Effective Date: May 16, 2005 / Revised Date: July 1, 2012
THIS NOTICE DESCRIBES HOW 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, you may contact the Compliance Officer for Yavapai County Community Health Services (YCCHS) at (928) 442-5272 or the Department Director at (928) 771-3122.
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 care and services you receive from us. We need this record to provide you with quality care and to comply with certain laws. This Notice applies to all records that contain your personally identifiable health information. The Notice describes the privacy practices that Yavapai County Community Health Services and all of our employees and other personnel are required to follow in handling your protected health information.
The following categories describe different ways that we use and disclose protected health 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.
1. To provide and coordinate medical treatment for you. We create a record of the treatment and services you receive from us. The record may include your health history, symptoms, examination and test results, and other information about you and your health.
We may disclose the protected health information in your record to doctors, nurses, dentists, nutritionists or other YCCHS personnel who are involved in taking care of you. For example, a nurse or nutrition worker involved in your care may need to know if you have diabetes or another health condition because it may affect the recommendations they make for you. We may share your protected health information in order to coordinate the different things you need, such as prescriptions, lab work, and referrals to other health care providers and agencies. We may also disclose your protected health information to people outside this agency who may be involved in your treatment, such as another doctor or a case manager. This is done to coordinate and manage your health care.
2. Obtain payment for the services we provide you. We may use and disclose your protected health information in order to get paid for the treatment and services we have provided you. For instance, we may provide information about the services you have received from us to your health insurance plan or to federal or state funded programs that reimburse us for providing these services. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will pay for this treatment. We may also disclose your protected health information to other health care providers for their payment purposes.
3. To support the healthcare operations or business activities of the organization. We may use and disclose your protected health information to carry out activities that are necessary to run our operations and make sure that all of our patients receive quality care. For example, we may use your health information as a tool to review our treatment and services and to evaluate the performance of our personnel in caring for you. We may share your protected health information with third party “business associates” who provide services to us. In these cases, the “business associate” is required to sign a written agreement to ensure that your protected health information remains private.
YCCHS may use and disclose your protected health information without your written authorization under the following circumstances or situations:
Other Uses of Your Protected Health Information
Other uses and disclosures of your protected health information not covered by this Notice or the laws that apply to us will be made only with your valid written authorization. If you provide us authorization to use or disclose your protected health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by the authorization, except that we are unable to take back any disclosures that were made when the authorization was in effect, and we are required to retain our records of the care that we provided to you.
Although your medical record is the physical property of YCCHS, the protected health information in the record belongs to you. You have certain rights related to the protected health information that we maintain about you.
1. Right to Inspect and Obtain Copies
You have the right to inspect and request copies of your protected health information, with some limited exceptions. Usually this includes treatment and billing records. You may be denied access to psychotherapy notes, and information relating to legal proceedings, as well as certain other information. To inspect or obtain a copy your protected health information, you must complete and submit your request in writing to the Compliance Officer, 1090 Commerce Drive, Prescott, AZ 86305 or firstname.lastname@example.org . We may deny your request to inspect in certain limited circumstances. If you are denied access, you may request that the denial be reviewed. To obtain a copy of any or all of your PHI, your request will be forwarded to YCCHS’ Medical Record vendor. Copies are available for a nominal fee.
2. Right to Request an Amendment or Correction
If you feel that the protected health information maintained by us is incorrect or incomplete, you may request that we amend the information. Your request must be made in writing and must include the reason that supports your request. We may deny your request if, for example, you ask us to amend information that was not created by us, or you ask us to amend a record that is already accurate and complete. If we deny your request to amend, we will notify you in writing. You then have the right to submit a written statement of disagreement with our decision. If requested by you, your statement of disagreement will be included in your medical record and will be included in any future disclosure of the item you believe to be incomplete or incorrect.
3. Right to an Accounting of Disclosures
You have the right to request a list of the disclosures of your protected health information that we have made. The list will not include those disclosures made within YCCHS that relate to our own uses for treatment, payment and health care operations purposes. It also will not include disclosures made to you or with your authorization. Your request for an accounting of disclosures must be made in writing to the Compliance Officer, 1090 Commerce Drive, Prescott, AZ 86305 or email@example.com, and must state the time period for which you want an accounting. This time period may not be longer than 6 years and may not include dates before April 14, 2003. The first accounting that you request within a 12-month period will be free. We may charge for additional accountings within the 12-month period. You will be informed of the cost in advance and you may choose to withdraw or modify your request at that time.
4. Right to Request Restrictions on the Use and Disclosure of Your Protected Health Information
You have the right to request that we follow additional, special restrictions when we use or disclose your protected health information for treatment, payment or health care operations. Your request for a restriction must be made in writing. Your request must tell us: 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the restriction to apply. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed for an emergency or required by law.
5. Right to Request Confidential Communications
You have the right to request that we communicate with you about your appointments or other matters related to your treatment in a specific way or at a specific location. For example, you can ask that we only contact you at work or by mail. Your request to receive confidential communications must be in writing. Your request must specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.
6. Right to Receive a Paper Copy of this Notice
You may ask us to give you a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy.
If you want to exercise any of these rights, please ask to speak to the Compliance Officer or Records Clerk at any YCCHS office. The Records Clerk can assist you with your request.
We reserve the right to change the terms of 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 revised Notice in each of our facilities. Each Notice will clearly indicate its effective date. If we change our Notice, you may obtain a copy of the revised Notice by requesting one from our staff. The current Notice will also be posted at our website: www.YavapaiHealth.com
If you believe your privacy rights have been violated, you may file a complaint with Yavapai County Community Health Services or the Federal government. All complaints must be submitted in writing. YCCHS will not retaliate against anyone who files a complaint. To file a complaint, or if you have comments or questions about our privacy practices, you may speak to the Compliance Officer for Yavapai County Community Health Services or the Department Director at (928) 771-3122. The directions for filing a complaint with the Federal Government can be found at http://www.hhs.gov/ocr/hipaa. To file a complaint with the State contact the Arizona Department of Health Services at (602) 542-1025.
Yavapai County Community Health Services
928-771-3377 Prescott Valley
928-639-8130 or 928-639-8132 Cottonwood