Western Regional Medical Center, Inc.
EFFECTIVE DATE: April 28, 2014
THIS AMENDED 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 We Are
This Notice describes the privacy practices of WESTERN REGIONAL MEDICAL CENTER, INC. (“Facility”) and CANCER TREATMENT CENTERS OF AMERICA PROFESSIONAL CORPORATION OF ARIZONA, P.C., (“PC”), and our respective physicians, nurses, naturopathic practitioners, nutritionists, and other personnel (collectively for purposes of this Notice, "we" or "us"). It applies to services we furnish to you.
Our Privacy Obligations
We are committed to protecting information about you regarding your health treatment and related health care services (“protected health information” or “PHI”).We create a record of the care and services you receive at our Facility for use in your care and treatment. This Notice tells you about the ways in which we may use or disclose your protected health information. It also describes your rights and certain obligations we have regarding the use and disclosure of your protected health information. We are required by law to give you this Notice describing our legal duties and privacy practices with respect to your protected health information.
How We May Use or Disclose Your Protected Health Information:
The following categories describe different ways in which we use or disclose your PHI without your written permission. We have not listed every use or disclosure, but permitted uses or disclosures typically are in one of the following categories:
For Treatment. We may use or disclose your PHI to provide treatment and other services to you (for example, to diagnose and treat your injury or illness). We may also disclose PHI to other providers involved in your treatment, or people outside of the Facility who may be involved in your continuing health or medical care after you leave, such as other health care providers, transportation companies, community agencies and family members.
For Payment. We may use or disclose your PHI to bill and obtain payment for services that we provide to you--for example, disclosures to claim and obtain payment from Medicare, your health insurer, or other company or program that arranges for or pays the cost of some or all of your health care. We may also tell your health plan about a proposed treatment to determine whether your plan will cover the cost of treatment (subject to your requested restrictions of disclosures to a health plan under “Right to Request Restrictions” below).
For Health Care Operations. We may use or disclose your PHI for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to our patients. For example, we may use PHI to evaluate the quality and competence of our physicians, nurses and other health care workers. We may disclose PHI to our Patient Relations Coordinator to help make sure the care you receive is of the highest quality.
Hospital Directory. We may include your name, general health condition (e.g., fair, stable, etc.) and religious affiliation in a patient directory. Except for religious affiliation (which may be given to members of the clergy only), the information in the directory may be released so that your family, friends, and others who ask for you by name, can visit you in the hospital and generally know how you are doing, unless you restrict or prohibit the use or disclosure of this information.We may tell your family, other relative, a close personal friend or any other person identified by you about your general condition and that you are in the hospital, unless you request that we do not provide this information. If you are unable to authorize the release of such information, we are required to give notification of your presence in the hospital, except to the extent prohibited by law. Upon request of a family member, we are required to provide information regarding your release, transfer, serious illness, injury or death, unless you request that this information not be provided.
Appointment Reminders. We may contact you to remind you that you have an appointment with a provider.
Treatment Alternatives. We may contact you to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health Related Benefits and Services. We may contact you about benefits or services that we provide.
Fund-Raising Activities. We may contact you to provide information about Facility sponsored activities, including fund-raising programs and events. We would use only contact information, such as your name, address, phone number and the dates you received treatment or services at our Facility. Please contact our Privacy Office if you do not wish to receive fund-raising communications. Your written authorization (permission) is required if we want to use your PHI, such as the department where you were seen or the name of the physician you saw, in order to contact you to ask you to make a charitable contribution to support research or patient care at our Facility related to your specific treatment.
News Gathering Activities. We may contact you or one of your family members to discuss whether or not you want to participate in a story for our publications or external news media. Your written authorization (permission) is required if we want to use any of your medical information for these kinds of news gathering purposes.
Research. Our Facility conducts research which must be approved through a special review process to protect patient safety, welfare and confidentiality. We may use or disclose PHI about our patients for research purposes, subject to the confidentiality provisions of state and federal law. Researchers may contact you regarding your interest in participating in certain research studies after receiving your authorization (permission) or approval of the contact from a special review board. Enrollment in these studies may occur only after you have been informed about the study, had an opportunity to ask questions and indicated your willingness to participate by signing a consent form. When approved by a special review board, other studies may be performed using your PHI without your authorization. For example, a research study may involve a chart review to compare the outcomes of patients who received one medication to those who received another for the same condition.Federal law also allows us to create a “limited data set” (limited amount of medical information from which almost all identifying information such as your name, address, Social Security number and medical record number have been removed) and share it with those who have signed a contract promising to use it only for research, public health and healthcare operations purposes and to protect its confidentiality.
As Required by Law. We will disclose your PHI when required and/or authorized to do so by federal or state law.
To Avert a Serious Threat to Health or Safety. We may use or disclose your PHI when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person.Any disclosure would be to help stop or reduce the threat.
