Arizona Telepsychiatry Clinic

How We May Use and Disclose Your Health Information

1. Treatment

We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This includes consultation between healthcare providers regarding your care and referrals to other providers.

Example: We may share your information with specialists, pharmacies, or laboratories to coordinate your psychiatric treatment.

2. Payment

We may use and disclose your health information to bill and collect payment for services provided. This may include disclosure to your health insurance company or third-party payer.

Example: We may submit claims to your insurance company that include diagnosis codes and treatment information.

3. Healthcare Operations

We may use and disclose your health information for healthcare operations purposes, including quality assessment, training, credentialing, and business management.

Example: We may review your records for quality improvement or use de-identified information for research.

4. Business Associates

We may disclose your health information to business associates who perform services on our behalf. These associates are required by contract to protect the privacy of your information.

Example: Our telehealth platform provider, billing company, and IT support services.

Special Circumstances

We may use or disclose your health information without your authorization in the following circumstances:

• As Required by Law: When required by federal, state, or local law
• Public Health Activities: To prevent or control disease, injury, or disability
• Victims of Abuse, Neglect, or Domestic Violence: When required or authorized by law to report
• Health Oversight Activities: To health oversight agencies for audits, investigations, or inspections
• Judicial and Administrative Proceedings: In response to a court order or subpoena
• Law Enforcement: For law enforcement purposes as required by law
• Coroners and Medical Examiners: For identification or cause of death determinations
• Serious Threat to Health or Safety: To prevent a serious threat to your health and safety or the health and safety of others
• Military and Veterans: If you are a member of the armed forces
• Workers' Compensation: For workers' compensation or similar programs

Arizona-Specific Requirements

Your Rights Regarding Your Health Information

Right to Access

You have the right to inspect and obtain a copy of your health information. We may charge a reasonable fee for copying and mailing costs. We will respond to your request within 30 days.

Right to Request Amendment

You have the right to request that we amend your health information if you believe it is incorrect or incomplete. We may deny your request under certain circumstances, and you may submit a statement of disagreement.

Right to an Accounting of Disclosures

You have the right to receive a list of certain disclosures we have made of your health information. The first accounting in any 12-month period is free; we may charge a reasonable fee for additional requests.

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information. We are not required to agree to your request except in limited circumstances, such as when you pay out-of-pocket in full for services and request we not disclose to your health plan.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically.

Right to Breach Notification

You have the right to be notified if there is a breach of your unsecured health information.

Uses and Disclosures That Require Your Authorization

For the following uses and disclosures, we will obtain your written authorization:

• Marketing purposes (except for face-to-face communications or promotional gifts of nominal value)
• Sale of your health information
• Most uses and disclosures of psychotherapy notes
• Other uses and disclosures not described in this notice

You may revoke any authorization in writing at any time, except to the extent we have already taken action in reliance on your authorization.

Telehealth-Specific Privacy Considerations

Our telehealth services involve the use of electronic communications to provide healthcare services. We take the following measures to protect your privacy:

• Use of HIPAA-compliant, encrypted video conferencing platforms
• Secure storage of electronic health records
• Limited access to your health information based on role and necessity
• Regular security risk assessments and updates
• Staff training on privacy and security practices

Changes to This Notice

We reserve the right to change this notice and make the new notice apply to health information we already have as well as any information we receive in the future. We will post the current notice on our website with the effective date. You may request a copy of the current notice at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.