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NOTICE OF PRIVACY PRACTICES
LA FRONTERA CENTER, INC.
Effective
Date: January 1, 2003
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.
Any questions about this
notice should be addressed to the Director of Administration at
(520)838-3922 or the Privacy Officer at (520)258-5014.
La Frontera Center, Inc.,
(hereinafter referred to as LFC) is dedicated to protecting your
medical information. We are required by law to maintain the privacy of
protected health information and to provide you with this notice of
our legal duties and privacy practices with respect to protected
health information. LFC is required by law to abide by the terms of
this notice; however, LFC does reserve the right to change the terms
of this notice. LFC is required to follow the terms of the notice
currently in effect. Any revisions to this notice will be posted at
all sites with the effective date indicated, and paper copies of this
notice will be provided upon request.
Who Will
Follow This Notice
This notice describes LFC’s
practice and that of any LFC workforce member who is authorized to
enter information in your medical record. Facilities or programs may
share medical information for treatment, payment, or LFC operations
purposes described in this notice.
This Notice of Privacy
Practices describes how LFC may use and disclose your protected health
information to carry out treatment, payment, or health care
operations, and for other purposes that are permitted or required by
law. “Protected health information” is information about you,
including demographic information, that may identify you and that
relates to your past, present, or future behavioral health and related
health care services.
You will be asked to sign a
consent form at time of intake. Once your consent is obtained, your
protected health information may be used and disclosed by LFC staff
members and others outside our offices who are involved in your care
and treatment for the purpose of providing health care services to
you. Examples of the types of uses and disclosures that are permitted
are given below. These are not meant to be exhaustive, but to describe
the types of uses and disclosures that may be made by our office once
you have provided consent.
Treatment:
LFC may use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with a
third party that has already obtained your permission to have access
to your protected health information. For example, LFC would disclose
your protected health information to other physicians who may be
treating you, to a physician to whom you have been referred, or to any
other physician or health care provider who, at the request of your
primary physician, becomes involved in your care by providing
assistance with your diagnosis or treatment to your primary physician.
Payment:
LFC may use and disclose your protected health information
to obtain payment for your health care services. This may include the
disclosure of medical information to obtain prior authorization, for
making a determination of eligibility or coverage, for reviewing
services for medical necessity, and for utilization review activities.
Health Care Operations:
LFC may use and disclose protected health information about you
for internal operations. These uses and disclosures can include
quality assessment activities, employee review activities, licensing
and accreditation activities, and conducting or arranging for other
business activities.
LFC may share your
information with third party “business associates” that perform
various activities (e.g., records storage) for LFC. Whenever an
arrangement between our office and a business associate involves the
use or disclosure (or potential use or disclosure) of your protected
health information, LFC will have a written agreement that contains
the terms that will protect the privacy of your health information.
Appointment Reminders:
LFC may use and disclose protected health information to
contact you as a reminder that you have an appointment at one of our
facilities/programs.
As
Required by Law: LFC will disclose protected
health information about you when required to do so by federal, state,
or local law.
To
Avert a Serious Threat to Health or Safety:
LFC may use and disclose protected health information about you
when necessary to prevent a serious threat to your health or safety or
the health and safety of the public or another person.
Health
Oversight Activities: LFC may disclose
protected health information to a health oversight agency for
activities authorized by law. These oversight activities could include
audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system,
government programs and compliance with civil rights laws.
Law
Enforcement: LFC may disclose protected
health information if asked to do so by law enforcement officials:
- In response to a court
order, subpoena, warrant, summons, or similar process.
- About the victim of a crime if, under certain limited
circumstances, LFC is unable to obtain the person’s agreement.
- About criminal conduct at any LFC program/facility.
- In emergency situations.
Coroners, Medical Examiners, and Funeral Home Directors:
LFC may disclose protected health information to a coroner or
medical examiner if necessary to identify a deceased person or to
determine the cause of death. Information may also be disclosed to
funeral home directors in order to carry out their duties.
