Arizona Pioneers’ Home

NOTICE OF PRIVACY PRACTICES

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.  Understanding what is in your record and how your health information is used helps you to:

1. Ensure accuracy; 
2. Better understand who, what, when, where and why others may access your health information; 
3. Make more informed decisions when authorizing disclosure.

The Arizona Pioneers’ Home has the legal duty to safeguard all Protected Health Information (PHI) of the residents at the Arizona Pioneers’ Home.

This Notice of Privacy Practices describes how the Arizona Pioneers’ Home may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes as permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

The Arizona Pioneers’ Home is required to abide by the terms of the Notice of Privacy Practices. The Arizona Pioneers’ Home may change the terms of the notice at any time. The new notice will be effective for all protected health information that the Arizona Pioneers’ Home maintains at that time. You can obtain a copy of any revised Notice of Privacy Practices by requesting a copy from Resident Services, the Administrative Services Officer or the Privacy Officer.

How the Arizona Pioneers’ Home may use and disclose the PHI of the residents at the Arizona Pioneers’ Home.

The Arizona Pioneers’ Home uses and discloses health information for many different reasons. The following are examples of the types of uses and disclosures of Protected Health Information that the Arizona Pioneers’ Home is permitted to make. These examples are not meant to be exhaustive, but describe the types of uses and disclosures that may be made by the Arizona Pioneers’ Home.

A. Uses and Disclosures of Protected Health Information—Where No Authorization is Needed.

Your Protected Health Information may be used and disclosed by the Arizona Pioneers’ Home and others outside of the Arizona Pioneers’ Home who are involved in your care and treatment when providing health care services to you. Your Protected health Information may also be used and disclosed for the purpose of paying your health care bills and to support the operations of the Arizona Pioneers’ Home.

Treatment: The Arizona Pioneers’ Home will use and disclose your Protected Health Information to provide, coordinate, or manage your health care with a third party who has already obtained your permission to have access to your Protected Health Information. For example, the Arizona Pioneers’ Home would disclose your Protected Health Information, as necessary, to a health plan that provides care to you. The Arizona Pioneers’ Home will also disclose Protected Health Information to physicians who may be treating you. Your Protected Health Information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, the Arizona Pioneers’ Home may disclose your Protected Health Information to another physician or health care provider (e.g., a specialist, or laboratory) who, at the request of your physician, becomes involved in your care, diagnosis or treatment.

Payment: Your Protected Health Information will be used, as needed, to make or obtain payment for your health care services. This may include certain activities that the Arizona Pioneers’ Home or your health insurance plan may undertake before it approves or pays for health care services provided to you by a health care provider. For example, obtaining approval for a clinic visit may require that your relevant Protected Health Information be disclosed to your health plan to approve and pay for the visit.

Healthcare Operations: The Arizona Pioneers’ Home may use or disclose, as needed, your Protected Health Information in order to support the business activities of the Arizona Pioneers’ Home. These activities include, but are not limited to, quality assessment activities, employee review activities, training of staff, research, resolving grievances and conducting or arranging for other business activities.

For example, the Arizona Pioneers’ Home may disclose your Protected Health Information to the Arizona Department of Health Services as part of the annual survey of the Arizona Pioneers’ Home for quality assurance/quality improvement purposes.

The Arizona Pioneers’ Home will share your Protected Health Information with third party “business associates” that perform various activities (e.g., pharmacy services, hospice services, etc.) for the Arizona Pioneers’ Home. Whenever an arrangement between the Arizona Pioneers’ Home and a private business associate involves the use or disclosure of your Protected Health Information, the Arizona Pioneers’ Home will have a written contract with the business associate that contains terms that will protect the privacy of your health information. If the business associate is required by law to provide the service, the Arizona Pioneers’ Home will obtain written assurance that the entity or individual will safeguard the privacy of your Protected Health Information.

B. Uses and Disclosures of Protected Health Information—Based Upon Your Written authorization.

Other uses and disclosures of your Protected Health Information will be made only with your written authorization unless otherwise permitted or required by law as described below. You may revoke your authorization, at any time, in writing, except to the extent that your health care provider has taken an action in reliance on the use or disclosure indicated in the authorization.

1. Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object.  The Arizona Pioneers Home may use and disclose your Protected Health Information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your Protected Health Information. If you are not present or able to agree or object to the use or disclosure of the Protected Health Information, the Arizona Pioneers Home may, using the professional judgment of its staff, determine whether the disclosure is in your best interest. In this case, only the Protected Health Information that is relevant to your health care will be disclosed.
2. Others Involved in Your Healthcare: Unless you object, the Arizona Pioneers’ Home may disclose to a member of your family, a relative, a close friend or any other person that you identify, your Protected Health Information that directly relates to that person’s involvement in your health care or payment of your health care. If you are unable to agree or object to such a disclosure, the Arizona Pioneers’ Home may disclose such information as necessary, if the Arizona Pioneers’ Home determines that it is in your best interests based on Arizona Pioneers’ Home staff’s professional judgment. The Arizona Pioneers’ Home may use or disclose Protected Health Information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, the Arizona Pioneers’ Home may use or disclose your Protected Health Information to an authorized public or private entity, to assist in disaster relief efforts and to coordinate uses and disclosures to family members or other individuals involved in your health care.
3. Emergencies: The Arizona Pioneers’ Home may use or disclose your Protected Health Information in an emergency treatment situation in which you are involved, or for such other emergencies as disaster relief.

C. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object

The Arizona Pioneers’ Home may use or disclose your Protected Health Information in the following situations without your authorization. These situations include:

1.  Required by Law: The Arizona Pioneers’ Home may use or disclose your Protected Health Information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of certain uses or disclosures.
2. Public Health: The Arizona Pioneers’ Home may disclose your Protected Health Information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. The Arizona Pioneers’ Home may also disclose your Protected Health Information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
3. Communicable Diseases: The Arizona Pioneers’ Home may disclose your Protected Health Information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
4. Health Oversight: The Arizona Pioneers’ Home may disclose Protected Health Information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
5. Abuse or Neglect: The Arizona Pioneers’ Home may disclose your Protected Health Information to a public health authority that is authorized by law to receive reports of abuse or neglect. If the Arizona Pioneers’ Home reasonably believes that you have been a victim of abuse or neglect, the Arizona Pioneers’ Home may disclose your Protected Health Information to a government authority authorized to receive reports of abuse or neglect. The information will be disclosed when you agree to the release of the information or the disclosure will be made consistent with the requirements of applicable federal and state laws including protections afforded you to prevent serious harm.
6. Food and Drug Administration: The Arizona Pioneers’ Home may disclose your Protected Health Information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or to track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.
7. Criminal Activity: Consistent with applicable federal and state laws, the Arizona Pioneers’ Home may disclose your Protected Health Information if you are a victim of a crime or the Arizona Pioneers’ Home believes that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. The Arizona Pioneers’ Home may also disclose Protected Health Information if it is necessary for law enforcement authorities to identify or apprehend an individual.
8. Law Enforcement: The Arizona Pioneers’ Home may also disclose Protected Health Information so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include: (1) legal processes as otherwise required by law; (2) limited information requests for identification and location purposes; (3) gathering information pertaining to victims of a crime; (4) suspicion that death has occurred as a result of criminal conduct; (5) gathering information in the event that a crime occurs; and (6) a medical emergency and it is likely that a crime has occurred.
9. Legal Proceedings: The Arizona Pioneers’ Home may disclose your Protected Health Information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request or other lawful process.
10. Coroners, Funeral Directors and Organ Donation:  The Arizona Pioneers’ Home may disclose Protected Health Information to a coroner or medical examiner for identification purposes for determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. The Arizona Pioneers’ Home may also disclose Protected Health Information to a funeral director, as authorized by law, in order to permit the funeral director to carry out necessary duties. The Arizona Pioneers’ Home may disclose such information in reasonable anticipation of death. Protected Health Information may be used and disclosed for cadaver organ, eye or tissue donation purposes.
11. Research: The Arizona Pioneers’ Home may disclose your Protected Health Information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your Protected Health Information.

