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Horizon
Human Services is required by law to:
This
Notice of Privacy Practices tells you: ·
How we may use
and share your protected health information for treatment, billing, or program
operations and other reasons permitted or required by law. ·
How to access and
control your protected health information. “Protected health information”
is any information that may identify you or relates to your past, present or
future health care services. ·
We have to follow
the terms of this Notice. ·
We can change the
terms of our Notice, at any time. When
you ask, we will provide you with the changed Notice in the following ways: o
Accessing our
website o
Calling the
office o
Requesting a
revised copy be sent to you in the mail o
Asking for a copy
at the time of your next appointment. ·
The new Notice
will only apply to the protected health information we receive after the date
of the new Notice. How
we can use your protected health information when you give us written
permission. ·
Before we can use
your protected health information, you will be asked to sign an authorization
form. ·
After you have
signed an authorization form, those who are involved in your treatment may use
and/or share your protected health information for treatment, billing and
program operations. ·
Here are some
examples of how we may use and/or share your protected health information: o
To provide,
coordinate, or manage your treatment and/or services such as reviewing
services provided to you and utilization review activities. o
Billing to a
third party payor (AHCCCS, Insurance Companies, etc.) when you have also
signed authorization with the third party payor. o
Your protected
health information may be shared with your primary care physician to make sure
that the physician has the necessary information to diagnose or treat you. o
We may share your
protected health information with other providers who, at the request of your
physician, may become involved in your care. o
To support Agency
activities such as quality assessment, employee review, and training of agency
staff. o
Other reasons we
may use and/or share your protected health information will be made only with
your written authorization, unless otherwise permitted or required by law. o
You may cancel
the authorization in writing at any time with the understanding that
information may have been used and/or shared before you canceled.
We
may use and/or share your protected health information when you have been
given a chance to agree or disagree. ·
You have the
opportunity to agree or disagree to the use or sharing of any part of your
protected health information. ·
If you are not
present or able to agree or disagree, we may use and/or share your protected
health information if we decide it is in your best interest. In this case,
only the protected health information about your treatment may be used and/or
shared. Others
Involved in Your Healthcare:
·
Unless you
disagree, we may share your protected health information with a member of your
family, a close friend or any other person you choose, only as it relates to
that person’s involvement in your treatment such as o
Relevant
information about your treatment, location, or general condition o
In the event of
your death. ·
We may use and/or
share your protected health information with authorized public or private
official(s) who may be involved in disaster relief efforts. Emergencies:
·
We may use and/or
share your protected health information in an emergency treatment situation. o
We will try to
obtain your written authorization as soon as possible after the emergency
treatment. o
If we are
required by law to treat you and have attempted to obtain your written
authorization, but we are unable to obtain it, we may still use and/or share
your protected health information in order to treat you. Communication
Barriers: ·
We may use and/or
share your protected health information if: o
There are any
significant communication problems (such as a different primary language or
need for an interpreter), o
We try, but are
unable, to obtain written authorization and o
We determine that
you intended to give permission for the use and/or sharing of your information
under the circumstances. Protected
health information we can use and/or share without your written authorization.
·
We may use and/or
share your protected health information in the following situations: Required
By Law:
· If we are required by law to use and/or share any part of your protected health information, you will be notified.
Public Health:
·
We may use and/or
share your protected health information with a public health authority for the
following reasons: o
Controlling
disease, injury, and/or disability. o
To inform any
foreign public health agency if there is risk of spreading contagious
disease(s) and/or condition(s).
Communicable Diseases:
·
We may share your
protected health information, if authorized by law, with a person who may have
been exposed to a disease or may otherwise be at risk of contracting or
spreading the disease(s) and/or condition(s). Health
Oversight:
·
We may share your
protected health information with a health oversight agency for these reasons: o
Activities
authorized by law (such as audits, investigations, and inspections). o
Oversight
agencies include government agencies that oversee the health care system (such
as government benefit programs, other government regulatory programs and civil
rights laws). Abuse
or Neglect:
·
We may share your
protected health information with any public health agency authorized by law
to receive reports in the case of: o
Child abuse or
neglect o
You have been a
victim of abuse, neglect or domestic violence Food
and Drug Administration:
·
We may share your
protected health information with a person or company required by the Food and
Drug Administration to report the following: o
Adverse events,
product defects and/or problems o
To track products o
To enable product
recalls, make repairs or replacements Legal
Proceedings:
·
We may share your
protected health information for the following legal reasons: o
In response to a
court order (only protected health information specified in the order) o
In certain
conditions in response to a subpoena or other lawful process Law
Enforcement:
·
We may also share
your protected health information for these law enforcement reasons: o
Legal processes
and otherwise required by law o
Limited
information requests for identification and location purposes o
Information about
victims of a crime o
Suspicion that
death has occurred as a result of criminal conduct o
In the event that
a crime occurs on our agency property o
Medical emergency
not on our agency property and it is likely that a crime has occurred Coroners,
Funeral Directors, and Organ Donation:
·
We may share your
protected health information with a coroner or medical examiner for: o
Identification
purposes, determining cause of death, and/or to perform other duties
authorized by law ·
We may share your
protected health information with a funeral director, as authorized by law: o
In order to
permit the funeral director to carry out their duties o
To inform the
funeral director in reasonable anticipation of death ·
Your protected
health information may be used and/or shared for organ, eye or tissue donation
reasons. Research:
·
We may share your
protected health information with researchers when our agency review board has
reviewed the research proposal and established ways to make sure your privacy
is protected. Criminal
Activity:
·
We may share your
protected health information as required by federal and state law(s) when: o
We believe it is
necessary to prevent or lessen a serious and imminent threat to the health or
safety of a person or the public o
If it is
necessary for law enforcement officers to identify or apprehend an individual Military
Activity and National Security:
·
When the
appropriate conditions apply, we may use and/or share protected health
information if you are in the Armed Forces for the following reasons: o
Activities deemed
necessary by appropriate military command authorities o
Determination by
the Department of Veterans Affairs of your eligibility for benefits o
To a foreign
military authority if you are a member of that foreign military service o
To authorized
federal officials for conducting national security and intelligence activities o
Provision of
protective services to the President or others legally authorized. Workers’
Compensation:
·
We may use and/or
share your protected health information as authorized to comply with
workers’ compensation laws and other similar legally-established programs. Inmates:
·
We may use and/or
share your protected health information if you are an inmate of a correctional
facility and we created or received your protected health information in the
course of providing care to you. Required
Uses and Disclosures:
·
Under the law, we
must share your protected health information with you, and when required by
the Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of the Health Insurance
Portability and Accountability Act of 1996.
