HIPAA
Notice of Privacy Practices
Southern Arizona Center Against Sexual Assault
1632 N. Country Club Rd
Tucson, AZ 85716
(520) 327-1171
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.
This
Notice of Privacy Practices as required by the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA") describes
how the Southern Arizona Center Against Sexual Assault (the "Center")may
use and disclose your protected health information (PHI)
to carry out treatment, payment or health care operations (TPO)
and for other purposes that are permitted or required by law. It
also describes your rights to access and control your PHI. PHI is
information about you, including demographic information, that may
identify you and that relates to your past, present or future physical
or mental health or condition and related health care services.
Uses
and Disclosures of Protected Health Information
Your PHI may be used and disclosed by your therapist, or office
staff and others outside of our office that are involved in your
care and treatment for the purpose of providing health care services
to you, to pay your health care bills, and any other use required
by law.
Uses and Disclosures will be made only with your consent,
authorization or opportunity to object unless required by law.
You may revoke this authorization, at any time, in writing.
Treatment:
We will use and disclose your PHI to provide, coordinate, or manage
your health care and any related services. This includes the coordination
or management of your health care with a third party. Two examples
follow: 1) We would disclose your PHI, as necessary, to another
heath care agency that provides care to you. 2) Your PHI may be
provided to a physician to whom you have been referred to ensure
that the physician has the necessary information to diagnose or
treat you.
Payment:
Your PHI will be used, as needed, to obtain payment for your
health care services. For example, obtaining approval for payment
for our services may require that your relevant PHI be disclosed
to the health plan to obtain approval for therapy sessions.
Healthcare
Operations: We may use or disclose, as needed your PHI in order
to support the business activities of Center. These activities include,
but are not limited to, quality assessment, employee review, risk
management activities, staff member training, licensing and accreditation.
For
example, the Center regularly reviews the quality and content of
the clinical charts. This requires that actual clinical records
be reviewed on a random basis to ensure that clinical documentation
meet the regulatory requirements under which we operate.
We
will share your PHI with third party "Business Associates"
(e.g. an insurance company is an business associate) that perform
various activities for the Center. Whenever an arrangement between
our office and a business associate involves the use or disclosure
of your PHI, we will have a written contract that contains terms
that will protect the privacy of your PHI.
Your
Rights
Following
is a statement of your rights with respect to your protected health
information.
You
have the right to inspect and copy your PHI. Under federal law,
however, you may not inspect or copy the following records; psychotherapy
notes; information complied in reasonable anticipation of, or use
in, a civil, criminal, or administrative action or proceeding, and
PHI that is subject to law that prohibits access to PHI.
You
have the right to request a restriction of your PHI. This means
you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected
health information not be disclosed to family members or friends
who may be involved in your care or for notification purposes as
described in this Notice of Privacy Practices. Your request must
state the specific restriction requested and to whom you want the
restriction to apply.
Your therapist is not required to agree to a restriction that you
may request. If the therapist believes, it is in your best interest
to permit use and disclosure of your PHI, your PHI will not be restricted.
You then have the right to use another Healthcare Professional.
You
have the right to request to receive confidential communications
from us by alternative means or at an alternative location.
You
have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice alternatively,
i.e. electronically.
You
may have the right to have your therapist/physician amend your protected
health information. If we deny your request for amendment, you
have the right to file a statement of disagreement with us and we
may prepare a rebuttal to your statement and will provide you with
a copy of any such rebuttal.
You
have the right to receive an accounting of certain disclosures we
have made, if any, of your protected health information.
We
reserve the right to change the terms of this notice and will inform
you of any changes on your next visit or communication to the Center.
You then have the right to object or withdraw as proved in this
notice.
Complaints
You may complain to us or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our HIPAA Compliance Officer
of your complaint. We will not retaliate against you for filing
a complaint.
The
HIPAA Compliance Officer for the Center is the Data Systems Administrator
and can be contacted at 520-327-1171.
This
notice was published and becomes effective on/or before April 14,
2003.
We
are required by law to maintain the privacy of, and provide individuals
with, this notice of our legal duties and privacy practices with
respect to PHI. If you have any objections to this form, please
ask to speak with our HIPAA Compliance Officer in person or by phone
at our Main Phone Number.
