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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.
Your health information may be used by staff members or disclosed to other health care professionals or family members for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
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 insurance company may ask to see parts of your medical record before they pay us for treatment. We are required to agree to restrict disclosure of your medical information to a health plan in certain instances.
Your health information may be used as necessary to support the day-to-day activities and management of ASU Health Services. For example, your information may be used to evaluate care, for accreditation, and to promote quality at ASU Health Services.
Your health information may be disclosed to law enforcement agencies or government agencies to comply with legally required or government-mandated reporting.
Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.
ASU Health Services staff who telephone you for appointment reminders will have access to your health information for that purpose. We may also send you information describing treatment alternatives and other health-related products and services that we believe may interest you.
If you have any questions about this notice or our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact the ASU Health Services Privacy Officer at the address or telephone number listed above.
Effective Date: This notice is effective on or after 9/23/2013.
Disclosure of your health information or its use for any purpose other than those listed in this Notice requires your specific written authorization including disclosure of psychotherapy notes, use of your health information for marketing purposes, and the sale of your health information. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
You have the right to expect the following from us:
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of our legal duties and privacy practices.
We are also required to abide by the privacy policies and practices that are outlined in this notice.
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
ASU Health Services
P O Box 872104
Tempe, AZ 85287-2104
If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You may also send a written complaint to the Secretary of the Department of Health and Human Services.
You will not be penalized or otherwise retaliated against for filing a complaint.