Fecha de vigencia de este aviso: 5 de septiembre de 2014
ESTE AVISO DESCRIBE CÓMO SE PUEDE UTILIZAR Y DIVULGAR LA INFORMACIÓN MÉDICA SOBRE USTED
Y CÓMO PUEDE ACCEDER A ESTA INFORMACIÓN.
POR FAVOR REVISE CUIDADOSAMENTE.
Para más información, ver: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
Tus derechos
You have rights when it comes to your health information. These include the right to:
Receive an electronic or paper copy of your medical record.
To request a copy, contact UCP’s front desk at 602-943-5472 extension 2001 and request the Program Manager. We will provide a copy or summary of your health information within 30 days of the request. A reasonable fee may be charged.
Request corrections to your medical record
To request corrections to your health information, UCP’s front desk at 602-943-5472 extension 2001 and request the Program Manager. If your request is denied, you will receive an explanation in writing within 60 days.
Solicitar comunicaciones confidenciales
If you would prefer that UCP only contact you in a specific way (for example, a home or office phone) or to send mail to a different address than is on file, contact UCP’s front desk at 602-943-5472 extension 2001 and request the Program Manager. All reasonable requests will be accommodated.
Request that UCP limit data used or shared
To request that UCP not use or share health information for treatment, payment, or our operations, UCP’s front desk at 602-943-5472 extension 2001 and request the Program Manager. Please note that UCP is not required to agree, and may deny the request if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you may request that information not be shared for the purpose of payment or our operations with your health insurer. Unless the law requires otherwise, this request will be accommodated.
Obtain a list of those with whom UCP has shared information
You may request a list (accounting) of times UCP has shared your health information for up to six years prior to the request date, who it was shared with, and why. All disclosures except those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make) will be included. One accounting a year will be provided free of cost, however additional requests in a 12-month period will result in a reasonable, cost-based fee.
Receive 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. A paper copy will be provided promptly.
Designate someone to act for you
Si le ha otorgado a alguien un poder notarial médico o si alguien es su tutor legal, esa persona puede ejercer sus derechos y tomar decisiones sobre su información de salud.
File a complaint
To file a complaint, individuals may contact the Quality Assurance and Compliance Manager at 602-999-9391. If further assistance is needed, individuals may contact:
UCP Privacy Officer
1802 West Parkside Lane
Phoenix, AZ 85027
P: 602-943-5472
O
The Arizona Department of Health Services
1501 North 18thAvenue, Suite 450
Phoenix, AZ 85007
P: 602-364-3030
You also have the option to file a complaint with the US Department of Health and Human Service Office for Civil Rights by sending a letter to
https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html
UCP will not retaliate against any complaint filed against the agency.
Tus opciones
For certain health information, you can decide what we share.
In these cases, you have both the right and choice to tell us whether or not to:
Comparta información con su familia, amigos cercanos u otras personas involucradas en su atención.
Compartir información en una situación de socorro en casos de desastre.
Incluya su información en un directorio del hospital
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.
We never share your information unless you give us written permission for the following:
Marketing purposes
Sale of your information, and
Most sharing of psychotherapy notes.
We may contact you for fundraising efforts, but you can tell us not to contact you again.
Nuestros usos y divulgaciones
We typically use or share your health information in the following ways:
For your treatment - Podemos usar su información de salud y compartirla con otros profesionales que lo están tratando.
Running our organization - Podemos usar y compartir su información de salud para llevar a cabo nuestra práctica, mejorar su atención y contactarlo cuando sea necesario.
Billing for your services — We can use and share your health information to bill and receive payment from health plans or other entities.
Example: We provide information about you to your health insurance plan so it will pay for your services.
Other Disclosures:
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. However, we are required by law to meet many conditions before we can share your information for these purposes.
Para más información, ver: https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf
Examples of other situations in which we may share your information are:
Helping with public health and safety issues — We can share health information about you for certain situations such as:
Prevenir enfermedades
Ayudar con el retiro de productos
Informar reacciones adversas a medicamentos
Informar sospechas de abuso, negligencia o violencia doméstica
Prevenir o reducir una amenaza grave para la salud o seguridad de cualquier persona
Research — We can use or share your information for health research.
To 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.
In response to organ and tissue donation requests — We can share health information about you with organ procurement organizations.
For 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.
To address workers’ compensation, law enforcement, and other government requests — We can use or share health information about you:
Para reclamos de indemnización laboral
Para fines de aplicación de la ley o con un oficial de la ley
Con agencias de supervisión de salud para actividades autorizadas por ley
Para funciones especiales del gobierno como servicios militares, de seguridad nacional y de protección presidencial
To 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.
Nuestras responsabilidades
La ley nos exige mantener la privacidad y seguridad de su información de salud protegida.
We will let you know promptly if a breach that may have compromised the privacy or security of your information occurs.
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. You may change your mind at any time. Let us know in writing if you change your mind.
Cambios a los Términos de este Aviso
Podemos cambiar los términos de este aviso, y los cambios se aplicarán a toda la información que tengamos sobre usted. El nuevo aviso estará disponible a pedido, en nuestra oficina y en nuestro sitio web.
