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Banner – University Medicine


PRIVACY
PRACTICES
For
University Medical Center
Corporation and University
Physicians Healthcare (excluding the
Health Plan Division of UPH
)











NOTICE OF PRIVACY PRACTICES

Effective: April, 2003
Revised April 27, 2012

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this Notice, please call the Alertline at 1-800-726-0713.



WHO WILL FOLLOW THIS NOTICE

This Notice describes the privacy practices of the University Medical Center Corporation and University Physicians Healthcare (excluding the Health Plan Division of UPH). To better serve you, we provide you with this Notice regarding our privacy practices and your privacy rights established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Upon request, we will provide you with a list of sites and locations that apply to this Notice. The organizations mentioned above include their employees, physician staff, trainees, volunteer groups and other health care personnel. These organizations, sites and locations may share your health information with each other for treatment, payment or health care operations purposes described in this Notice and are allowed to do so by law for the benefit of providing you with efficient health care services.






NOTICE OF PRIVACY PRACTICES
for
University Medical Center Corporation and University Physicians
Healthcare (excluding the Health Plan Division of UPH)


Our Commitment to You

We are committed to protecting your health information. We educate our workforce members and utilize safeguards to protect your privacy and ensure the confidentiality of your personal health information. We are required by law to keep health information about you private, to give you this Notice about our privacy practices and to follow the practices outlined in this Notice.

Our Pledge Regarding Health Information

We understand that health information about you is personal. We are committed to protecting health information about you. We create a record of care and services you receive at our facilities. We need these records to provide you with complete and comprehensive care and to comply with certain legal requirements. This Notice applies to all of the health and billing records generated at our various sites and locations where you receive care.

This Notice tells you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of health information.

We are required by law to:    Make sure that health information that identifies you is kept private;    Give you this Notice of our legal duties and privacy practices; and    Follow the terms of this Notice currently in effect.




How We May Use and Disclose Health Information about You

The following categories describe different ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories:


For Treatment

We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, physician assistants, nurses, technicians, students, therapists, emergency services and medical equipment providers, and others involved in your care. For example, different departments of our organizations may share health information about you in order to coordinate elements of your care, such as prescriptions, lab work and x-rays. We also may disclose your personal health information to people outside our organizations such as referring physicians and home health care nurses in connection with your health care treatment.


For Payment

We may use and disclose health information about you to your insurance plan, or other parties who help pay for your care. For example, we may tell your health plan about a treatment you are going to receive to determine whether your plan will pay for that treatment.


For Health Care Operations

We may use and disclose health information about you for our operations. These uses and disclosures are necessary to run our organizations and to make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, students (e.g. medical students and residents), and other health care personnel for teaching purposes.


Business Associates

There may be some activities provided for our organizations through contracts with outside businesses. Examples include transcription services and collection agencies. Under such contracts, we may disclose your health information to these businesses to perform the job we have asked them to do. These contracts also require the businesses to protect the health information we disclose to them.


Appointment Reminders

We may contact you to remind you about your appointment for medical care.


Treatment Alternatives

We may use and disclose health information to tell you about possible treatment options or alternatives that may be of interest to you and other health related benefits and services.


Hospital Directory

We may include certain limited information about you in the hospital directory while you are an inpatient at one of our hospitals. This information may include your name, location in the hospital, your general condition (fair, stable, etc.) and your religious affiliation. The directory information, except for your religious information, may also be disclosed to people who ask for your name. Your religious affiliation may be given to a member of the clergy, even if they don’t ask for you by name. We provide this service so your family, friends and clergy can visit you in the hospital and generally know how you are doing. If you are admitted to the hospital, we will not provide this information or even acknowledge your presence in the hospital at your written request. Tell a representative from the Banner – University Medicine Patient Access office when you register to be admitted to the hospital if you do not want this information provided.


Individuals Involved In Your Care

Unless you object, we may disclose health information about you to a friend or family member who is involved in your health care and we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your location and condition. If you are not present or able to object we may use our professional judgment to determine whether the disclosure is in your best interest.


Research

As an academic medical center, we may use and disclose health information about you for research purposes. We will only use and disclose your information for a research project if we obtain your permission, if the need to obtain your permission has been waived by a designated review committee that meets Federal requirements or as otherwise permitted by law.


Information Not Personally Identifiable

We may use or share your health information when it has be “de-identified.” Health Information is considered to be de-identified when it does not personally identify you. We may also use a “limited data set” that does not contain any information that can directly identify you. This limited data set may only be used for the purposes of research, public health matters or health care operations. For example, a limited data set may include your city, county and zip code, but not your name or street address.


As Required by Law

We will disclose health information about you when required to do so by federal, state or local law.


Fundraising Activities

We may use information about you to contact you in an effort to raise funds for our organizations and their operations. We may disclose information about you to a foundation related to us so that the foundation may contact you in raising funds, including, for example, mailing you invitations to fundraising events, mailing you annual financial reports, and other types of mailings related to fundraising activities. We would only disclose contact information, such as your name, address and phone number and the dates you received treatment or services. If you do not wish to be contacted for fundraising purposes, contact the Alertline at 1-800-726-0713


To Avert a Serious Threat to Health or Safety

We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of others. Disclosure would only be to persons who could help prevent the threat.






HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU. EXAMPLES OF SPECIAL SITUATIONS


Organ and Tissue Donation

We may disclose health information to organizations that handle and monitor organ donation and transplantation.


Military

If you are a member of the armed forces, we may disclose health information about you as required by military command authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority.


Worker’s Compensation

We may disclose health information about you for workers’ compensation or similar programs to the extent necessary to comply with laws relation to workers’ compensation or other similar programs established by law. These programs provide benefits for work-related injuries or illness.


Public Health Risks

As required by law, we may disclose health information about you for public health activities. For example, we may undertake these activities:    To prevent or control disease, injury or disability;    To report births and deaths;    To report child abuse or neglect;    To report reactions to medications or problems with products;    To notify people of recalls of products they may be using;    To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and    To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure subject to certain requirements when mandated or authorized by law.


Health Oversight Activities and Registries

We may disclose health information to a health oversight agency for activities authorized by law and to patient registries for conditions such as tumors, traumas and burns. These oversight activities include, for example, audits, investigations, inspections and licensure surveys. These activities are necessary for the government to monitor the health care system, the outbreak of disease, government programs, compliance with civil rights laws, and to improve patient outcomes.


Lawsuits and Disputes

If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process.


Law Enforcement

We may disclose health information if asked to do so by a law enforcement official:    For the reporting of certain types of wounds;    In response to a court order, subpoena, warrant, summons or similar process;    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 person’s agreement;    About a death we believe may be the result of criminal conduct;    About suspected criminal conduct on the premises; and    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 disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose health information about patients of the hospital to funeral directors as necessary to carry out their duties.


National Security

We may disclose health information about you to authorized federal officials for purposes of national security.


Inmates

An inmate does not have the right to this Notice.






YOUR RIGHTS REGARDING HEALTH INFORMATION WE MAINTAIN ABOUT YOU


Right to Inspect and Copy

You have the right to inspect and have copied health information used to make decisions about your care. To inspect and have copied health information used to make decisions about you, you must submit your request in writing on the authorized form we will provide you upon your request. Call Release of Information at 520-694-7310 (University Campus) or 520-874-4010 (South Campus) for further details and a copy of the form, or talk with the Medical Office’s Custodian of Records if you have been seen at a medical office that is not physically located at one of the hospitals. We may charge a fee for the costs of processing your request.
Under very limited circumstances, your request may be denied, such as a request for psychotherapy notes. You may request that a denial be reviewed by contacting the Alertline at 1-800-726-0713.

Right to Request an Amendment

If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment of your record for as long as the information is kept by or for our organizations. To request an amendment to your record, your request must be made in writing and provide a reason that supports your request and submitted to facility where you received your care:

Banner – University Medicine — Tucson Campus HIM/ROI, 1501 N. Campbell Avenue, Box 245008 Tucson, Arizona 85724, Or Banner – University Medicine — South Campus HIM/ROI 2800 E. Ajo Way Tucson, Arizona 85713 Or The Medical Office’s Custodian of Records if you have been seen at a physician office that is not physically located at the hospital.

We may deny your request for an amendment to your record if it is not in writing or does not include a reason to support the request. We also 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 not longer available to make the amendment;    Is not part of the records used to make decisions about you;    Is not part of the information which you are permitted to inspect or copy; or    Is accurate and complete.


Right to an Accounting of Disclosures

You have the right to receive a list of the disclosures we made of your health information. This list will not include all disclosures made. For example, this list will not include disclosures we made for treatment, payment, health care operations, disclosures made prior to six years from the date of the request or disclosures you specifically authorized.
To request this list or an ‘accounting of disclosures,’ you must submit your request in writing on the authorized form we will provide to you upon your request. Contact Release of Information at 520-694-7310 (University Campus) or 520-874-4010 (South Campus) for more information and a copy of the form, or contact the Clinic’s Custodian of Records if you have been seen at a clinic or physician office that is not physically located at the hospital.


Right to Request Restrictions

You have the right to request a restriction or limitation on the health information we use or disclose about you to someone who is involved in your care or in 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 make your request in writing on a form that will be provided to you upon 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. Call Release of Information at 520-694-7310 (University Campus) or 520-874-4010 (South Campus) for further information and to request copy of the form, or contact the Clinic’s Custodian of Records if you have been seen at a clinic or physician office that is not physically located at the hospital.


Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at certain locations. You must make your request in writing on a form that will be provided to you upon your request. We will accommodate all reasonable requests. Call the Banner – University Medicine Patient Access office at 520-694-2823 (Tucson Campus) or 520-874-4910 (South Campus) for further information or speak to the health care provider at the site where you received your care.


Right to a Paper Copy of This Notice

You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this notice. You may download a copy of our current Notice from our website at www.uahealth.com.







COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Alertline at 1-800-726-0713. You may also file a complaint with the Arizona Department of Health Services (www.azdhs.gov) or the Office of Civil Rights (www.hhs.gov/ocr). You will not be penalized for filing a complaint.



OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or other laws that apply to us will be made only with your written authorization. If you provide authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization. We are unable to retract any disclosures we have already made with your authorization. We are required to retain records of the care that we provided to you.



REVISIONS TO THIS NOTICE

We may revise this Notice to reflect any changes in our privacy practices. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as for any information we receive in the future. We will post a copy of the current Notice in the locations where you receive services.