NORTHERN ARIZONA HEALTHCARE CORPORATION
NOTICE OF PRIVACY PRACTICES
This notice outlines how medical information may be used and disclosed and how to access to this information.
This privacy notice applies to all patients of Flagstaff Medical Center, Northern Arizona Homecare, Northern Arizona Hospice, Verde Valley Medical Center and all licensed healthcare institutions owned by these entities (collectively and individually referred to as “facility”).
Use and disclosure of medical information
We may use your medical information to provide you with medical services and supplies. Northern Arizona Healthcare may disclose your medical information to others who need that information to treat you, such as physicians, nurse practitioners, physician and medical assistants, nurses, healthcare professions students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers, and others involved in your care. We may allow physicians and other healthcare providers to have access to your facility medical record to assist in your treatment and follow-up care. Additionally, we may participate in a Health Information Exchange that securely shares health-related data among healthcare providers, organizations and government agencies for treatment and medical services. We may use and disclose your medical information to remind you of an upcoming appointment, inform you about possible treatment options or alternatives, or tell you about health-related services available to you.
Patient directory: To assist family members and other visitors in locating you while you are in the facility, Northern Arizona Healthcare maintains a patient directory. This directory includes your name, room number and any religious affiliation. The directory may include your general condition (such as good, fair, serious or critical). We will disclose this information to someone who asks for you by name, including, but not limited, to family members, visitors and the media. Religious affiliation will be disclosed only to clergy members. If you do not want to be included in the facility’s patient directory, please notify your patient registrar or nurse, who will explain the implications of not being listed in the directory and have you sign a “Notice to Patients Requesting No Information/Special Confidentiality” form.
Disclosure of information to family members and others involved in your care: We may disclose your medical information to a family member or friend who is involved in your medical care or to someone who helps to pay for your care. We may disclose your medical information to disaster relief organizations to help locate a family member or friend in a disaster. If you do not want your medical information disclosed to family members or those who will visit you, please notify your nurse.
Payment: We may use and disclose your medical information to get paid for the medical services and supplies we provide. For example, your health plan or health insurance company may ask to see parts of your medical record before they will pay us for your treatment.
Facility operations: We may use and disclose your medical information if necessary to improve the quality of care we provide to patients or to run the facility. We may use your medical information to conduct quality improvement activities; to obtain audit, accounting or legal services; or to conduct business management and planning. For example, we may look at your medical record to evaluate whether personnel, physicians or other healthcare professionals provided the best care possible.
Fundraising: The facility may contact you to request a donation. If you do not want to be contacted for fundraising purposes or to specific events, you have the right to opt out by notifying the Northern Arizona Healthcare Foundation, 1200 N. Beaver St., Flagstaff, AZ, 86001; or call 928-773-2093. You may opt in once you have opted out.
Research: We may use or disclose your medical information for research projects, such as studying the effectiveness of a treatment you received. These research projects must go through a special process that protects the confidentiality of your medical information.
Required by law: In certain instances, federal, state or local laws require the disclosure of medical information. We are required to report child abuse or neglect and must provide certain information to law enforcement officials in domestic violence cases. We are required to give information to the Arizona Workers’ Compensation Program for work-related injuries.
Public health: We may report certain medical information for public health purposes. For instance, we are required to report births, deaths and communicable diseases to the State of Arizona. We also may report patient problems with medications or medical products to the FDA, or may notify patients of recalls of products they are using.
Public safety: We may disclose medical information for public safety purposes in limited circumstances. We may disclose medical information to law enforcement officials in response to a search warrant or a grand jury subpoena. We may disclose medical information to assist law enforcement in identifying or locating a person, to prosecute a crime of violence, to report deaths that may have resulted from criminal conduct, to report criminal conduct at the facility or to prevent a serious threat to health or safety.
Government health agencies: We may disclose medical information to an agency that oversees the facility or its personnel, such as the Arizona Department of Health Services, the federal agencies that oversee Medicare, the Arizona Medical Board or the Board of Nursing, that utilize medical information to monitor compliance with state and federal laws.
Coroners, medical examiners and funeral directors: We may disclose medical information concerning deceased patients to coroners, medical examiners and funeral directors to assist in their duties.
Organ and tissue donation: We may disclose medical information to organizations that handle organ, eye or tissue donation or transplantation.
Military, veterans, national security and other government agencies: If you are a member of the armed forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. The facility may disclose medical information to federal officials for intelligence and national security purposes.