D. Your Rights

The following is a statement of your rights with respect to your Protected Health Information and a brief description of how you may exercise these rights.

1. You have the right to inspect and copy your Protected Health Information. This means you may inspect and obtain, upon written consent, a copy of your Protected Health Information that is contained in a designated record set, as defined by federal law, for as long as the Arizona Pioneers’ Home maintains the Protected Health Information.
2. Under federal law, however, you may not automatically inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and Protected Health Information that is subject to law that prohibits access to Protected Health Information. In some circumstances, you may have a right to have this decision reviewed. Please contact the Arizona Pioneers’ Home Privacy Officer if you have questions about access to your records.
3. You have the right to request a restriction of your Protected Health Information. This means you may ask the Arizona Pioneers’ Home not to use or disclose any part of your Protected Health Information for the purposes of treatment, payment or health care operations. You may also request that any part of your Protected Health Information not be disclosed to family members, relatives or friends who may be involved in your care or payment for your care, or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
4. The Arizona Pioneers’ Home is not required to agree to a restriction that you may request. If the Arizona Pioneers’ Home believes it is in your best interest to permit use and disclosure of your Protected Health Information, your Protected Health Information will not be restricted. If the Arizona Pioneers’ Home does agree to the requested restriction, the Arizona Pioneers’ Home may not use or disclose your Protected Health Information in violation of that restriction unless it is needed to provide emergency treatment; even then the Arizona Pioneers’ Home will request that the information not be further disclosed. With this in mind, please discuss any restriction you wish to request with Resident Services. You may request a restriction by submitting the request in writing to the Arizona Pioneers’ Home Privacy Officer.
5. You have the right to request to receive confidential communications from the Arizona Pioneers’ Home by alternative means or at an alternative location. The Arizona Pioneers’ Home will accommodate reasonable requests for communications by alternative means and/or location. The Arizona Pioneers’ Home may also condition this accommodation by asking you to specify an alternative address or method of contact. The Arizona Pioneers’ Home will not request an explanation from you as to the basis for the request. Please make this request in writing to the Arizona Pioneers’ Home Privacy Officer.
6. You may have the right to have your Protected Health Information amended. This means you may request an amendment of Protected Health Information about you the Arizona Pioneers’ Home created in a designated record set for as long as the Arizona Pioneers’ Home maintains this information. This statement must provide a reason to support the requested amendment. In certain cases, the Arizona Pioneers’ Home may deny your request or an amendment. If the Arizona Pioneers’ Home denies your request for an amendment, you have the right to file a statement of disagreement with the Arizona Pioneers’ Home Privacy Officer. If the Arizona Pioneers’ Home continues to deny your request, it may prepare a rebuttal to your statement; The Arizona Pioneers’ Home will provide you a copy of any such rebuttal. Please contact the Arizona Pioneers’ Home Privacy Officer to determine if you have any questions about amending your medical records.
7. You have the right to receive an accounting of certain disclosures the Arizona Pioneers’ Home has made, if any, of your Protected Health Information. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes disclosures authorized by you or which we may have made to you, to family members, relatives or friends involved in your care, as well as any releases authorized by federal law or required by law. You have the right to receive specific information regarding these disclosures that occurred after June 1, 2005. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
8. You have the right to obtain a paper copy of this notice from the Arizona Pioneers’ Home, upon request, even if you have agreed to accept this notice electronically.

E. Complaints

You may complain to the Arizona Pioneers Home or to the secretary of Health and Human Services if you believe your privacy rights have been violated by the Arizona Pioneers Home. You may file a written complaint with the Arizona Pioneers’ Home by sending it to the Arizona Pioneers Home Privacy Officer. The Arizona Pioneers Home will not retaliate against you for filing a complaint.

Contact the Arizona Pioneers’ Home Privacy Officer, Jessica Sullivan, at (928) 445-2181, by email at [email protected], or in person at the Arizona Pioneers’ Home, 300 S. McCormick, Prescott, AZ, 86303.

This notice is effective May 15, 2021.