Privacy Policy
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| Cottonwood Medical Center, LTD. 560 N Camino Mercado, Suite 7, Casa Grande, Arizona 85222 Tel: (520) 836-5538 Fax: (520) 876-0878 Toll Free: (800) 895-5538 www.cottonwoodmedical.com |
To our patients: This notice describes how information about you (as a
patient of this practice) may be used and disclosed and how you can get
access to this information. [This is required by the Privacy Regulations
created as a result of the Health Insurance Portability and Accountability
Act of 1996 (HIPPA).] Please review it carefully.
Web Site
The privacy of our customers has always been of utmost importance to
Cottonwood Medical Center, Ltd. Cottonwood Medical Center, Ltd. has a
long history of protecting your privacy and our concern for your privacy is
no different in the electronic age. Our Internet privacy policy is:
You do not have to give us personal information to visit our site.
We will collect personally identifiable information (name, email address,
Social Security number, or other unique identifier) only if specifically and
knowingly provided by you.
Personally identifying information you provide will be used only in
connection with Cottonwood Medical Center, Ltd. programs and services or
for such other purposes as are described at the point of collection.
Information is collected for statistical purposes and Cottonwood Medical
Center sometimes performs analyses of user behavior in order to measure
customer interest in the various areas of our site.
We do not give, sell or transfer any personal information to a third party.
We may enable "cookies." A "cookie" is a file placed on your personal
computer's hard drive by a Web site that allows it to monitor your use of the
site.
Health Insurance Portability and Accountability Act of 1996 Statement
Introduction
At Cottonwood Medical Center, Ltd. we are committed to treating and using
your protected health information responsibly. This Notice of Health
Information Practices describes the personal information we collect, and
how and when we use or disclose that information. It also describes your
rights as they relate to your protected health information. This Notice is
effective April 2003, and applies to all protected health information as
defined by federal regulations.
Understanding Your Health Record/Information.
Each time you are seen by Cottonwood Medical Center, Ltd., a record of
your visit is made. Typically, this record contains your symptoms,
examination and test results, diagnosis, treatment, and a plan for future
care and treatment. This information, often referred to as your health or
medical record, serves as a:
•Basis for planning your care and treatment,
•Means of communication among the many health professionals who
contribute to your care,
•Legal documents describing the care you received,
•Means by which you or a third-party payer can verify that services billed
were actually provided.
•A tool in educating health professionals,
•A source of data for medical research,
•A source of information for public health officials charged with improving
the health of this state of this nation,
•A source of data for our planning and marketing,
•A tool with which we can assess and continually work to improve the care
we render and the outcomes we achieve.
Understanding what is in your record and how your health information is
used helps you to: ensure its accuracy, better understand who , what, when,
where, and why others may access your health information, and make more
informed decisions when authorizing disclosure to other.
Your Health Information Rights
Although your health record is the physical property of Cottonwood Medical
Center, Ltd. the information belongs to you. You have the right to:
• Communications. You can request that our practice communicate with
you about your health and related issues in a particular manner or at a
certain location. For instance, you may ask that we contact you at home
rather than work. We will accommodate reasonable requests.
• You can request a restriction in our use or disclosure of your health
information for treatment, payment, or health care operations. Additionally,
you have the right to request that we restrict our disclosure of your health
information to only certain individuals involved in your care or the payment
for your care, such as a family member or friend. We are not required to
agree to your request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in emergencies, or
when the information is necessary to treat you.
• You have the right to inspect and obtain a copy of the health information
that may be used to make decisions about you, including patient medical
records and billing records, but not including psychotherapy notes. You
must submit your request in writing to (Attn: Privacy Officer, Kathy Apodaca.
Cottonwood Medical Center, Ltd., 560 N Camino Mercado, Ste 7, Casa
Grande, AZ 85222).
• You may ask us to amend your health information if you believe it is
incorrect or incomplete, and as long as the information is kept by or for our
practice. To request an amendment, your request must be made in writing
and submitted to (Attn: Privacy Officer, Kathy Apodaca at Cottonwood
Medical Center Ltd., 560 N Camino Mercado, Ste 7, Casa Grande, AZ
85222). You must provide us with a reason that supports your request for
amendment.
