As a recipient of Federal financial assistance, Haven Senior Horizons of Phoenix, does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of race, color or national origin, or on the basis of disability or age in admission to, participation in or receipt of the services and benefits under any of its programs, activities and employment, whether carried out by Haven Senior Horizons of Phoenix directly or through a contractor or another entity with which Haven Senior Horizons of Phoenix arranges to carry out its programs and activities.
This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at Title 45 Code of Federal Regulations Parts 80, 84 and 91.
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.
Who Will Follow This Notice
This Notice describes our organization’s practices and those of:
- Healthcare professionals who are members of our workforce authorized to access and/or enter information into your medical record or billing record.
- All departments and units of this facility.
- All employees, volunteers and other facility personnel considered a part of our workforce.
- Any Haven Behavioral owned healthcare entities and medical offices.
Our Pledge Regarding Medical and Billing Information
We understand that information about you and your health is personal. We are committed to protecting medical and billing information about you. We create a record of the care and services you receive at our facility. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment and charges or bills for services related to your care. These records are used to provide you with quality care and to comply with certain legal requirements.
This Notice applies to all of the records of your care generated by the facility, whether made by facility personnel or your personal care provider. Your personal care provider (for example, your primary care physician, etc.) may have different policies or Notices regarding the provider’s use and disclosure or your medical and billing information created in the practice office or clinic.
This Notice will tell you about the ways in which we may use and disclose medical and billing information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.
We are required by law to:
- Make sure that medical and billing information that identifies you is kept private
- Give you this Notice of our legal duties and privacy practices with respect to medical and billing information about you
- Follow the terms of the Notice that is currently in effect
We may use and disclose medical information to contact you as a reminder that you have an appointment for tests, treatment or medical care.
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you or offer you optional care alternatives.
Health-Related Products and Services
We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
There are some services provided in our organization through contracts with business associates. Examples may include: contracted physical therapy and speech therapy. When these services are contracted, we may disclose your health information to our business associates so they can perform the job we’ve asked them to do, and bill you or a third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who receive one medication to those who received another, for the same condition. In certain circumstances, we are permitted to disclose medical information about you to prepare for research. For example, researchers may look for patients with specific treatment needs to develop a research protocol, but may not remove the medical information they review from the facility. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ needs for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the facility.
As Required By Law
We will disclose medical information about you when required to do so by federal, state or local laws.
To Avert a Serious Threat to Health or Safety
We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or other person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation
If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
If you are a member of the armed forces, active or reserve, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
We may release medical information about you as necessary to comply with laws related to workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Other uses of medical information: Authorization and Right to Revoke Authorization
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to use, will be made only with your written authorization. If you authorized us to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required by State Law to retain our records of the care that we provide to you.
Your Rights Regarding Medical and Billing Information About You
You have the following rights regarding your medical and billing information we maintain.
Right to Inspect and Copy Your Medical and Billing Information
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and obtain a copy of medical and billing information that may be used to make decisions about you, you must submit your request in writing to Haven Senior Horizons of Phoenix. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy this information in certain limited circumstances. If you are denied access to medical or billing information, you may make a request, in writing to the Haven Senior Horizons of Phoenix, Privacy Officer, so that the denial be reviewed. Another licensed healthcare professional chosen by the facility will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend Your Medical and Billing Information
If you feel that medical and billing information we have about you is incorrect or incomplete, you may ask us to amend the information. You have a right to request an amendment for as long as the information is kept by or for the facility.
The request amendment must be made in writing and submitted to Haven Senior Horizons of Phoenix. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing, or does not include a reason to support the request. In addition, 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 or billing information kept by or for the facility
- Is not part of the information which you would be permitted to inspect and copy
- Is accurate and complete.