Public Health Activities. We may disclose your PHI for public health purposes, which generally include the following:(1) for the purpose of preventing or controlling disease (e.g., cancer or tuberculosis), injury or disability; (2) to report child abuse or neglect; (3) to report adverse events or surveillance related to food, medications or defects or problems with products; (4) to alert persons who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; (5) to report findings to your employer concerning a work-related illness or injury or workplace related medical surveillance; (6) to notify persons of recalls, repairs or replacements of products they may be using; (7) reporting vital events such as births and deaths; and (8) to notify the appropriate government authority as authorized or required by law if we believe a patient has been the victim of abuse, neglect or domestic violence.
Health Oversight Activities. We may disclose your PHI to governmental, licensing, auditing and accrediting agencies as authorized or required by law.
Lawsuits and Other Legal Actions. In connection with lawsuits or other legal proceedings, we may disclose your PHI in response to a court or administrative order, or in response to a subpoena, warrant, summons or other lawful process.
Law Enforcement. We may release health information to law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to a coroner or medical examiner as authorized by law.
Organ and Tissue Procurement. We may disclose your PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
National Security and Intelligence Activities. We may use or disclose your PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.
Uses or Disclosures Requiring Your Written Authorization
Other Uses and Disclosures. For any purpose other than described in the categories above, we only may use or disclose your PHI when you grant us your written authorization (permission), which we may require to be on our authorization form (such as most uses and disclosures of psychotherapy notes, or uses and disclosures of PHI for marketing). If you provide us authorization to use or disclose your PHI, you may revoke (withdraw) that authorization, in writing, at any time. However, we cannot take back any disclosures we may have already made with your authorization before you revoked it.
Marketing. We may ask you to sign an authorization to use or disclose your PHI to send you any marketing materials. The authorization will state if we received any direct or indirect compensation for such marketing. Your authorization is not needed for face-to-face communications we make to you, for promotional gifts of nominal value or about prescriptions you have already been prescribed. In addition, we may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without your authorization as these communications are considered to be within the definition of “health care operations”.
Sale of PHI. We may ask you to sign an authorization to sell your PHI. The authorization will state if we received any direct or indirect compensation for such disclosure.
Your Rights Regarding Your Protected Health Information
Right to Request Restrictions. You have a right to request restrictions or limitations on our use or disclosure of your PHI: (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of those individuals regarding your location and general condition. If you wish to request such restrictions, please obtain a request form from our Privacy Office and submit the completed form to the Privacy Office. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction, subject to the following exception: We must agree to a requested restriction of disclosure of PHI to a health plan: (1) you have paid us out-of-pocket for the item or service that is the subject of the PHI, and (2) the disclosure is for payment or health care operations purposes. If we do agree to a restriction, our agreement must be in writing and we will comply with your request, unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications. You have a right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate all reasonable written requests. You must specify how or where you wish to be contacted (alternative means of communication or at alternative locations).
Right to Inspect and Copy Your Health Information. You have a right to access and inspect your medical record file and billing records maintained by us and to request copies of the records in either paper or electronic form. You also have a right to access your laboratory test results from our laboratories. Under limited circumstances, we may deny you access to a portion of your records. If you desire access to your records (including your laboratory test results), please obtain a record request form from the Privacy Office and submit the completed form to the Privacy Office. We may charge you for our postage costs, if you request that we mail the copies to you.
Right to Amend Your Records. If you believe that the medical information that we have about you is incorrect or incomplete, you have the right to request that we amend PHI maintained in your medical record file or billing records or add an addendum (addition to the record). If you desire to amend your records, you will need to complete and submit a form for requesting amendments, which is available from the Privacy Officer. We will comply with your request unless we believe that the current information (i) is accurate and complete, (ii) was not created by our healthcare team, (iii) is not part of the information kept at our facility, or (iv) other special circumstances apply. Even if we accept your request, we are not required to delete any information from your medical record.
Right to Receive an Accounting of Disclosures. You have the right to receive a list of certain disclosures of your PHI made by us during any period of time prior to the date of your request, provided the period does not exceed six (6) years and does not apply to disclosures that occurred prior to April 14, 2003.
Right to Receive Paper Copy of this Notice. Upon request, you have a right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically.
Right to be Notified of a Breach of Unsecured PHI. You have the right to be notified in the event of a breach of your unsecured PHI.
Duration of this Notice, Questions or Complaints, Right to Check Your Identity
Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in common areas in our Facility. You also may obtain any new notice by contacting the Privacy Office.
Questions or Complaints. If you have any questions about this Notice, please contact the Privacy Office at the number listed below. If you believe your privacy rights have been violated, you may file a complaint with the Facility or with the US Secretary of the Department of Health and Human Services, Office for Civil Rights. To file a complaint with the Facility, please contact the Privacy Office.
Right to Check Your Identity. For your protection, we may check your identity whenever you have questions about your treatment or billing activities. We will check your identity whenever we get requests to look at, copy or amend your records or to obtain a list of disclosures of your health information.
You may contact the Privacy Office at:
Western Regional Medical Center, Inc.
14200 W. Celebrate Life Way
Goodyear, AZ 85338
Telephone Number: (623) 207-3081
This Notice replaces all earlier versions.