• Right to a copy of this notice. You are entitled to receive a copy of this
Notice of Privacy Practices. You may ask us to give you a copy of this
notice. Contact our front desk receptionist.
• Right to file a complaint. If you believe your privacy rights have been
violated, you may file a complaint with our practice or with the Secretary of
Department of Health and Human Services. To file a complaint with our
practice, contact our Privacy Officer, Kathy Apodaca at Cottonwood
Medical Center Ltd., 560 N Camino Mercado, Ste 7, Casa Grande, AZ
85222). All complaints must be submitted in writing. You will not be
penalized for filing a complaint.
• Right to provide an authorization for other uses and disclosures. Our
practice will obtain your written authorization for uses and disclosures that
are not identified by this notice or permitted by applicable law.
OUR RESPONSIBILITIES
Cottonwood Medical Center, Ltd. is required to
• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and
privacy practices with respect to information we collect and maintain about
you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested
restriction, and
• Accommodate reasonable requests you may have to communicate health
information by alternative means or at alternative locations.
We reserve the right to change our practices and to make the new
provisions effective for all protected health information we maintain.
Should our information practices change, we will mail a revised notice to
the address you've supplied us.
We will not use or disclose your health information without your
authorization, except as described in this notice. We will also discontinue
to use or disclose your health information after we have received a written
revocation of the authorization according to the procedures included in the
authorization.
For More Information or to Report a Problem
If you have questions or would like additional information, you may contact
the Practice's Privacy Officer, Kathy Apodaca at 520-836-5538.
If you believe your privacy rights have been violated, you can file a
complaint with the practice's Privacy Officer, or with the Office for Civil
Rights, U.S. Department of Health and Human Services. There will be no
retaliation for filing a complaint with either the Privacy Officer or the Office
for Civil Rights. The address for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services 200 Independence
Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your information for treatment.
For example: Information obtained by a nurse, physician, or other member
of your health care team will be recorded in your record and used to
determine the course of treatment that should work best for you. Your
physician will document in your record his or her expectations of the
members of your health care team. Members of your health care team will
then record the actions they took and their observations. In that way, the
physician will know how you are responding to treatment.
We will provide a subsequent health care provider with copies of various
reports that should assist him or her in treating you.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The
information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement
manager, or members of the quality improvement team may use
information in your health record to assess the care and outcomes in your
case and others like it. This information will then be used in an effort to
continually improve the quality and effectiveness of the health care and
service we provide.
Business associates: There are some services provided in our organization
through contacts with business associates. Examples include physician
services in the emergency department and radiology, certain laboratory
tests, and a copy service we use when making copies of your health record.
When these services are contracted, we may disclose your health
information to our business associate so that they can perform the job we've
asked them to do and bill you or your third-party payer for services rendered.
To protect your health information, however, we require the business
associate to appropriately safeguard
your information.
Notification: We may use or disclose information to notify or assist in
notifying a family member, personal representative, or another person
responsible for your care, your location, and general condition.
Communication with family: Health professionals, using their best
judgment, may disclose to a family member, other relative, close personal
friend or any other person you identify, health information relevant to that
person's involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research
has been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of your
health information.
Funeral Directors: We may disclose health information to funeral directors
consistent with applicable law to carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may
disclose health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of organs
for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide appointment reminders or
information about treatment alternatives or other health-related benefits
and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA health
information relative to adverse events with respect to food, supplements,
product and product defects, or post marketing surveillance information to
enable product recalls, repairs, or replacement.
Workers Compensation: We may disclose your health information to public
health or legal authorities charged with preventing or controlling disease,
injury, or disability.
Law Enforcement: We may disclose health information for law enforcement
purposes as required by law or in response to a valid subpoena.
Federal law makes provisions for your health information to be released to
an appropriate health oversight agency, public health authority or attorney,
provided that a work force member or business associate believes in good
faith that we have engaged in unlawful conduct or have otherwise violated
professional or clinical standards and are potentially endangering one or
more patients, workers or the public.
