Notice of Privacy Practices
This Notice describes how medical information about you may be used and disclosed and how you can get access to your information.
Please review this Notice carefully.
OUR PLEDGE REGARDING YOUR MEDICAL INFORMATION
The Mohave County Department of Public Health, Nursing Division, 928-753-0714, Ext 4281, is committed to protecting your medical and health information. This Notice of Privacy Practices describes how we may use, share and protect your medical and health information. It also explains your rights to privacy of your medical and health information as required by law. “Protected Health Information” (PHI) is information about you, including demographic information, that identifies you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. The terms of this Notice apply to all records containing your PHI that are created or retained by us. 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 records that we have created or maintained in the past, or for any records that we may create or maintain in the future. We will post a copy of our current Notice of Privacy Practices in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time. You may also contact the Privacy Officer at the number above if you have questions or complaints about this Notice or the Mohave County Department of Public Health, Nursing Division’s, privacy practices.
HOW WE MAY USE AND DISCLOSE YOUR PHI
The HIPAA Privacy Rule recognizes the legitimate need for public health authorities and others responsible for ensuring public health and safety to have access to PHI to carry out their public health mission. Following are some examples of the types of uses and disclosures of your PHI that the Mohave County Department of Public Health, Nursing Division, is permitted to make without your authorization or consent. These examples are not meant to be all-inclusive:
1. To arrange for or provide health care treatment to you. For example, we may use and disclose PHI about you when you need a prescription, lab work, an x-ray, or other health care services.
2. To obtain payment for services we provide to you.
3. We may use and disclose PHI in performing business activities, which we call “health care operations”, allowing us to improve the quality of care we provide and to help us run our Nursing Programs.
4. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care or payment for that care. If you are unable to agree or object to such a disclosure, the Mohave County Department of Public Health, Nursing Division, may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. In addition, we may disclose your PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care your location, general condition or death.
5. We may disclose your PHI to an authorized public or private entity to assist in disaster relief efforts.
6. We may use and disclose your PHI as required by law, for example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding.
7. We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat.
8. If you are a current or former member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
9. We may release PHI about you for workers' compensation or similar programs that provide benefits for work-related injuries or illness.
10. We may use your PHI for public health activities and disclose your PHI to other public health authorities that are authorized by law to collect information for the following purposes:
• To prevent or control disease, injury or disability
• To maintain vital records, such as births and deaths
• To report reactions to medications or problems with products or devices
• To notify a person if a product or device they may be using has been recalled
• To notify a person regarding a potential exposure to a communicable disease
• To notify a person regarding a potential risk for spreading or contracting a disease or condition
• To notify the appropriate government authority if we suspect a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree to allow us to make the disclosure or when we are required or authorized by law to disclose this information
• To report child abuse or neglect
• To notify your employer under limited circumstances regarding work-place injury or illness or medical surveillance.
11. We may disclose your PHI to government agencies that oversee health care systems, benefit programs and/or civil rights laws.
12. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We also may disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
13. We may disclose your PHI to law enforcement as required to comply with legal processes and to provide necessary information for identification and location purposes pertaining to victims of crime, or in the event that a crime occurs on County premises, and in a medical emergency where it is likely that a crime occurred.
14. We may release PHI to a coroner or medical examiner, as necessary, to identify a deceased person or determine the cause of death. We may also release PHI to funeral directors, as necessary, to allow them to carry out their duties.
15. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
16. We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or to conduct special investigations.
17. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
18. We may contact you by telephone, letter or electronic communication, or by postcard for immunizations you of appointments or that it is time to receive a health care service or to inform you of treatment alternatives or other health care related benefits to which you may wish to avail yourself and/or for which you may be eligible. Your signature on the Acknowledgement of Receipt of Notice of Privacy Practices authorizes Mohave County to use an automated telephone system or other messaging system to use my name, address, and phone number, the name of my provider or nurse, and the time and place of my appointment, for the limited purpose of contacting me to notify me of a pending appointment or other healthcare related communication. I also authorize Mohave County to disclose to third parties who answer my phone limited information regarding pending appointments or healthcare information, and to leave a reminder message on my voice mail system or answering machine.
OTHER USES AND DISCLOSURES OF YOUR PHI
Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose your PHI, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your PHI 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 to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING PHI ABOUT YOU
You have several rights regarding PHI we maintain about you:
Right to Inspect and Copy. You, or approved designee, have the right to inspect and obtain copy of your paper or electronic PHI that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. You must submit your request to inspect and/or copy PHI that may be used to make decisions about your care, in writing, to the Privacy Officer. If you request a copy of your PHI, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We will provide a copy of a summary of your health information, usually within 30 days of your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed. A licensed health care professional chosen by the entity 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
• Limit what is used or shared. You may request that we NOT use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request and may deny the request if it affects your care. If you pay for services or health care items out-of-pocket in full, you may request that information not be shared for the purpose of payment or our operations with your health insurer.
• Right to Amend. If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request for amendment.
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:
• Not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Not part of the PHI kept by or for us;
• Not part of the information which you would be permitted to inspect and copy; or That is accurate and complete.
• Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures, which is a list of PHI disclosures made about you. To request an accounting of disclosures, you must submit your request, in writing, to the Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
• Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must submit your request, in writing, to the Privacy Officer. In your request, 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 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 work or by mail. To request confidential communications, you must submit your request, in writing, to the Privacy Officer. We will not ask you the reason for your request. We will do our best to 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 obtain a paper copy of this Notice. To obtain a paper copy of this Notice, contact the Privacy Officer.
• Right to File a Complaint. If you believe your privacy rights have been violated by the Mohave County Department of Public Health, Nursing Division you may file a complaint with us and/or with the U.S. Department of Health and Human Services-Office for Civil Rights. To file a complaint with us, submit your complaint, in writing, to the Privacy Officer. You will not be penalized or otherwise retaliated against for filing a complaint.
Privacy Officer Contact Information
Mohave County Department of Public Health Nursing Division
P.O. Box 7000
Kingman, AZ 86402
Attn: Administration
Telephone Number: (928) 753-0743, ext 4281
Fax Number: (928) 753-0775
To file a complaint directly with the U.S. Department of Health and Human Services-Office for Civil Rights regarding a covered entity located in Arizona, send your complaint to:
Region IX, Office for Civil Rights
U.S. Department of Health and Human Services
50 United Nations Plaza—Room 322 San Francisco, CA 94102