Privacy Policy

NOTICE OF HEALTH INFORMATION/PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

SUMMARY OF FEDERAL REGULATIONS REGARDING CONFIDENTIALITY OF ALCOLHOL AND DRUG ABUSE PATIENT RECORDS

The confidentiality of alcohol and drug abuse patient's records maintained by this program is protected by federal law and regulations. Generally, the program may not say to a person outside the program that a person attends the program or disclose any information identifying a patient as an alcohol or drug abuser unless:

1. the patient consents in writing;
2. the disclosure is allowed by court order; or
3. the disclosure is made to medical personnel in a medical emergency or to qualified personnel for audit or program evaluation.

Violation of the federal laws and regulations by a program is a crime. Suspected violations may be reported to authorities in accordance with federal regulations.

Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal law and regulations do not protect any information about suspected child abuse, neglect or HIV/AIDS communicable diseases from being reported under state law to appropriate state or local authorities.

OUR COMMITMENT TO YOUR PRIVACY

Our facility is dedicated to maintain the privacy of your Protected Health Information (PHI). In conducing our business, we will create records regarding you and your treatment and services we provide to you. We also are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain at our facility concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy practices that we have in effect at this time.

We will provide you with the following important information:

*How we may use and disclose your PHI
*Your privacy rights in your PHI
*Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by our facility. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all your records that our facility has created or maintained. We post a notice in a visible location at all times, and you may request a paper copy of our most current Notice at any time.

UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION (PHI)

Your treatment on a daily basis is documented and the record is made. Typically this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, referred as your Protected Health Information (PHI) serves as a:

Understanding what is in your record and how your Protected Health Information is used helps you to:

OTHER USES OR DISCLOSURES

We may share your Protected Health Information (PHI) with third party "business associates" that perform various activities (e.g., collections, transcription services, pharmacy) for our facility. Whenever an arrangement between our facility and our business associate involves the use or disclosure of your Protected Health Information, we will have a written contract that contains terms that will protect the privacy of your Protected Health Information (PHI).

OUR RESPONSIBLITIES:

This facility is required to:

We will not use or disclose your health information without your authorization, except as described in this notice.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI):

Following is a statement of your rights with respect to your Protected Health Information (PHI) and a brief description of how you may exercise these rights:

1. Requesting restrictions. You have the right to request communication of your health information by alternative means or at alternative locations. You may ask us not to use or disclose any part of your Protected Health Information for purposes of treatment, payment or health care operations. Your request must state the specific restrictions requested and to whom you want the restriction to apply.

2. Right to inspect and obtain a copy of your PHI. You have the right to inspect and obtain a copy of your PHI including billing records. A request must be made to us in writing and with signed authorization.

3. Right to a paper copy of this notice. You are entitled to receive a paper copy of our notice of privacy practices. You will be offered a copy in the orientation process. You may ask us to give you a paper copy of this notice at any time. You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your Protected Health Information (PHI). If you decline to provide a signed acknowledgement, we will continue to provide you treatment, and will use and disclose your Protected Health Information for the purposes described in this notice.

4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our facility. All requests for amendment must be in writing. Please contact our Clinical Records Department with attention to the Privacy Officer when making an amendment.

5. Accounting of disclosures. You have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our facility has made of your PHI for non-treatment, non-payment, or non-operations purposes. Use of your PHI as part of the routine patient care at our facility is not required to be documented. Examples would include the doctor sharing information with the staff to order tests, or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to our Clinical Records Department with attention to the Privacy Officer.

6. Right to provide an authorization for other uses and disclosures. Our facility will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note we are required to retain records of your treatment and care.

7. Right to file a complaint. If you believe you privacy rights have been violated, you may file a complaint with this facility or with the U.S. Secretary of the Department of Health and Human Services. You will NOT be penalized for filing a complaint.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

To file a complaint with this facility or if you have any questions regarding this notice or our health information practices policies, please contact our Privacy Officer at:

Cottonwood Tucson
Clinical Records Department
Attn: Privacy Officer
4110 West Sweetwater Drive
Tucson, AZ 85745
Toll-free Phone: (800) 877-4520
Local Phone: (520) 743-0411
Fax: (520) 743-2189

// Effective 03-17-03

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Call for more information and daily rates:
(800) 877-4520

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