Copyright 2003-2007 Cottonwood Medical Center, Ltd.
www.cottonwoodmedical.com/privacy.html
patient of this practice) may be used and disclosed and how you can get
access to this information. [This is required by the Privacy Regulations
created as a result of the Health Insurance Portability and Accountability
Act of 1996 (HIPPA).] Please review it carefully.
Web Site
The privacy of our customers has always been of utmost importance to
Cottonwood Medical Center, Ltd. Cottonwood Medical Center, Ltd. has a
long history of protecting your privacy and our concern for your privacy is
no different in the electronic age. Our Internet privacy policy is:
You do not have to give us personal information to visit our site.
We will collect personally identifiable information (name, email address,
Social Security number, or other unique identifier) only if specifically and
knowingly provided by you.
Personally identifying information you provide will be used only in
connection with Cottonwood Medical Center, Ltd. programs and services or
for such other purposes as are described at the point of collection.
Information is collected for statistical purposes and Cottonwood Medical
Center sometimes performs analyses of user behavior in order to measure
customer interest in the various areas of our site.
We do not give, sell or transfer any personal information to a third party.
We may enable "cookies." A "cookie" is a file placed on your personal
computer's hard drive by a Web site that allows it to monitor your use of the
site.
Health Insurance Portability and Accountability Act of 1996 Statement
Introduction
At Cottonwood Medical Center, Ltd. we are committed to treating and using
your protected health information responsibly. This Notice of Health
Information Practices describes the personal information we collect, and
how and when we use or disclose that information. It also describes your
rights as they relate to your protected health information. This Notice is
effective April 2003, and applies to all protected health information as
defined by federal regulations.
Understanding Your Health Record/Information.
Each time you are seen by Cottonwood Medical Center, Ltd., a record of
your visit is made. Typically, this record contains your symptoms,
examination and test results, diagnosis, treatment, and a plan for future
care and treatment. This information, often referred to as your health or
medical record, serves as a:
•Basis for planning your care and treatment,
•Means of communication among the many health professionals who
contribute to your care,
•Legal documents describing the care you received,
•Means by which you or a third-party payer can verify that services billed
were actually provided.
•A tool in educating health professionals,
•A source of data for medical research,
•A source of information for public health officials charged with improving
the health of this state of this nation,
•A source of data for our planning and marketing,
•A tool with which we can assess and continually work to improve the care
we render and the outcomes we achieve.
Understanding what is in your record and how your health information is
used helps you to: ensure its accuracy, better understand who , what, when,
where, and why others may access your health information, and make more
informed decisions when authorizing disclosure to other.
Your Health Information Rights
Although your health record is the physical property of Cottonwood Medical
Center, Ltd. the information belongs to you. You have the right to:
• Communications. You can request that our practice communicate with
you about your health and related issues in a particular manner or at a
certain location. For instance, you may ask that we contact you at home
rather than work. We will accommodate reasonable requests.
• You can request a restriction in our use or disclosure of your health
information for treatment, payment, or health care operations. Additionally,
you have the right to request that we restrict our disclosure of your health
information to only certain individuals involved in your care or the payment
for your care, such as a family member or friend. We are not required to
agree to your request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in emergencies, or
when the information is necessary to treat you.
• You have the right to inspect and obtain a copy of the health information
that may be used to make decisions about you, including patient medical
records and billing records, but not including psychotherapy notes. You
must submit your request in writing to (Attn: Privacy Officer, Kathy Apodaca.
Cottonwood Medical Center, Ltd., 560 N Camino Mercado, Ste 7, Casa
Grande, AZ 85222).
• You may ask us to amend your health information if you believe it is
incorrect or incomplete, and as long as the information is kept by or for our
practice. To request an amendment, your request must be made in writing
and submitted to (Attn: Privacy Officer, Kathy Apodaca at Cottonwood
Medical Center Ltd., 560 N Camino Mercado, Ste 7, Casa Grande, AZ
85222). You must provide us with a reason that supports your request for
amendment.
