Effective Date: April 14, 2003
NOTICE OF PRIVACY PRACTICES
SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.
THIS NOTICE DESCRIBES HOW MEDICAL (BEHAVIORAL HEALTH) 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, please contact HIPAA Officer, SEABHS, P.O. Box 2161, Benson, AZ 85602; Phone: (520) 586 - 0800, ext. 205.
SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC. (SEABHS)
SEABHS is one of the contracted providers of the Community Partnership of Southern Arizona, Inc. (CPSA), the publicly funded Regional Behavioral Health Authority (RBHA) for Pima, Cochise, Graham, Greenlee, and Santa Cruz Counties. SEABHS provides behavioral health care for persons in Cochise, Graham, Greenlee, and Santa Cruz Counties. All client care is overseen and supervised by a Medical Director and provided by a team of health care professionals. Residents, postgraduate fellows, interns, medical students, and students of ancillary health care professions may participate in examinations or procedures and in the care of clients as a part of SEABHS programs.
This Notice applies to information and records regarding your health care kept at SEABHS.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION
We are committed to protecting health information about you. SEABHS creates a record of the care and services you receive at SEABHS for use in your care and treatment.
This Notice tells you about the ways that SEABHS may use and disclose health information about you. It also describes your rights and certain obligations SEABHS has about the use and disclosure of your health information.
SEABHS is required by law to:
• make sure that your health information is protected;
• give you this Notice describing our legal duties and privacy practices regarding health information about you; and
• follow the terms of the Notice that is currently in effect.
HOW SEABHS MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following describes different ways that SEABHS may use and disclose your 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 will be listed. All of the ways SEABHS is permitted to use and disclose information, however, will be in one of the following categories.
For Treatment. SEABHS may use health information about you to provide you with treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, or personnel who are involved in taking care of you at SEABHS. For example, a doctor treating you for psychological or psychiatric problems may need to know if you have diabetes because diabetes may affect your treatment process with SEABHS. We may also share health information about you with other SEABHS personnel or non-SEABHS providers, agencies, or facilities in order to provide or coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose health information about you to people outside SEABHS who may be involved in your continuing care after you leave SEABHS, including other health care providers, transport companies, other health care facilities, community agencies, family members, or others that are part of your care.
If SEABHS is providing emergency care to you before we can give you our Notice, we will give it to you as soon as possible after the emergency ends.
For Payment. We may use and disclose health information about you so that the treatment and services you receive at SEABHS may be billed to, and payment may be collected from, you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received at SEABHS so your health plan will pay us or reimburse you for the treatment. SEABHS may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations. We may use and disclose health information about you for SEABHS operations. These uses and disclosures are made to promote quality of care activities, compliance with law, regulations, professional staff bylaws, rules and regulations, contractual obligations, clients' claims, health sciences education, legal services, business planning and development, business management and administration, underwriting and other insurance activities, and to operate SEABHS. For example, SEABHS may use health information to review our treatment and services and to evaluate and improve the performance of our staff in caring for you. SEABHS may also disclose information to doctors, nurses, technicians, medical and other students, and other health system personnel for performance improvement and educational purposes.
Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or care at SEABHS.
Treatment Options. SEABHS may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Development and Fundraising Activities. We may contact you to provide you information about SEABHS sponsored activities, including fundraising programs and events. We only would use contact information, such as your name, address and phone number and the dates you received treatment or services at SEABHS.
Individuals Involved in Your Care. SEABHS may release health information to anyone involved in your care, e.g., a friend, family member, personal representative, or any individual you identify. SEABHS may also tell your family directly involved in your care about your general condition; or that you are in the SEAPHF (Southeastern Arizona Psychiatric Health Facility).
Disaster Relief Efforts. SEABHS may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
Research. SEABHS conducts research, planning, and evaluation to improve the quality of care of our services. All projects conducted by SEABHS must be approved through a special review process to protect client safety, welfare, and confidentiality. Your health information may be important to further efforts and the development of new knowledge.
To Prevent a Serious Threat to Health or Safety. SEABHS may use and disclose health information about you when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat.
Military and Veterans. If you are or were a member of the armed forces, SEABHS may release health information about you to military command authorities as required by law. SEABHS may also release health information about foreign military personnel to the appropriate foreign military authority as required by law.
Workers' Compensation. SEABHS may use or disclose health information about you for Workers' Compensation or similar programs as permitted or required by law. These programs provide benefits for work-related injuries or illness.
Public Health Risks. SEABHS may disclose health information about you for public health purposes. These purposes generally include the following:
• preventing or controlling disease (such as tuberculosis), injury or disability;
• reporting vital events such as deaths;
• reporting abuse, neglect, or exploitation;
• reporting adverse events or surveillance related to food, medications, or defects or problems with products;
• notifying persons of recalls, repairs, or replacements of products they may be using;
• notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Health Oversight Activities. SEABHS may disclose health information to governmental, licensing, auditing, and accrediting agencies for activities authorized by law.
Lawsuits and Other Legal Actions. In connection with lawsuits or other legal proceedings, SEABHS may disclose health information about you in response to a court or administrative order, or in response to a grand jury subpoena, discovery request, warrant, summons, or other lawful process.
Law Enforcement. In accordance with state and federal law, SEABHS may release health information:
• About criminal conduct at SEABHS; and
• In case of a medical emergency.
