Your Rights

You have the right to: 

• • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share

• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we: 

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds

Our Uses and Disclosures

We may use and share your information as we: 

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

Your Rights

• When it comes to your health information, you have certain rights.
  This section explains your rights and some of our responsibilities to help you.
• Get an electronic or paper copy of your medical record.
  You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 15 days of your request. We may charge a reasonable, cost-based fee. If we do not have the record you asked for but we know who does, we will tell you who to contact to request it. In limited situations, we may deny some or all of your request to see or receive copies of your records, but if we do, we will tell you why in writing and explain your right, if any, to have our denial reviewed.
• Ask us to correct your medical record. If you think that there is a mistake in your PHI or that important information is missing, you may request to correct or add to your record.
  Requests must be in writing, tell us what corrections or additions you are requesting, and why the corrections or additions should be made. We will respond in writing after reviewing your request. If we approve your request we will make the correction or addition to your PHI. If we deny your request, we will tell you why and explain your right to file a written statement of disagreement. Your statement must be limited to 250 words for each item in your record that you believe is incorrect or incomplete. Also, please indicate in writing if you want us to include your statement or a summary of such in future disclosures. If feasible we can make the request part of your record.
• Request confidential communications.
  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. You may provide us with an alternative address so that we may direct communications regarding your receipt of sensitive services (health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, etc.) directly to you. 
• Ask us to limit what we use or share.
  You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
• Get a list of those with whom we’ve shared information.
  You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.
• Get a copy of this privacy notice.
  You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• Choose someone to act for you.
  If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
• File a complaint if you feel your rights are violated.
  We will not retaliate against you for filing a complaint.
  • You can complain if you feel we have violated your rights by contacting our Privacy Officer by sending an email to PrivacyOfficer@aleracare.com
    or by sending a letter to Compliance Officer, 5350 E High Street, Suite 300, Phoenix, AZ 85054.
  •  You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
    www.hhs.gov/ocr/privacy/hipaa/complaints/. 

Your Choices

For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

If you are not able to tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

How do we typically use or share your health information? 

We typically use or share your health information in the following ways.

• Treat you.
  We can use your health information and share it with other professionals who are treating you.
  
  Example: A doctor treating you for an injury asks another doctor about your overall health condition.
  
• Run our organization.
  We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  
  Example: We use health information about you to manage your treatment and services. 
  
• Bill for your services.
  We can use and share your health information to bill and get payment from health plans or other entities.
  
  Example: We give information about you to your health insurance plan so it will pay for your services. 
  

How else can we use or share your health information? 

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

• Help with public health and safety issues.
  We can share health information about you for certain situations such as: Preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious threat to anyone’s health or safety
• Do research.
  We can use or share your information for health research.
• Comply with the law.
  We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• Respond to organ and tissue donation requests.
  We can share health information about you with organ procurement organizations.
• Work with a medical examiner or funeral director.
  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
• Address workers’ compensation, law enforcement, and other government requests.
  We can use or share health information about you: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.

• Respond to lawsuits and legal actions.
  We can share health information about you in response to a court or administrative order, or in response to a subpoena.

All Other Uses and Disclosures Require Prior Authorization

• Marketing:
  We may ask for your authorization in order to provide information about products and services that you may be interested in purchasing or using. Note that marketing communications do not include our contacting you with information about treatment alternatives, prescription drugs you are taking or health-related products or services that we offer or that are available only to our health plan enrollees. Marketing also does not include any face-to-face discussions you may have with your providers about products or services.
• Sale of PHI:
  We may only sell your PHI if we received your prior written authorization to do so. 
• Psychotherapy Notes
  : On rare occasions, we may ask for your authorization to use and disclose “psychotherapy notes”

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information. 
• We promptly notify you if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it. 
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.