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.
You have the right to obtain notice of the uses and disclosures of your protected health information with respect to your protected health information. This notice shall describe your rights pertaining to protective health information.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
- We may use health information about you for treatment, payment or health care operational purposes. Information that we may use or disclose includes your health information obtained from this time forward and all other health information in your medical record prior to this date. We may disclose your complete medical record, including portions that were created by another health care provider, as long as the disclosure is for the purpose of treatment, payment and health care operations.
- Your medical information may be used to treat your medical condition or to consider treatment for your medical condition. Your medical record information may also be sent to a specialist physician as part of a referral.
- Your medical information may also be used to send billing information to a health insurance plan or to obtain payment from other insurers, including, but not limited to, AHCCCS, Medicare or other third party insurers. If your health information is used for payment purposes, we will only disclose the minimal amount of information that is necessary for payment purposes.
- Your medical information may also be used to evaluate the quality of care that you receive, and for other quality assurance and quality assessment purposes. For example, your health information may be used to compare patient data to approve treatment methods. If your medical information is used for health care operational purposes, we will only disclose the minimal amount of information that is necessary for operational purposes.
- We may use or disclose identifiable health information about you without your authorization for several other reasons, including those required by law. Subject to certain requirements, we may report health information for reasons such as:
- Public health purposes, including but not limited to, for the purpose of protecting the health and safety of you and others;
- Abuse or neglect reporting;
- Auditing purposes;
- Research studies;
- Funeral arrangements;
- Contact for organ donation purposes;
- Workers’ compensation purposes;
- Communicating with your employer concerning a work-related injury or illness that may affect your ability to work;
- Communicating with your employer, in order to help it meet its workplace medical surveillance obligations;
- Proof of immunization to a school as part of a student’s admission
- Information when otherwise required by law, such as for law enforcement in specific circumstances.
- We may also contact you about appointment reminders, treatment alternatives, or other health related benefits and services that may be of interest to you.
- If the use or disclosure of your medical information is prohibited or limited by any other applicable law, disclosure of your medical information will comply with the more stringent law.
- Other uses and disclosures of your medical information will be made only with your written authorization.
- IF YOU SIGN AN AUTHORIZATION TO DISCLOSE INFORMATION, YOU CAN LATER REVOKE THAT AUTHORIZATION TO STOP ANY FUTURE USES AND DISCLOSURES. In the event that you decide that you do not want your medical information disclosed or used as described above, please notify us in writing immediately.
YOUR RIGHTS CONCERNING DISCLOSURE OF PROTECTED HEALTH INFORMATION
- You have the right to request restrictions on certain uses and disclosures of your protected health information. However, we are not required to agree to such restrictions. If you would like to restrict the use and disclosure of your information, please provide notice to us in writing. You should address your written notification to the HIPAA Officer, listed below.
- You have the right to request that your health information be communicated to you in a confidential manner. For example, you may request that we send mail to an address other than your home.
- In most cases, you have the right to look at or get a copy of health information about you that we use to make decisions about If you request copies, we will charge you $ 0.25 for each page and $10.00/hr. for clerk fee. You should note that fees that we charge for copying your records will not include costs associated with searching for and retrieving the requested information.
- You have the right to request to amend protected health information. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. If we receive and accept your request to amend any health information from you, we may be required to release any such changes to persons who may have relied or could have foreseeably relied upon such information to the detriment of the individual. By requesting an amendment to your protected health information, you consent to the release of the changes.
- You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or related administrative purposes. This right will enable you to receive information regarding who has received your medical information.
- You have the right to receive copies of your medical records in electronic format, if you ask for them.
- Upon your request, you have the right to obtain a paper copy of this notice.
- If you choose to pay out of pocket for a health service rather than having a claim submitted to your health plan, you may dictate to us that the insurer not have access to information about the service.
- You may request in writing that we not use or disclose your information for treatment, payment, or administrative purposes or to persons involved in your care, except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request but are not legally required to accept it.
GILA HEALTH RESOURCES’ DUTIES
Gila Health Resources:
- Is required by law to protect the privacy of your health information and to provide you with notice of our legal duties and privacy practices described in this notice.
- Is required to abide by the terms of the Notice currently in effect
- Reserves the right to change our policies at any time and to make the new Notice provision effective for all protected health information that it maintains. Before GHR makes a significant change in our policies, we will change our Notice and post the new Notice in the waiting area. You can also request a copy of the new Notice at any For more information about our privacy practices, contact the HIPAA Officer listed below. You may receive a copy of the changed Notice of Privacy Practices by requesting a copy from the receptionist or the HIPAA Officer, listed below.
- If you are concerned that we have violated your privacy rights or you disagree with a decision we made about access to your records, you may contact the HIPAA Privacy Officer, at Gila Health Resources and/or to the Office of Civil Rights. Your complaint to the Office of Civil Rights must be submitted either on paper or electronically. Your complaint must be filed within 180 days from the date that you either knew or should have known that your privacy was violated. The Office of Civil Rights may waive this 180-day time limit if good cause is shown. To obtain the electronic address to file a complaint with the Office of Civil Rights, you may contact Rick Miller, HIPAA Privacy Officer, at: (928) 865-7548.
