HIPAA

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

We are committed to protecting the confidentiality of your medical information, and are required by law to do so. This notice describes how Summit Healthcare may use your medical information, and how we may disclose it to other providers. This notice also describes the rights you have concerning your own medical information. Please review it carefully and let us know if you have questions.

HOW WILL WE USE AND DISCLOSE YOUR MEDICAL INFORMATION?

Treatment: We may use your medical information to provide you with medical services and supplies. We may also disclose your medical information to others who need that information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers, and others involved in your care. For example, we will allow your physician to have access to your medical record to assist in your treatment and for follow-up care. We also may use and disclose your medical information to contact you to remind you of an upcoming appointment.

Patient Directory: At the medical center, in order to assist family members and other visitors in locating you while you are in the medical center, the medical center maintains a patient directory. This directory includes your name, room number, your general condition (such as fair, stable, or critical), and your religious affiliation (if any). We will disclose this information to someone who asks for you by name. If you do not want to be included in the medical center’s patient directory, please inform our registration personnel during your admission process.

Family Members and Others Involved in Your Care: We may disclose your medical information to a family member or friend who is involved in your medical care, or to someone who helps to pay for your care. If you do not want Summit Healthcare to disclose your medical information to family members or others who will visit you or assist in your medical care, please inform our Summit Healthcare personnel as soon as possible.

Payment: We may use and disclose your medical information to get paid for the medical services and supplies we provide to you. For example, your health plan or health insurance company may ask to see parts of your medical record before they will pay us for your treatment.

Summit Healthcare Operations: We may use and disclose your medical information if it is necessary to improve the quality of care we provide to patients or to operate Summit Healthcare. We may use your medical information to conduct quality improvement activities, to obtain audit, accounting or legal services, or to conduct business management and planning.

Fundraising: The Summit Healthcare Foundation may contact you in the future to raise money for the Summit Healthcare Association. If you do not want the Summit Healthcare Foundation to contact you for fundraising, please notify the Foundation Department in writing. Send requests to Foundation Department at Summit Healthcare, 2200 Show Low Lake Rd., Show Low, AZ 85901.

Required by Law: Federal, State, or local laws sometimes require us to disclose patients’ medical information. For instance, we are required to report child abuse or neglect and must provide certain information to law enforcement officials in domestic violence cases. We also are required to give information to the Arizona Workers’ Compensation Program for work-related injuries.

Public Health and Safety: We also may report certain medical information for public health purposes. For instance, we are required to report births, deaths, and communicable diseases to the State of Arizona. We may disclose medical information for public safety purposes in limited circumstances. We may disclose medical information to law enforcement officials in response to a search warrant or a grand jury subpoena.

Health Oversight Activities: We may disclose medical information to a government agency that oversees Summit Healthcare or its personnel, such as the Arizona Department of Health Services, the federal agencies that oversee Medicare, the Board of Medical Examiners or the Board of Nursing. These agencies need medical information to monitor Summit Healthcare’s compliance with state and federal laws.

Coroners, Medical Examiners and Funeral Directors: We may disclose medical information concerning deceased patients to coroners, medical examiners and funeral directors to assist them in carrying out their duties.

Organ and Tissue Donation: We may disclose medical information to organizations that handle organ, eye or tissue donation or transplantation.

Military, Veterans, National Security and Other Government Purposes: If you are a member of the armed forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. Summit Healthcare may also disclose medical information to federal officials for intelligence and national security purposes or for presidential Protective Services.

Judicial Proceedings: Summit Healthcare may disclose medical information if the Summit Healthcare Association is ordered to do so by a court or if the Summit Healthcare Association receives a subpoena or a search warrant. You will receive advance notice about this disclosure in most situations so that you will have a chance to object to sharing your medical information.

Information with Additional Protection: Certain types of medical information have additional protection under state or federal law. For instance, medical information about communicable disease and HIV/AIDS, drug and alcohol abuse treatment, genetic testing, and evaluation and treatment for a serious mental illness is treated differently than other types of medical information. For those types of information, Summit Healthcare is required to get your permission before disclosing that information to others in many circumstances.

