PINAL GILA COUNCIL FOR SENIOR CITIZENS
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.
Pinal-Gila Council for Senior Citizens (PGCSC) understands that your medical information and your health are personal. We are committed to protecting your medical information. PGCSC and its contracted providers create a record of medical information about the care and services you receive during your enrollment. We need this medical information to provide you with quality care and to comply with certain legal requirements. This Notice of Privacy Practices applies to your medical information generated and/or maintained by PGCSC.
This notice will tell you about the ways in which we may use and disclose your medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.
PGCSC is required by law to:
- Make certain that medical information that identifies you is kept private
- Make certain that you are given notice of our legal duties and privacy practices with respect to your medical information
- Make certain that PGCSC follows the terms of the Notice of Privacy Practices that is currently in effect
HOW WE MAY USE OR DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following describes different ways we use and disclose your medical information. If you are receiving services for the evaluation or treatment of substance abuse or Human Immunodeficiency Virus (HIV) conditions, specific rules apply to the use and disclosure of information related to those services. Please refer to the section entitled Substance Abuse Health Information and HIV Information for those rules.
For Treatment We may use your medical information to provide you with behavioral health treatment or services. We may disclose your medical information to psychiatrists, your primary care physician, nurses, therapists, case managers or other behavioral health professionals who are involved in your care. For example, a psychiatrist treating you may need to know if you have allergies to certain psychotropic medications. The psychiatrist may need to contact your primary care physician to obtain that information. Different departments within PGCSC may also share your medical information to arrange services you may need, such as medications, therapy, or case management. If you are in jail, PGCSC may share your medical information with necessary medical personnel to coordinate your ongoing care.
- For Payment We may use and disclose your medical information so that the treatment and services you receive may be billed and payment may be collected from appropriate payors, such as an insurance company or a third party. For example, we may need to give your network provider medical information about treatment you received at the hospital so the hospital can receive payment. Your network provider may share your medical information with your insurance company or a third party payor to check that you qualify for services, or to obtain approval for the services requested.
- For Health Care Operations We may use and disclose your medical information for the business activities of PGCSC. These uses and disclosures are necessary for administrative functioning and to ensure our members receive quality care. For example, we may use your medical information to review a contract providerŐs services and to evaluate their performance in caring for you. We may combine medical information about many members to decide what additional services PGCSC should offer, what services are needed, and whether certain new treatments are effective. We may also use and disclose your medical information to assess PGCSCŐs compliance with the ArizonaŐs Department of Health Services, AHCCCS, or the Joint Commission on Accreditation of Healthcare standards. For example, this disclosure may be required to evaluate the quality of services we provide or to resolve a specific treatment issue you have raised.
- Individuals Involved in Your Care We may release your medical information to a family member actively involved in your care and treatment as allowed under Arizona state law and in accordance with PGCSC policies and procedures. This information is limited and will not be disclosed without first obtaining your written authorization.
- Research Under certain limited circumstances; we may use and disclose your medical information for research purposes. For example, a research project may involve the care and recovery of all members who receive one medication for the same condition. All research projects are subject to a special approval process. We will obtain your written authorization if the researcher will use or disclose your medical information.
- Substance Abuse Health Information All medical information regarding substance abuse is kept strictly confidential and released only in conformance with the requirements of federal law (42 U.S.C. 29odd-3 and 42 U.S.C. 290ee-3) and regulation (42 C.F.R. part 2). Disclosure of any medical information referencing alcohol or substance abuse may only be made with your written authorization. A general authorization for the release of medical or other information is not sufficient for this purpose.
- HIV Information All medical information regarding HIV is kept strictly confidential and released only in conformance with the requirements of state law (A.R.S. 36-664). Disclosure of any medical information referencing HIV status may only be made with your written authorization. A general authorization for the release of medical or other information is not sufficient for this purpose.
Federal and state laws allow or require PGCSC to disclose your medical information in certain special circumstances that include, but are not limited to, the situations described below.