Research:
LFC may disclose your protected health information to researchers when
their research has been approved by the La Frontera Center, Inc.,
Institutional Review Board. Such approval ensures that protocols have
been established to ensure the privacy of your protected health
information.
Abuse or Neglect:
LFC may disclose your protected health information to an
authority that is authorized by law to receive reports of abuse or
neglect (e.g., CPS, APS). In addition, LFC may disclose your protected
health information if we believe that you have been a victim of abuse,
neglect or domestic violence to the governmental entity or agency
authorized to receive such information. In this case, the disclosure
will be made consistent with the requirements of applicable laws.
Your
Rights Regarding Protected Health Information About You
You have the following rights
regarding protected health information LFC maintains about you:
Right to Inspect and Copy: You have the right to inspect
and copy protected health information that may be used to make
decisions about your care. Usually this includes medical and billing
records but does not include psychotherapy notes.
If you request a copy of your
records, LFC may charge a fee for the cost of copying, mailing, or
other supplies associated with your request. You will not be allowed
to remove your original record.
In certain very limited
circumstances your request to inspect and copy your record may be
denied. If this occurs, you can request a review of the denial.
Right to
Amend: If you feel that protected health
information we have about you is incorrect or incomplete, you may ask
that the information be amended. Your request must be submitted in
writing to the Clinical Director. Additionally, you must provide a
reason that supports such a request.
If your request is not in
writing or does not include a reason to support the request, LFC may
deny the request. In addition, LFC may deny the request if you ask
that information not compiled by LFC, or information that is not part
of the protected health information maintained by LFC. LFC may deny
the request if the maintained protected health information is complete
and accurate.
Right to an Accounting of Disclosures:
You have a right to request a list of disclosures LFC has made
of protected health information about you to others except for
purposes of treatment, payment, and operations specified above.
Any request for a list of
disclosures must be made in writing to the Clinical Director. Your
request must state a time period that cannot be longer than six years
and cannot include dates prior to April 14, 2003. Your written request
should dictate the form in which you wish to receive this list. The
first list requested in a 12 month period will be provided free of
charge to you. For any additional lists requested you will be charged
the cost of providing this information to you.
Right to
Request Restrictions: You have the right to
request a restriction or limitation on the protected health
information LFC would use or disclose about you for treatment,
payment, or health care operations. To request restrictions, you must
make your request in writing to the Clinical Director. That request
must define what information you want to limit, whether to want to
limit use, disclosure, or both, and to whom you want the limits to
apply.
LFC is not
required to agree to your request. If the
request is granted, LFC will comply with your request unless the
information is needed to provide emergency treatment or to meet orders
of the court.
Right to Request Confidential Communications:
You have the right to request that LFC communicate with you
about medical matters in a certain way or at a certain location. For
example, you can ask that LFC only contact you at work or by mail.
To request confidential
communications, you must make your request in writing to the Clinical
Director. We will accommodate all reasonable requests.
Right to a
Paper Copy of this Notice: You have the
right to a paper copy of this privacy notice. You may ask us to give
you a copy of this privacy notice at any time by requesting a copy
from any LFC staff member.
Complaints
If you believe your privacy
rights have been violated, you may contact or submit your complaint in
writing to the Director of Administration or the Privacy Officer at
502 W. 29th St. Tucson, AZ 85713. You can also file a complaint with
the 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.
Other Uses
of Protected Health Information
Other uses and disclosures of
protected health information not covered by this notice or the laws
that apply to La Frontera Center, Inc., will be made only with your
written permission. If you provide LFC permission to use or disclose
medical information about you, you may revoke that permission, in
writing, at any time. If you revoke your permission, LFC will no
longer use or disclose protected health information about you for the
reasons covered by your written authorization. You understand that LFC
is unable to take back any disclosures already made with your
permission and that LFC is required to retain our records of the care
that is provided to you.
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