Your Rights ·
The following is
a statement of your rights with respect to your protected health information
and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health
information. ·
For as long as we
maintain our records, you may look at and/or get a copy of your protected
health information including: o
Medical, billing,
and any other records used in making treatment decisions about you. ·
You may not
inspect and/or copy the following records: o
Psychotherapy
notes; o
Information
compiled in reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and o
Protected health
information that is subject to law that prohibits access to protected health
information. ·
In some cases, a
decision to deny access to your record may be reviewed. o Contact our Privacy Officer to request a review of your record ·
You have
the right to request a restriction of your protected health information. ·
You may ask us
not to use and/or share any part of your protected health information: o
For the purposes
of treatment, payment or healthcare operations o
To family members
or friends who may be involved in your care o
For notification
purposes as described in this Notice ·
Your request must
state the specific restriction(s) requested and to whom you want the
restriction to apply. ·
We are not
required to agree to any restriction that you may request. ·
If we believe it
is in your best interest to permit use and/or sharing of your protected health
information, your protected health information will not be restricted. ·
If we do agree to
the requested restriction, we may not use and/or share your protected health
information unless it is needed to provide emergency treatment. ·
Any restriction
you wish to request may be discussed with our Privacy Officer. ·
You have
the right to request to receive confidential communications from us by
alternative means or at an alternative location. ·
We will
accommodate reasonable requests. o
We will ask you
to tell us: §
How to get
confidential information to you §
Where we will
send this information ·
A specific
alternate address ·
A specific method
of contact o
We will not
request an explanation from you as to the basis for the request. o
Please make this
request in writing to our Privacy Officer. ·
You may
have the right to have us change your protected health information. ·
You may request
your protected health information to be changed for as long as we maintain
this information in your record. ·
We may deny your
request for any change. ·
If we deny your
request for any change: o
You have the
right to file a statement of disagreement o
We will prepare a
timely response to your statement o
We will provide
you with a copy of any such response ·
Please contact
our Privacy Officer to change your protected health information ·
You have
the right to receive an account of certain information we have shared, if any,
of your protected health information. ·
This right
applies to information shared for purposes other than treatment, payment or
program operations as described in this Notice. ·
This right excludes
the following: o
Information we
may have shared with you o
Information about
you we may have shared with family members or friends involved in your care
for notification purposes. ·
You have the
right to receive specific information about your protected health information
used and/or shared by us after April 14, 2003. ·
You may request a
shorter timeframe. ·
The right to
receive this information is subject to certain exceptions, restrictions and
limitations. ·
You have
the right to obtain a paper copy of this notice. ·
Upon request to
us, even if you have agreed to accept this notice electronically.
Complaints ·
If you believe
your privacy rights have been violated, you may submit your complaint in
writing to Horizon Human Services’ Privacy Officer, at 120 West Main Street,
Casa Grande, AZ 85222.
·
For further
information about the complaint process, contact our Privacy Officer by phone
at (520) 836-1688 or by e-mail at horizon@horizonhumanservices.org ·
If we cannot
resolve your concern, you have the right to file a written complaint with the
United States’ Secretary of the Department of Health and Human Services.
·
We will not
retaliate against you for filing a complaint.
·
The quality of
your care will not be jeopardized nor will you be penalized for filing a
complaint.
Changes to this policy ·
Horizon Human
Services reserves the right to change this Notice.
·
Horizon Human
Services reserves the right to make the revised Notice effective for the
protected health information Horizon Human Services already has about you, as
well as any information we will receive following the revision. ·
Horizon Human
Services will post a copy of the current Notice on its website.
·
The Notice will
contain the effective date at the bottom of each page.
Other Uses and Disclosures ·
Other uses and/or
sharing of your protected health information not covered by this Notice
will be made only with your written authorization.
There is a possibility that your protected health information may be
re-used and/or shared by others who may have received your information.
·
If you provide us
with written authorization to use and/or share your protected health
information, you may revoke that authorization, in writing, at any time.
·
If you revoke
your written authorization, Horizon Human Services will no longer use and/or
share your protected health information for the reasons covered by the
authorization. ·
Horizon Human
Services is unable to take back any information already used and/or shared
based on your authorization.
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