Notice of Privacy Practices
Grand Canyon Psychiatric Services PLLC
Effective Date: 01/01/2022
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
This notice describes how medical information about you may be used and disclosed, and how
you can access this information. Please review it carefully.
Your Rights
Access to your Records
- View or Obtain Copies: You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary within 30 days of your request and may charge a reasonable, cost-based fee.
- Request Corrections: You can ask us to correct your health information if you believe it is incorrect or incomplete. We may deny your request, but we will provide a written explanation within 60 days.
Confidential Communications
- Special Requests: You can ask us to contact you in a specific way (e.g., home or office phone) or send mail to a different address. We will accommodate reasonable requests.
Restrict Information Sharing
- Limit Use and Sharing: You can ask us not to use or share certain health information for treatment, payment, or our operations. We may not agree if it affects your care
- Out-of-Pocket Payments: If you pay for a service or health care item out-of-pocket in full, you can request that we do not share that information with your health insurer.
Accounting of Disclosures
- List of Disclosures: You can ask for a list of the times we’ve shared your health information for six years prior to your request. We will provide one accounting a year for free but will charge a reasonable, cost-based fee for additional requests within 12 months.
- Request a Copy: You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.
Authorized Representatives
- Medical Power of Attorney: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
Filing a Complaint
- Complaints: You can complain if you feel we have violated your rights by contacting us at [clinic information]. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
Your Choices
For certain health information, you can tell us your choices about what we share.
● Sharing with Family and Friends: You have the right to tell us to share information with your family, close friends, or others involved in your care.
● Disaster Relief: You can inform us if you prefer how we share information in a disaster relief situation.
● Hospital Directory: You can decide if your information is included in a hospital directory.
● Marketing and Psychotherapy Notes: We never share your information for marketing purposes, sell your information, or share most psychotherapy notes without your written permission.
● Fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
Our Uses and Disclosures
We typically use or share your health information in the following ways:
● Treatment:
We can use your health information to treat you and share it with other professionals who are treating you.
● Operations:
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
● Billing:
We can use and share your health information to bill and get payment from health plans or other entities.
Privacy Assurance for Phone Numbers and SMS Consent
We understand the importance of your privacy. Your phone number and SMS consent will not be shared with any third parties. We will use your contact information solely to communicate with you regarding your treatment, practice operations, and billing processes. Rest assured, we are committed to protecting your personal information and maintaining your trust.
Special Circumstances
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.
SMS Communication
By providing your phone number, you consent to receive SMS messages from us regarding our services, including appointment reminders and important updates. Message and data rates may apply. You can opt out of receiving SMS messages at any time by following the instructions provided in the messages.
● Public Health and Safety: We can share health information for various reasons such as preventing disease, reporting adverse reactions, or suspected abuse.
● Research: We can use or share your information for health research.
● Compliance with Law: We will share information about you if state or federal laws require it.
● Organ Donation: We can share health information about you with organ procurement organizations.
● Deceased Individuals: We can share health information with a coroner, medical examiner, or funeral director.
● Worker’s Compensation, Law Enforcement, and Government Functions: We can use or share health information about you for these purposes as authorized by law.
● Legal Requirements: We can share health information in response to a court order or subpoena.
Our Responsibilities
- Protecting Your Information: We are required by law to maintain the privacy and security of your protected health information.
- Notification of Breach: We will let you know promptly if a breach occurs that may compromise the privacy or security of your information.
- Adherence to This Notice: We must follow the duties and privacy practices described in this notice and provide you a copy of it.
- Authorization: We will not use or share your information other than as described here unless you give us written permission. You can change your mind at any time by letting us know in writing.
For more detailed information, visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Contact Information
Grand Canyon Psychiatric Services, PLLC
28581 N Clover Cir, San Tan Valley, AZ 85143
Phone: 480-716-8473
Email: grandcanyonpsychiatric@gmail.com
This notice applies to Grand Canyon Psychiatric Services, PLLC.