Coroners, Medical Examiners and Funeral Directors. In most circumstances, SEABHS may disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. SEABHS may also disclose health information about clients of SEABHS to funeral directors as necessary to carry out their duties.
Inmates. If you are an inmate of a correctional institution or under the custody of law enforcement officials, SEABHS may release health information about you to the correctional institution if required by law.
YOUR RIGHTS REGARDING HEATH INFORMATION ABOUT YOU
Your health information is the property of SEABHS. You have the following rights, however, regarding health information SEABHS keeps about you:
Right to Inspect and Copy. With certain exceptions, you have the right to review and/or get a copy of your health information.
To review and/or to get a copy of your health information, you must give your request in writing to: SEABHS Medical Records at the SEABHS site you where you receive, or received, services or treatment. If you ask for a copy of the information, SEABHS may charge a reasonable fee for these services.
SEABHS may deny your request to review and/or to get a copy, in certain limited circumstances (for example, access is reasonably likely to endanger the life or safety of you or someone else). If you are denied access to health information, in most cases, you may have the denial reviewed. Another behavioral health care professional chosen by SEABHS will review your request and the denial. SEABHS will follow the review’s suggestions/requirements.
You will receive a response to your written request within thirty (30) days if your protected health information is onsite (generally, you are actively receiving treatment) or sixty (60) days if your protected health information is offsite (generally, if you are not currently receiving treatment). SEABHS may have one thirty-day (30 day) time extension, as needed and with notice to you.
If you ask for information that SEABHS does not have, but we know who does have it, we will redirect you to the right individual or agency.
Right to Request an Amendment or Addendum. If you feel that health information SEABHS has about you is incorrect or incomplete, you may ask us to amend the information or add an addendum. You have the right to ask for an amendment or addendum for as long as the information is kept by or for SEABHS.
To ask for an amendment, you must ask in writing and send it to Medical Records at the SEABHS site where you receive, or received, services or treatment. You must give a reason that supports your request.
SEABHS will respond to your written request within sixty (60) days. SEABHS may deny your request for an amendment if it is not in writing or does not include a reason to support the request. Also, SEABHS may deny your request if you ask us to amend information that:
• Was not created by SEABHS;
• Is not part of the health information kept by or for SEABHS;
• Is not part of the information that you would be allowed to review and copy; or
• Is accurate and complete in the record.
If SEABHS denies your written request, you will receive: the reason for the denial; your right to submit a statement of disagreement; your right to request that the statement be included in your record; and how to appeal the denial.
An addendum must not be longer than 250 words per alleged incomplete or incorrect item in your record.
Right to an Accounting of Disclosures. You have the right to ask for an "accounting of disclosures." This is a list of the disclosures SEABHS has made of health information about you that were for purposes other than treatment, payment, health care operations, and certain other purposes.
To ask for this accounting of disclosures, you must send/give your request in writing to Medical Records at the SEABHS site where you receive, or received, services or treatment.
Your request must state a time period that may not be longer than the six (6) previous years and may not include dates before April 14, 2003. You are entitled to one (1) accounting within any twelve (12) month period at no cost. If you request a second accounting within that twelve (12) month period, SEABHS may charge you for the cost of the accounting. SEABHS will tell you of the cost involved and you may choose to withdraw or change your request at that time before any costs occur.
Right to Request Restrictions. You have the right to ask for a restriction or limitation on the health information SEABHS uses or discloses about you for treatment, payment or health care operations. You also have the right to ask for a limit on the health information SEABHS discloses about you to someone who is involved in your care or the payment for your care, such as a family member. For example, you could ask that SEABHS not use or disclose information about a treatment you had.
SEABHS is not required to agree to your request. If SEABHS does agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency treatment.
To ask for a restriction, you must make your request in writing to Medical Records at the SEABHS site where you receive, or received, services or treatment.
You 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 limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that SEABHS communicates with you about health matters in a certain way or at a certain location. For example, you can ask that SEABHS only contact you at work or by mail.
To ask for confidential communications, you must make your request in writing to Medical Records at the SEABHS site where you receive, or received, services or treatment. SEABHS will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a 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. You will be given a new copy of this Notice every three (3) years. To get a paper copy of this Notice, please ask any SEABHS staff for assistance.
CHANGES TO SEABHS' PRIVACY PRACTICES AND THIS NOTICE
SEABHS reserves the right to change our privacy practices and this Notice. SEABHS reserves the right to make the revised or changed Notice effective for health information we already have about you as well as any information we get in the future. We will post a copy of the current Notice at SEABHS sites. The Notice will contain the effective date on the first page in the top right-hand corner. Also, each time you register at or are admitted to SEABHS for treatment or behavioral health care services as an inpatient or outpatient, or treated at any of SEABHS outpatient clinics, you may request a copy of the current Notice.
If you believe your privacy rights described here have been violated, you may file a complaint, in writing, with the SEABHS HIPPA Officer, P.O. Box 2161, Benson, AZ 85602. FAX (520) 586 –7138 or Region IX, Office for Civil Rights, U.S. Department of Health and Human Services, 50 United Nations Plaza – Room 322, San Francisco, CA 94102. Voice Phone (415) 437 –8310. FAX (415) 437 – 8329. TDD (415) 437 – 8311. You may ask any SEABHS staff to assist you in filing a complaint.
You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you give us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, SEABHS will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that SEABHS is unable to take back any disclosures we have already made with your permission, and that we will keep our records of the care provided to you as required by law.