRIBES HOW MEDICAL, DENTAL, AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.) Effective date September 23, 2013 (Revised May 1, 2014)
PLEASE REVIEW CAREFULLY
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices of Desert Senita Community Health Center (DSCHC) regarding the use of your health information and that of:
- any of our healthcare professionals authorized to enter information into your medical, dental or behavioral health record
- all departments and units of Desert Senita Community Health Center, any member of a volunteer/student group we allow to help you while you are in our facility
- all employees, contracted staff and other DSCHC personnel
- all affiliates, sites and locations of the Desert Senita Community Health Center will follow the terms of this notice. In addition, these affiliates, sites and
- locations may share health information with each other for the treatment, payment or health care purposes described in this notice.
OUR PLEDGE REGARDING YOUR HEALTH CARE INFORMATION
We understand that medical information about you and your health is personal. Protecting medical information about you is important. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated at Desert Senita Community Health Center whether made by health care professionals or other personnel.
This notice will tell you about the ways in which we may use and disclose healthcare information about you. Disclosure, as appropriate, may be verbal communication, electronic transmission, paper record, or by fax. We also describe your rights and certain obligations we have regarding the use and disclosure of healthcare information.
We are required by law to:
- Keep personal healthcare information private;
- Give you this notice of our legal duties and privacy practices with respect to your healthcare information; and
- Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTHCARE INFORMATION ABOUT YOU
The following are examples of the types of permitted uses and disclosures of your protected healthcare information. These examples are not meant to be all inclusive, but rather to describe the types of uses and disclosures that may be made by our office once you have provided consent.
I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
- For Treatment Information obtained by a nurse, provider, or other member of your healthcare team will be recorded in your healthcare record and used to determine the course of treatment that should work best for you. We may disclose your health information to others who will need this information in order to treat you, for example another DSCHC provider, nurse practitioners, pharmacists, or others involved in your care. We may also disclose your protected health information to another healthcare provider (e.g., a specialist or laboratory) who, at the request of your DSCHC provider, becomes involved in your care by providing assistance with our healthcare diagnosis or treatment.
- For Payment We may use and disclose your protected health information for billing and collection purposes. For example, we may need to give your 3rd party payor/Health Plan information about your care so that they will pay us or reimburse you for this care. We may also provide information to your Health Plan or 3rd party payer about a treatment/service that has been ordered by your healthcare provider in order to obtain prior approval or to determine whether your plan will cover the treatment/service.
- For Healthcare Operations. We may use or disclose, as needed, your personal health information in order to support our business activities. These activities include, but are not limited to quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities.
- Other examples of healthcare operations might include:
- Use of a sign-in sheet at the front desk where you will be asked to sign your name.
- Calling you by name in the waiting room when your healthcare provider is ready to see you.
- We may contact you (by telephone or mail) to remind you about your appointment.
We will share your personal health information with 3rd party “business associates” that perform various activities for DSCHC. Whenever an arrangement between our office and a business associate involves the use or disclosure of your personal health information, we will have a written contract that contains terms that will protect the privacy of your health information. Some examples of our business associates would include X-ray interpretation services, contracted laboratory testing, medical transcription services, record copy service and record storage facilities.
II. OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT.We may use and disclose your personal health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your personal health information.
- Individuals Involved in Your Care or Payment for Your Care. Unless you object in advance, we may release protected health information about you to a friend or family member who is involved in your medical care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may also give information to someone who helps pay for your care. In addition, we may disclose personal health information about you to an authorized entity assisting with disaster relief efforts. We may allow family or friends to act on your behalf to pick up filled prescriptions, medical supplies, x-rays, and similar forms of personal health information, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
- Emergencies.We may use or disclose your protected health information in an emergency treatment situation should you be unable to consent prior to treatment. If this happens, we shall try to obtain your consent as soon as reasonably practicable after the treatment. If we are required by law to treat you and are unable to obtain your consent, we may still use or disclose your protected health information to treat you.
- Treatment Alternatives. We may use or disclose your personal health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services, that are available from DSCHC, that may be of interest to you. We may also send you information about products or services that we believe may be beneficial to you. You may contact our Privacy Officer to request that these materials not be sent to you.
- Fundraising Activities. We may use or disclose your demographic information in order to contact you for fundraising activities supported by our clinic. If you do not want to receive these materials, please contact our Privacy Officer and request that these fundraising materials not be sent to you.
III. OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT.
- As Required By Law. We will disclose your personal health information when required to do so by federal, state or local law.
- Research. We may disclose your personal health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your personal health information. For example, we may conduct a research project involving the review of healthcare records for all patients with specific types of medical conditions.
- Public Health Risks. We may disclose your personal health information for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report deaths
- To report child abuse or neglect
- To report reactions to medications or problems with products
- To notify people about 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 authority if we believe a patient has been the victim of abuse, neglect or domestic violence
- Worker’s Compensation. We may release your personal health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Coroners, Funeral Directors, and Organ Donation. We may release your personal health information to a coroner or medical examiner to assist with identifying the deceased or determining the cause of death. We may release your personal health information to a funeral director as necessary to carry out their duties. If you are an organ donor, we may release your personal 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.
- Military and Veterans. If you are a member of the armed forces, we may release your personal medical information as required by military command authorities.
- Health Oversight Activities. We may disclose your personal health information to a health oversight agency for activities authorized by law. Examples of oversight activities include 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.
- Legal Proceedings. We may release your personal health information in response to a subpoena, discovery request, or other lawful orders from a court or administrative tribunal (to the extent such disclosure is expressly authorized).
- Law Enforcement. We may release your health information if asked to do so by a law enforcement official as part of law enforcement activities; in investigations of criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or whenever required to do so by law.
- Inmate. We may use or disclose your personal health information if you are an inmate of a correctional facility and your healthcare provider created or received your personal health information in the course of providing care to you.
- Protected Services for the President, National Security and Intelligence Activities. We may release your personal health information to authorized federal officials so they may provide protection to the President, other authorized persons of foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.
IV. USES AND DISCLOSURES OF PERSONAL HEALTH INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION. Other uses and disclosures of your personal health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us permission to use or disclose your personal health information, you may revoke this authorization, at any time, in writing. If you revoke your permission, thereafter we will no longer use or disclose your personal health information 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 permission, and that we are required to retain our records of the care that we provide to you.
Authorization is required for: most uses and disclosures of psychotherapy notes, uses and disclosures of Protected Health Information for marketing purposes, and disclosures that constitute a sale of Protected Health Information.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Although your healthcare record is the physical property of the Desert Senita Community Health Center, the information belongs to you. You have the following rights regarding the healthcare information we maintain about you:
- Right to Inspect and Copy. You have the right to inspect and obtain a copy of healthcare information that may be used to make decisions about your care. Usually, this includes medical, dental, prescription, and billing records, but does not include psychotherapy notes.
To inspect and obtain a copy of healthcare information that may be used to make decisions about you, you must submit a written request to our Medical Records Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.We may deny your request to inspect and obtain a copy in certain very limited circumstances. It you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Desert Senita Community Health Center will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Amend. It you feel that the health 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. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. 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;
- Is not part of the medical information kept by the Desert Senita Community Health Center;
- 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 health information about you.To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12- month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the personal health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the personal health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.We are not required to agree to your request, with one exception*. 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 our Privacy Officer at the address below. In your request, you must tell us:
- What information you want to limit;
- Whether you want to limit our use of your information, disclosure to outside entities or both; and
- To whom you want the limits to apply.
* Exception: When you are paying for a service out of pocket and request we not provide it to the Health Plan, we must comply with the request.
- Right to Request Confidential Communications. You have the right to request that we communicate with you about health 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 our Privacy Officer. 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 he contacted.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time. You may request a copy of our most current privacy notice from our Registration Office or from the Privacy Officer.
- Breach Notification. A breach is, generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information (PHI) such that the use or disclosure poses a significant risk of financial, reputational, or other harm to the affected individual.If a breach occurs, you will be notified the Breach occurred no later than 60 days after the occurrence.
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 health 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. The notice will contain the effective date at the top of the first page.
COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with the Desert Senita Community Health Center or with the Secretary of the Department of Health and Human Services toll free at 1-877-696-6775. To file a complaint with the Desert Senita Community Health Center, contact our Privacy Officer at the address and phone number below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you have any questions about this notice, please contact:
Privacy Officer – Desert Senita Community Health Center • 410 Malacate Street • Ajo Arizona 85321• (520) 387 5651