Judicial proceedings: We may disclose medical information if the facility is ordered to do so by a court or receives a subpoena or a search warrant. In most situations, you will receive advance notice about this disclosure from the attorney requesting your medical information so you have the opportunity to object to the sharing of such information.
Information with additional protection: Certain types of medical information have additional protection under state or federal law. For instance, medical information about communicable diseases; drug and alcohol abuse treatment; genetic testing; and evaluation and treatment for a serious mental illness is treated differently than other types of medical information. For these types of information, the facility is required to get your permission before disclosing that information to others in many circumstances.
Other uses and disclosures: If the facility wishes to use or disclose your medical information for a purpose not discussed in this notice, the facility will seek your permission. You may revoke permission at any time, unless we have already relied on your permission to use or disclose the information. To revoke permission, write to Medical Records, 1200 N. Beaver St., Flagstaff, AZ 86001.
Right to request your medical information: You have the right to look at your own medical information and to get a copy of that information. (The law requires us to keep the original record for 10 years for adults and 25 years for minors). This includes your medical record, your billing record, and other records we use to make decisions about your care. To request your medical information, write to Medical Records, 1200 N. Beaver St., Flagstaff, AZ 86001. You may be charged to copy the information; we will tell you in advance what this copying will cost. You can look at your record at the facility at no cost.
Right to request amendment of medical information you believe is erroneous or incomplete: If you examine your medical information and believe some of the information is wrong or incomplete, you may ask to have your record amended. To do so, write to the Medical Records, 1200 N. Beaver St., Flagstaff, AZ 86001. Please note, we may deny the request if we did not create the information or if the record is accurate and complete.
Right to get a list of certain disclosures of your medical information: You have the right to request a list of disclosures of your medical information. To request the list, write to Medical Records,
1200 N. Beaver St., Flagstaff, AZ 86001. The first list is provided free of charge; there may be a charge for additional requests during the same calendar year. The cost will be provided in advance.
Right to request restrictions on use or disclosure of medical information for treatment, payment or operations: You have the right to ask us not to make use or disclose your medical information to treat you, to seek payment for care or to operate the facility. We are not required to agree to your request. To request a restriction, write to Medical Records, 1200 N. Beaver St., Flagstaff, AZ
86001, and describe your request in detail.
Right to request confidential communications: You have the right to ask us to communicate with you in a way you feel is more confidential. For example, you can ask us not to call your home, but to communicate only by mail. To make this request, write to Medical Records, 1200 N. Beaver St., Flagstaff, AZ 86001. You may speak with your healthcare providers in private, outside the presence of other patients.
Right to a paper copy: If you have received this notice electronically, you have the right to a paper copy at any time. You may download a copy of the notice from our website at NAHealth.com, or you may
obtain a paper copy of the notice from Medical Records.
Changes to this notice
From time to time, we may change our practices concerning how we use or disclose patient medical information, or how we will implement patient rights concerning their information. We reserve the right to change this Notice and to make the provisions in our new notice effective for all medical information we maintain. If we change these practices, we will publish a revised Notice of Privacy Practices. You can get a copy of our current notice of Privacy Practices at any time by downloading it from our website or requesting a paper copy at Health Information Management or Home Health.
Healthcare providers covered by this notice
This Notice of Privacy Practices applies to the facility and its physicians, personnel, volunteers, students, trainees, vendors and other healthcare providers who come to the facility to care for patients, such as physicians, physician assistants, therapists, other healthcare providers not employed by the facility, emergency service providers and medical transportation companies. The facility may share your medical information with these providers for treatment purposes, to get paid for treatment or to conduct healthcare operations. These healthcare providers will follow this notice for information they receive about you from the facility. These other healthcare providers may follow different practices at their own offices or facilities.
Concerns or complaints
If you have a concern, please contact the Privacy Officer at 928-773-2567.If for some reason the facility cannot resolve your concern, you may also file a complaint with the federal government. You will not be penalized or retaliated against in any way for filing a complaint with the federal government.
The facility is required by law to give you this notice and to follow the terms of the notice that is currently in effect. If you have any questions about this notice, or have further questions about how the facility may use and disclose your medical information, please contact the medical records custodian at the following numbers:
Flagstaff Medical Center: 928-773-2072
Northern Arizona Homecare and Northern Arizona Hospice: 928-773-2238
Verde Valley Medical Center: 928-639-6280
Effective date: 03/13/03
Revised date: 01/15/15
Revised date: 03/16/15