- To submit a complaint to Gila Health Resources, you may file your complaint, specifying the specific reason why you believe your privacy rights have been If possible, please include the name of the Gila Health Resources employee whom you believe to be responsible for violating your privacy rights and the date and time of such violation. You must deliver your complaint to the HIPAA Privacy Officer, at:
- Please be assured that in the event that you file a complaint, you will not be retaliated against for filing such a complaint.
Gila Health Resources
P.O. Box 218
Morenci, Arizona 85540
You may also file a complaint verbally by telephoning Rick Miller, HIPAA Privacy Officer, at (928) 865-7548.
DISCLOSURE OF PROTECTED HEALTH INFORMATION TO YOUR EMPLOYER FOR MEDICIAL SURVEILLANCE AND WORK RELATED ILLNESS AND INJURY
Gila Health Resources, LLC (GHR) is a private, independent healthcare services organization, separate from the Freeport McMoRan, Inc. We do not share your personal, non-work-related, medical information with Freeport McMoRan, Inc., or with other employers or individuals, unless you have provided us with the appropriate authorization to do so, or unless we are otherwise authorized or required to do so under the provisions of the Health Insurance Portability and Accountability Act (HIPAA), or by state or federal law.
As part of your medical surveillance and/or other work-related injury or illness examination, GHR will access your prior electronic medical record (EMR) for medical charting purposes. Your EMR may contain prior clinical information outside of an employer-related examination. GHR may also need to obtain past medical history, medications, allergies and vital signs, even if such information was provided outside of an employer-related examination, as a part of its authorized examination. Please note that GHR will limit its review of such prior medical records to what is medically necessary to accomplish your examination based on the medical provider’s clinical judgement.
Please note that HIPAA permits GHR to make disclosures of protected health information without the authorization of a patient, for work-related injury or illness, or for medical surveillance in situations where the patient’s employer has a duty under MSHA (the Federal Mine Safety and Health Administration), OSHA (the Federal Occupational Safety and Health Administration), and/or other state and federal laws. (45C.F.R.164.512(b)).
GHR may disclose protected health information about you to your employer, without your authorization, if:
GHR provides health care to you at your employer’s request to conduct an evaluation relating to medical surveillance of the workplace, or to evaluate whether you have a work-related illness or injury, and;
The disclosure consists of findings concerning a work-related illness or injury, or a workplace-related medical surveillance, and;
The employer needs such findings to comply with its obligations under MSHA, OSHA, and/or other federal/state regulations to record such illness or injury or to carry out responsibilities for workplace medical surveillance, and;
GHR provides written notice to you that such information is disclosed to your employer. (Note: This notice satisfies this requirement to provide you with written notice).
PATIENTS HAVE THE FOLLOWING RIGHTS:
- Not to be discriminated against the based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;
- To receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities;
- To receive privacy in treatment and care for personal needs;
- To review, upon written request, the patient’s own medical record according to A.R.S. 12-2293,12-2294, and 12-2294.01;
- To receive a referral to another health care institution if Gila Health Resources is not authorized or not able to provide physical health services or behavioral health services needed by the patient.
- To participate or have the patient’s representative participate in the development of, or decisions concerning, treatment;
- To participate or refuse to participate in research or experimental treatment; and
- To receive assistance from a family member, the patient’s representative, or other individual in understanding, protecting, or exercising the patient’s rights.
(Per Title 9. Health Services/Article 10/R9-10-1008)
Gila Health Resources shall ensure that:
- Patients are treated with dignity, respect, and consideration;
- Patients are not subjected to:
- Sexual abuse;
- Sexual assault;
- Except as noted in R9-10-1012(8), restraint or seclusion;
- Retaliation for submitting a complaint to the Department of Health Services or another entity;
- Misappropriation of personal and private property by Gila Health Resources’ personnel, employees, volunteers or students.
- Patients or their representatives:
- Except in an emergency, either consent to or refuse treatment:
- May refuse or withdraw consent for treatment before treatment is initiated;
- Except in an emergency, is informed of alternatives to a proposed psychotropic medication or surgical procedure and associated risks and possible complication of a proposed psychotropic medication or surgical procedure;
- Is informed of the following:
- Gila Health Resources policy on health care directives, and
- The patient complaint process;
- Consents to photographs of the patient before a patient is photographed, except that a patient may be photographed when admitted for identification and administrative purposes, and;
- Except as otherwise permitted by law, provides written consent to the release of information in the patient’s:
- Medical record, or
- Financial records.
EFFECTIVE DATE: The original effective date of this notice was February 1, 2004, with revision dates on September 5, 2013, December 12, 2014, and January 20, 2018.