Other Uses and Disclosures: If the Summit Healthcare Association wishes to use or disclose your medical information for a purpose that is not discussed in this Notice, the Summit Healthcare Association will seek your permission. If you give your permission to the Summit Healthcare Association, you may take back that permission any time, unless we have already relied on your permission to use or disclose the information. If you would ever like to revoke your permission, please notify the Summit Healthcare Association Compliance Officer in writing.

WHAT ARE YOUR RIGHTS?

Right to Request Your Medical Information: You have the right to look at your own medical information and to get a copy of that information. (The law requires us to keep the original record.) This includes your medical record, your billing record, and other records we use to make decisions about your care. To request your medical information, please contact the custodian of records at your provider’s office. If you request a copy of your information, we will charge you for our costs to copy the information. We will tell you in advance what this copying will cost. You can look at your record at no cost.

Right to Request Amendment of Medical Information You Believe Is Erroneous or Incomplete: You have the right to request a list of many of the disclosures we make of your medical information. If you would like to receive such a list, please contact the custodian of records at your provider’s office. We will provide the first list to you free, but we may charge you for any additional lists you request during the same year. We will tell you in advance what this list will cost.

Right to Get a List of Certain Disclosures of Your Medical Information: You have the right to request a list of many of the disclosures we make of your medical information. If you would like to receive such a list, write to the custodian of records at your provider’s office. We will provide the first list to you free, but we may charge you for any additional lists you request during the same year. We will tell you in advance what this list will cost.

Right to Request Restrictions on How the Summit Healthcare Association Will Use or Disclose Your Medical Information for Treatment, Payment, or Health Care Operations: You have the right to ask us not to make uses or disclosures of your medical information to treat you, to seek payment for care, or to operate the Summit Healthcare Association. We are not required to agree to your request, but if we do agree, we will comply with that agreement. If you want to request a restriction, write to the custodian of records at your provider’s office and describe your request in detail.

Right to Request Confidential Communications: You have the right to ask us to communicate with you in a way that you feel is more confidential. For example, you can ask us to send information about your healthcare to an address different than your home address. If you would like to do this, inform Summit Healthcare personnel as soon as possible. You can also ask to speak with your health care providers in private outside the presence of other patients-just ask them!

Right to a Paper Copy: If you have received this notice electronically, you have the right to a paper copy at any time. You may download a paper copy of the notice from our website, at http://www.summithealthcare.net or you may obtain a paper copy of the notice.

WHICH HEALTH CARE PROVIDERS ARE COVERED BY THIS NOTICE?

This Notice of Privacy Practices applies to the Summit Healthcare Association and its personnel, volunteers, students, and trainees. The notice also applies to other organized healthcare associates that utilize the Summit Healthcare Association to care for patients, such as physicians, physician assistants, therapists, emergency service providers, medical transportation companies, medical equipment suppliers, and other health care providers not employed by the Summit Healthcare Association. The Summit Healthcare Association may share your medical information with these providers for treatment purposes, to get paid for treatment, or to conduct health care operations. These health care providers will adhere to the rights stated in this notice for information they receive about you. These other health care providers may follow different practices at their own offices or facilities.

TO REPORT FRAUD, ABUSE, ETHICAL CONCERNS

Compliance Hotline – 1.888.826.8433

All calls are anonymous. Messages are picked up daily by an outside company and referred to Stan Adams, Chief Finance and Compliance Officer with Summit Healthcare.

DO YOU HAVE CONCERNS OR COMPLAINTS?

Please tell us about any problems or concerns you have with your privacy rights or how the Summit Healthcare Association uses or discloses your medical information. If you have a concern, please contact:

Chief Finance and Compliance Officer
928.537.6375

If for some reason the Summit Healthcare Association cannot resolve your concern, you may also file a complaint with the federal government. We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.

DO YOU HAVE QUESTIONS?

The Summit Healthcare Association is required by law to give you this Notice and to follow the terms of the Notice that is currently in effect. If you have any questions about this Notice, or have further questions about how the Summit Healthcare Association may use and disclose your medical information, please contact the Association Corporate Compliance Officer at 928-537-4375.