Notice of HIPAA Privacy Practice
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT PATIENTS AT Blue Door MAY BE USED AND DISCLOSED AND HOW PATIENTS CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
Blue Door’s Duty to Safeguard Your Protected Health Information: Individually identifiable information, maintained by Blue Door in a patient’s designated record set about past, present, or future health, the provision of behavioral health care, or payment for the behavioral health care is considered Protected Health Information (PHI).
This policy may change at any time. However, before Blue Door makes changes to this policy, patients will receive notice regarding any changes as required by law. Except as required by law, any changes to this policy will be effective the date put forth in the notice for all Protected Health Information that Blue Door maintains at that time.
You can receive a copy of Blue Door’s Notice upon request at the front desk, by calling and requesting a copy be sent to you by mail, or by accessing the Notice online at www.bluedoor.org.
For more questions, please contact:
10900 N Scottsdale Rd, Ste 609
Scottsdale, AZ 85254
(844) 504 – 4500
How Blue Door May Use and Disclose Your Protected Health Information:
Blue Door has a limited right to use or disclose your PHI for purposes of treatment, payment, and behavioral health care operations. For uses and disclosures, Blue Door must have your written permission unless otherwise required or permitted by law. You have the right to revoke your authorization, in writing, at any time. If Blue Door discloses your PHI to a business associate in order for that entity to perform a function on Blue Door’s behalf, Blue Door must have in place a signed agreement from the business associate that it will extend the same degree of privacy protection to your PHI. However, the law provides that Blue Door is permitted to make some uses or disclosures without your consent or authorization. The following offers more description and some potential examples of Blue Door’s possible uses or disclosures of your PHI:
For treatment: Blue Door may use or disclose your PHI to provide, coordinate, or manage your healthcare and any related services. For example, your PHI will be shared among members of your treatment team, Blue Door staff, and Blue Door contractors. Your PHI may also be shared with outside entities performing other services relating to your treatment. Some of these services include communicating with health professionals to plan your care and treatment or for consultation.
For payment: Blue Door may use or disclose your PHI in order to bill and collect payment for your medical and behavioral health care services. For example, Blue Door may contact your employer to verify employment status and/or release portions of your PHI to the ADHS central office. Blue Door may also use or disclose your PHI to your public or private insurer to receive payment for services delivered, if applicable.
For behavioral health care operations: Blue Door may use or disclose your PHI for behavioral health care operations. For example, member of the team may share PHI to assess the care and outcomes in your case. Blue Door may use you PHI in reviewing and improving the quality, efficiency, and cost of care.
Uses and Disclosures of PHI Not Requiring Authorization:
Unless otherwise prohibited by law, Blue Door may use or disclose you PHI without consent or authorization in the following circumstances:
When required by law: Blue Door may disclose PHI as required by state or federal law. Examples include reporting information about suspected abuse, neglect, domestic violence, relating to suspected criminal activity, in response to a court order or other legal process, judicial proceedings, in certain law enforcement situations, and workers compensation. Blue Door must also disclose PHI to authorities that monitor compliance with these privacy requirements.
For public health activities: Blue Door may disclose PHI when required to collect information for and situations pertaining to the conduct of public health surveillance, public health investigations and interventions, and the reporting of vital events such as birth or death to the public health authority.
For health oversight activities: Blue Door may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities may include monitoring, audits, investigations, inspections, and licensure.
Relating to decedents: Blue Door may disclose PHI relating to an individuals’ death including information to coroners, medical examiners, funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations or transplants.
For research purposes: In certain limited circumstances, Blue Door may disclose your PHI for research purposes. For example, a research project may involve the care and recovery of all enrolled persons who receive one medication for the same condition. All research projects are subject to a special approval process. Blue Door will obtain your written authorization if the researcher will use or disclose your behavioral health PHI.
To avert threat to health or safety: In order to avoid a serious threat to health or safety, Blue Door may disclose PHI as necessary to law enforcement or other person who can reasonably prevent or lessen the threat of harm.
For specific government functions: Blue Door may disclose PHI of military personnel and veterans in certain situations. Other government related disclosures may include information disclosed to Human Rights Committees, the Sexually Violent Persons Program, correctional facilities, other law enforcement custodial situations, to government benefit programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.
Uses and Disclosures To Which You Have an Opportunity to Object:
In the following situations, Blue Door may disclose a limited amount of your PHI, with advanced notice and if you do not object, as long as the disclosure is not otherwise prohibited by law.
To families, friends, or others involved in your care: Blue Door may share information directly related to their involvement in your care, or payment for your care. Blue Door may also share PHI with those involved in your care to notify them about your location, general condition, or death.
Your Rights Regarding Your Protected Health Information:
You have the following rights relating to your PHI:
Right to Request Restrictions: You have the right to request that Blue Door restricts the use or disclosure of your behavioral health information to carry out treatment, payment, health care operations, or communications with family, friends, or other individuals. Blue Door is not required to agree to a restriction. Blue Door cannot agree to limit uses or disclosures that are required by law.
Right to Request Conditions on Providing Confidential Communications: You have the right to request that Blue Door sends communications that contain PHI by alternative means or to alternative locations. Blue Door must accommodate your request if it is reasonable and you clearly state that the disclosure of all or part of that information could endanger you.
Right to Inspect and Copy: You have the right to inspect and copy your behavioral health information maintained by Blue Door. Such requests must be issued in writing. If you request copies, Blue Door may charge a reasonable fee based on the costs of preparation. Blue Door may deny such requests in certain circumstances as defined by law.
Right to Request an Amendment: You have the right to request an amendment be made to your behavioral health information for as long as Blue Door maintains such record. Such requests must be made in writing. Requests must include reason(s) that support the request for amendment. Blue Door may deny requests for amendments if the subject record was not created by Blue Door, is not available for inspection as specified by law, or is found to be accurate and complete.
Right to Receive Accounting of Disclosures: You have the right to receive an accounting of disclosures of your behavioral health information created by Blue Door. Accountings will not include those made to carry out treatment; payment and health care operations; to you; to family, friends, or others involved in your care; for national security or intelligence purposes; to correctional institutions or law enforcement officials. Your first request for accounting in any 12-month period will be provided free of charge and each subsequent request may be charged a reasonable cost-based fee.
You Have the Right to Receive this Notice: You have the right to receive a paper copy of this Notice and/or an electronic copy by email upon request. This information is also posted on Blue Door’s website at www.bluedoor.org.
How to File a Complaint if You Believe Your Privacy Rights Have Been Violated:
If you believe your privacy rights as set forth in this Notice have been violated and you wish to make a complaint, please write or contact one of the offices listed below:
Arizona Department of Health Services
Agency Privacy Officer
1740 West Adams – Room 101
Phoenix, AZ 85007
Phone: (602) 364-1560
Arizona Department of Health Services
Division of Behavioral Health Services
Manager for Grievance and Appeals
150 N. 18th Avenue, Suite 200
Phoenix, AZ 85007
Phone: (602) 364-4558
You also may file a written complaint with the Secretary of the U.S. Department of health and Human Services. To ask for a complaint form, write to or call:
US Dept of Health & Human Services
Office of Civil Rights
50 United Nations Plaza – Room 322
San Francisco, CA 94102
Blue Door will take no retaliatory action against a person making such complaints.