• Right to a copy of this notice. You are entitled to receive a copy of this
Notice of Privacy Practices. You may ask us to give you a copy of this
notice. Contact our front desk receptionist.
• Right to file a complaint. If you believe your privacy rights have been
violated, you may file a complaint with our practice or with the Secretary of
Department of Health and Human Services. To file a complaint with our
practice, contact our Privacy Officer, Kathy Apodaca at Cottonwood
Medical Center Ltd., 560 N Camino Mercado, Ste 7, Casa Grande, AZ
85222). All complaints must be submitted in writing. You will not be
penalized for filing a complaint.
• Right to provide an authorization for other uses and disclosures. Our
practice will obtain your written authorization for uses and disclosures that
are not identified by this notice or permitted by applicable law.
OUR RESPONSIBILITIES
Cottonwood Medical Center, Ltd. is required to
• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and
privacy practices with respect to information we collect and maintain about
you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested
restriction, and
• Accommodate reasonable requests you may have to communicate health
information by alternative means or at alternative locations.
We reserve the right to change our practices and to make the new
provisions effective for all protected health information we maintain.
Should our information practices change, we will mail a revised notice to
the address you've supplied us.
We will not use or disclose your health information without your
authorization, except as described in this notice. We will also discontinue
to use or disclose your health information after we have received a written
revocation of the authorization according to the procedures included in the
authorization.
For More Information or to Report a Problem
If you have questions or would like additional information, you may contact
the Practice's Privacy Officer, Kathy Apodaca at 520-836-5538.
If you believe your privacy rights have been violated, you can file a
complaint with the practice's Privacy Officer, or with the Office for Civil
Rights, U.S. Department of Health and Human Services. There will be no
retaliation for filing a complaint with either the Privacy Officer or the Office
for Civil Rights. The address for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services 200 Independence
Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your information for treatment.
For example: Information obtained by a nurse, physician, or other member
of your health care team will be recorded in your record and used to
determine the course of treatment that should work best for you. Your
physician will document in your record his or her expectations of the
members of your health care team. Members of your health care team will
then record the actions they took and their observations. In that way, the
physician will know how you are responding to treatment.
We will provide a subsequent health care provider with copies of various
reports that should assist him or her in treating you.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The
information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement
manager, or members of the quality improvement team may use
information in your health record to assess the care and outcomes in your
case and others like it. This information will then be used in an effort to
continually improve the quality and effectiveness of the health care and
service we provide.
Business associates: There are some services provided in our organization
through contacts with business associates. Examples include physician
services in the emergency department and radiology, certain laboratory
tests, and a copy service we use when making copies of your health record.
When these services are contracted, we may disclose your health
information to our business associate so that they can perform the job we've
asked them to do and bill you or your third-party payer for services rendered.
To protect your health information, however, we require the business
associate to appropriately safeguard
your information.
Notification: We may use or disclose information to notify or assist in
notifying a family member, personal representative, or another person
responsible for your care, your location, and general condition.
Communication with family: Health professionals, using their best
judgment, may disclose to a family member, other relative, close personal
friend or any other person you identify, health information relevant to that
person's involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research
has been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of your
health information.
Funeral Directors: We may disclose health information to funeral directors
consistent with applicable law to carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may
disclose health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of organs
for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide appointment reminders or
information about treatment alternatives or other health-related benefits
and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA health
information relative to adverse events with respect to food, supplements,
product and product defects, or post marketing surveillance information to
enable product recalls, repairs, or replacement.
Workers Compensation: We may disclose your health information to public
health or legal authorities charged with preventing or controlling disease,
injury, or disability.
Law Enforcement: We may disclose health information for law enforcement
purposes as required by law or in response to a valid subpoena.
Federal law makes provisions for your health information to be released to
an appropriate health oversight agency, public health authority or attorney,
provided that a work force member or business associate believes in good
faith that we have engaged in unlawful conduct or have otherwise violated
professional or clinical standards and are potentially endangering one or
more patients, workers or the public.
Copyright 2003-2007 Cottonwood Medical Center, Ltd.
www.cottonwoodmedical.com/privacy.html
