PLEASE READ IT CAREFULLY
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
DM Phoenix understands that your medical information and your health are personal. We are committed to protecting your medical information. DM Phoenix creates a record of the care and services you receive during your enrollment. We need this record to provide you with quality care and to comply with certain legal requirements. This “Notice of Privacy Practices” applies to all the records of your care generated and/or maintained by DM Phoenix, including the following people and organizations:
- Any health care professional who is authorized to enter information in your record;
- Any member of a volunteer group that we allow to help you while you are receiving services.
This Notice will tell you about the ways in which we may use and disclose your medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. DM Phoenix is required by law to:
- Make sure that medical information that identifies you is kept private.
- Make sure that you are given notice of our legal duties and privacy practices with respect to your medical information.
- Make sure that DM Phoenix follows the terms of the “Notice of Privacy Practices” that is currently in effect.
How We May Use or Disclose Your Medical Information
The following describes different ways we use and disclose 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 sections entitled “Substance Abuse 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, and other behavioral health professionals who are involved in your care.
- For Payment. We may use and disclose your medical information so that the services you receive may be billed and payment may be collected from payers, such as the Arizona Division of Behavioral Health Services/Department of Behavioral Health Services (ADHS/DBHS), the Regional Behavioral Health Authority (RBHA), your insurance company, or a third party.
- For Health Care Operations. We may use and disclose your medical information for business activities of DM Phoenix. These uses and disclosures are necessary for administrative functions and to ensure resident receive quality care. For example, we may use your medical information during a review by the Arizona Department of Health Services/Office of Behavioral Health Licensure or the Regional Behavioral Health Authority so they can evaluate our performance and program compliance in caring for you.
- Individuals Involved in Your Care. We may disclose your medical information to a family member actively involved in your care as allowed under Arizona state law and in accordance with DM Phoenix policies and procedures. This information is limited and will not be disclosed without first obtaining your written authorization.
- Substance Abuse Information. The privacy of alcohol and drug abuse medical information is protected by federal law and regulations (42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3) and regulation (42 C.F.R. part 2). Generally, DM Phoenix may not disclose that a resident attends substance abuse services or disclose any information identifying a resident as an alcohol or drug abuser, unless:
- The resident gives authorization in writing, (a general authorization for the disclosure of medical information is not enough for this purpose), or
- The disclosure is allowed by a valid court order, or
- The disclosure is made to medical personnel in a medical emergency or to a qualified staff person for research, audit, or program evaluation, or
- The resident commits or threatens to commit a crime either at DM Phoenix or against any person who works for DM.
Violations of the federal law and regulations by DM Phoenix are a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs, or to the Clinical Director of DM Phoenix. Federal law and regulations do not protect any information about suspected child abuse and neglect from being reported under state law to appropriate state or local authorities.
- HIV Information. All medical information regarding HIV is kept strictly confidential and disclosed only in accordance with the requirements of 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 disclosure of medical information is not enough for this purpose.
Uses and Disclosures for Purposes of Public Responsibility
Federal and state laws require DM Phoenix to use and/or disclose your medical information in certain circumstances that include, but are not limited to, the situations described below.
- As Required By Law. We may disclose your medical information when required to do so by federal, state, or local law.
- 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; or
- To notify the appropriate government authority if we believe a resident has been the victim of abuse, neglect, or domestic violence. We will make this disclosure when required or authorized by law.
- Health Oversight Activities. We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities may include, for example, 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 rights 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 DM Phoenix policies and procedures.
- Law Enforcement. 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, we may disclose your medical information if asked to do so by a law enforcement official.
- Coroners, Medical Examiners, and Funeral Directors. We may disclose your medical information to a coroner or medical examiner. This may be necessary for identification or to determine the cause of death. We may also disclose your medical information to funeral directors as necessary to carry out their duties.
- Research. Under certain limited circumstances, we may use and disclose your medical information for research or for research purposes. For example, a research project may involve the care and recovery of all residents 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.
- National Security and Intelligence Activities. We may disclose 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.
Your Rights Regarding Your Medical Information
- 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/or copy your medical information, contact the Clinical Director. Requests must be in writing and you will be charged .25 per page for all copies plus postage if you need your documents mailed. Faxed or secured emailed records can be completed at no charge. Your request to inspect and copy your medical information may be denied in certain limited circumstances. If you are denied access to all or 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 DM Phoenix. To request an amendment, your request must be made in writing and submitted to the Clinical Director. 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 DM Phoenix;
- 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 the disclosures we made of your medical information to others outside of DM Phoenix. The accounting does not include medical information disclosed as a part of treatment, payment, or health care operations as described above. The accounting does not include disclosures that were authorized by you in writing or disclosures of your medical information to you. To request an accounting of disclosures, you must submit your written request to the Clinical Director. Your request must specify a period for an accounting that may not be longer than six years and may not include dates before September 1st, 2019.
- 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 comply with your request, we reserve the right to use or disclose medical information as needed to provide you emergency treatment. To request a restriction, you must make your request in writing to the Clinical Director. In your request, you must tell us what information you want to us to limit 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. 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 Clinical Director. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted and how payment for services will be handled as applicable.
- Right to Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time by requesting it from any staff member at DM Phoenix.
Changes to the “Notice of Privacy Practices”
DM Phoenix reserves the right to change this Notice. DM Phoenix reserves the right to make the revised notice effective for your medical information that DM Phoenix already has about you, as well as any medical information we will receive following the revision. DM Phoenix will post a copy of the current Notice at all physical locations of this agency. The Notice will contain the effective date at the bottom of each page. DM Phoenix will make you aware of any revisions by posting the revised Notice in all the above locations.
If you believe your privacy rights have been violated, you may submit your complaint in writing to the Clinical Director. If we cannot resolve your concern, you also have the right to file a written complaint with the United States Secretary of the Department of Health and Human Services. The quality of your care will not be jeopardized, nor will you be penalized for filing a complaint.
Office of Civil Rights
US Department of Health and Human Services
Deputy Regional Manager
2201 6th Avenue, MS RX-11
Seattle Washington, 98121
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, we will no longer use or disclose your medical information for the reasons covered by the authorization. DM Phoenix is unable to take back any disclosures already made based on your authorization.