Privacy Policy

RECOVERY CENTER FOR THE ARTS/LIFELINE PCS

NOTICE OF PRIVACY PRACTICES & CLIENT RIGHTS & RESPONSIBILITIES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. FURTHERMORE, THIS DOCUMENT DISCUSSES YOUR RIGHTS AS A CLIENT/PATIENT AS WELL AS YOUR RESPONSIBILITIES.

PLEASE REVIEW THIS DOCUMENT CAREFULLY

Your health record contains personal information about you and your health. This information, which may identify you and relates to your past, present or future physical or mental health or condition and related health care services, is referred to as Protected Health Information ( PHI ). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI.

We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request, or providing one to you at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization.

For Payment. We may use or disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.

For Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, reminding you of appointments, to provide information about treatment alternatives or other health related benefits and services, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with this signed authorization.

Required by Law. We are required by law to maintain the privacy of your information.  Furthermore, under the law, we must make disclosures of your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization.

• Abuse and Neglect Judicial and Administrative Proceedings Emergencies
• Law Enforcement National Security Public Safety (Duty to Warn)
• Without Authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are:
• Required by law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as the social work licensing board or health department)
• Required by Court Order
• Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat, it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
• Verbal Permission. We may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
• With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked.

YOUR RIGHTS REGARDING YOUR PHI

• You have the following rights regarding your personal PHI maintained by our office. To exercise any of these rights, please submit your request in writing to our Privacy Officer, HEATHER JONES, at 335 N. Alma School Road, Suite E, Chandler AZ 85224.
• Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. We may charge a reasonable, cost-based fee for copies.
• Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information, although we are not required to agree to the amendment.
• Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
• Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction.
• Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Breach Notification. If there is a breach of unsecured protected health information concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself
• Right to a Copy of this Notice. You have the right to a copy of this notice.

YOUR RESPONSIBILITIES:

Clients are expected to provide relevant information as a basis for receiving services and participating in service decisions. Discharge criteria:

Discharge can happen when

1. You and your counselor agree that goals have been obtained and no further treatment at this time is needed.
2. You cease attending for 2 consecutive sessions and do not respond to outreach attempts.
3. You have a limited number of authorized sessions and/or time frame allotted and that has expired.
4. You have an outstanding balance in excess of $100 and have not made payment arrangements or have not followed through on payment arrangements.
5. You may be discharged from one therapist and assigned to another due to internship ending or other reasons for the initial therapist leaving the facility.
6. You are determined (by 2 or more staff members) to be a danger to others in the facility.
7. Terminate a counseling re-relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. When required by professional standards, pre termination sessions and referrals will be provided.

Basic expectations:

No weapons on the premise

Shoes, shirts, and lower garments at all times On time attendance

Maintain confidentiality of others you may be in a group therapy session with No alcohol or drugs on premise No acts of verbal, physical, aggression Clean up after yourself

Minors to be monitored at all times

Minors in therapy are to be dropped off on time and picked up on time Abuse of staff or other patients will not be tolerated. Use appropriate channels for questions, complaints, grievances, COMPLAINTS

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with HEATHER JONES our Privacy Officer, at 335 N Alma School Rd Suit E Chandler, AZ 85224 or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling (202) 619- 0257. We will not retaliate against you for filing a complaint.

These procedures outline the steps available to you to address a grievance.

1. First process the grievance or concern with staff. If the patient is not satisfied, he/she must obtain a grievance form.
2. Complete the form in detail when applicable
3. Submit form to staff or administrator. Grievance form will be initially responded to within two working days of it receipt.
4. The agency administrator will review, meet with patient and relevant parties (if applicable to address the issue raised in the grievance.
5. Filed grievances will receive a formal written response within five working days.
6. A person or persons shall not be discriminated against, prohibited reprisal or retaliated against, because he or she has filed a grievance with or outside of the agency.
7. No patient will be subjected to threats of early termination or rejection by staff
8. Policies and procedures will be explained to the patient, parent, and guardian or designated representative at time of admission.
9. A patient or representative may file a grievance directly with the Arizona Department Of Health Services Public Health Licensing- Medical facilities Licensing. 150 N. 18th Avenue, Suite 450, Phoenix, AZ 85007 AZDHS.GOV

Client Rights & Important Addresses, Phone Numbers and Information A client has the following rights:

R9-10-1008.