- Public Health (Health and Safety for you and/or others) We may disclose your medical information for public health activities. We may use and disclose your medical information to a public heath authority, when necessary, to prevent a serious threat to your health and safety or the health and safety of the public or another person. The activities generally include the following:
- To prevent or control disease, injury or disability
- To report births or deaths
- To report child abuse or neglect
- To report reactions to medications
- To notify people of recalls regarding medications they may be using
- To notify a person who may have been exposed to a disease or may be at risk for contracting a disease
- To avert a serious threat to the health or safety of a person or the public
- To notify the appropriate government authority if we believe a member has been the victim of abuse, neglect or domestic violence. We will make this disclosure when required or authorized by law
- Health Oversight Activities We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the behavioral health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Dispute If you are involved in a lawsuit or legal action, we may disclose your medical information in response to a valid court or administrative order, a valid subpoena, a discovery request, or other lawful process that complies with state law and PGCSC policies and procedures.
- Law Enforcement. We may release your medical information if asked to do so by a law enforcement official:
- In response to a valid court order, subpoena, warrant, summons, or similar lawful process that complies with state law and PGCSC policies and procedures
- To identify or locate a suspect, fugitive, material witness, or missing person
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the personŐs authorization
- About a death we believe may have been the result of criminal conduct
- About criminal conduct that occurs at PGCSC
- In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime
- Coroners, Medical Examiners and Funeral Directors We may release your medical information to a coroner or medical examiner. This may be necessary for identification or to determine the cause of a death. We may also release your medical information to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities We may also release your medical information to authorize federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and Others We may disclose your medical information to authorized federal officials so they may provide protection to the President or other authorized persons.
- As Required by Law We may disclose your medical information when required to do so by federal, state, or local law.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
- Right to Access You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy medical information contact the PGCSC Privacy Officer. If you request a copy of the information, you may receive one copy each year at no cost. For any additional copies during the same year, you may be charged a fee for the costs of copying, mailing, or other supplies associated with your request. Your request to inspect and copy your medical information may be denied in certain limited circumstances. If you are denied access to all, or any part, of your medical information, you may request that the denial be reviewed. Information regarding how to initiate the review process will be provided in writing at the time of any denial of access to your medical information.
- Right to Amend If you feel that your medical information is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as your medical information is kept by PGCSC. To request an amendment, your request must be made in writing and submitted to the PGCSC Privacy Officer. You must provide a reason that supports your request. We may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for PGCSC
- Is not part of the medical information which you would be permitted to inspect or copy; or
- Is accurate and complete.
to an Accounting of Disclosures You have the right to
request an accounting of disclosures of your medical information. This is a
list of disclosures we made of your medical information to others outside of
PGCSC. The accounting does not include information disclosed as a part of treatment,
payment, or health care operations. The accounting does not include disclosures
that were authorized by you in writing. To request this accounting you must
submit your request in writing to the PGCSC Privacy Officer. Your request must
state a period of time for the accounting that may not be longer than six years
and may not include dates before
- Right to Request Restrictions You have the right to request a restriction on the medical information we use or disclose about you. 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 a restriction, you must make your request in writing to the PGCSC Privacy Officer. In your request, you must tell us what information you want to restrict, and to whom you want the restriction to apply.
- 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 if you believe that you will be otherwise endangered. For example, you can ask that we only contact you at a certain telephone number or address. To request confidential communications, you must make your request in writing to the PGCSC Privacy Officer. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Paper Copy of this Notice You have the right to a paper copy this privacy notice. You may ask us to give you a copy of this privacy notice at any time by requesting it form PGCSC Privacy Officer.
CHANGES TO THIS NOTICE
PGCSC reserves the
right to change this notice. PGCSC reserves the right to make revised notice
effective for your medical information that PGCSC already has about you, as
well as any information we will receive following the revision. PGCSC will post
a copy of the current notice at our main office at
If you believe your
privacy rights have been violated, you may submit your complaint in writing to
the PGCSC Privacy Officer,
OTHER USES AND DISCLOSURES
Other uses and disclosures of your medical information not covered by this notice will be made only with your written authorization. If you provide us with written authorization to use or disclose your medical information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, PGCSC will no longer use or disclose your medical information for the reasons covered by the authorization. PGCSC is unable to take back any disclosures already based on your authorization.
*** Si desea obtener esta informacion en Espanol, porfavor hable al (520) 836-2758.