Patient Rights

1. An administrator shall ensure that:
   1. The requirements in subsection

1. and the patient rights in subsection
2. are conspicuously posted on the premises;
3. At the time of admission, a patient or the patient’s representative receives a written copy of the requirements in subsection

1. and the patient rights in subsection
2. ; and
3. Policies and procedures are established, documented, and implemented to protect the health and safety of a patient that include:
   1. How and when a patient or the patient’s representative is informed of patient rights in subsection (C); and
   2. Where patient rights are posted as required in subsection (A)(1).
4. An administrator shall ensure that:
   1. A patient is treated with dignity, respect, and consideration;
   2. A patient as not subjected to:
      1. Abuse;
      2. Neglect;
      3. Exploitation;
      4. Coercion;
      5. Manipulation;
      6. Sexual abuse;
      7. Sexual assault;
      8. Except as allowed in R9-10-1012(B), restraint or seclusion; This document contains an unofficial version of the new rules in 9 A.A.C. 10, Article 10, effective May 1, 2016. 13
      9. Retaliation for submitting a complaint to the Department or another entity; or
      10. Misappropriation of personal and private property by an outpatient treatment center s personnel member, employee, volunteer, or student; and
   3. A patient or the patient’s representative:

1. Except in an emergency, either consents to or refuses treatment;
2. May refuse or withdraw consent for treatment before treatment is initiated;
3. Except in an emergency, is informed of alternatives to a proposed psychotropic medication or surgical procedure and associated risks and possible complications of a proposed psychotropic medication or surgical procedure;
4. Is informed of the following:
   1. The outpatient treatment center’s policy on health care directives, and
   2. The patient complaint process; e. Consents to photographs of the patient before a patient is photographed, except that a patient may be photographed when admitted to an outpatient treatment center for identification and administrative purposes; and f. Except as otherwise permitted by law, provides written consent to the release of information in the patient’s:

1. Medical record, or
2. Financial records.
3. A patient has the following rights:
   1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;
   2. To receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities;
   3. To receive privacy in treatment and care for personal needs;
   4. To review, upon written request, the patient’s own medical record according to A.R.S. §§ 12-2293, 12- 2294, and 12-2294.01;
   5. To receive a referral to another health care institution if the outpatient treatment center is not authorized or not able to provide physical health services or behavioral health services needed by the patient;
   6. To participate or have the patient’s representative participate in the development of, or decisions concerning, treatment;
   7. To participate or refuse to participate in research or experimental treatment; and
   8. To receive assistance from a family member, the patient’s representative, or other This document contains an unofficial version of the new rules in 9 A.A.C. 10, Article 10, effective May 1, 2016. 14 individual in understanding, protecting, or exercising the patient’s rights. 

You may ask to see a copy of any of the documents referenced above. Also, you may speak to your therapist for an explanation or clarification of any of the above-listed rights.

Important Addresses, Phone Numbers and Information Arizona Department of Health Services 602- 542-1000 150 North 18th Avenue, Phoenix, Arizona 85007

Bureau of Medical Facilities Licensing

150 N. 18th Street, Suite 410, Phoenix, AZ 85007-3242……… (602) 364-3030 FAX: (602) 364-4764

Division of Behavioral Health Services… (602) 364-4558 150 N. 18th Avenue, 2nd Floor, Phoenix, AZ 85007

Child Protective Services – Child Abuse Hotline

3221 N. 16th Street, # 400, Phoenix, AZ 85016 1-888-SOS-CHILD (602-767-2445)

AZ DES Office of Adult Protective Services – Adult Abuse Hotline

1789 W. Jefferson, Site Code 950A, Phoenix, AZ 85007 1-877-SOS-ADULT (602-767-2385)

Ombudsman Office (Human Rights Advocate)… (602) 364-2860 or 1-866-362-2837

For Emergencies call:

– 911

-Empact Crisis Line 24 hrs 480-784-1500

-Banner Help Line 602-254-4357

-Banner Psychiatric Center 481-941-7600

-Terros (business hours) 602-685-6000

-St. Lukes Behavioral 800-821-4193

-Community Bridges-DETOX 602-222-9444

-Childhelp Hotline1-800-422-4453

-Maricopa Crisis Recovery Network/Magellan 24 hrs… 602-222-9444

-Warm Line (peer support available until midnight) 602-347-1100

-Community Information and Referral 602-263-8856