Notice of Privacy Practices


Notice of Privacy Practices

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.

Protecting Your Privacy

Hospice at Home of Arizona understands the importance and sensitivity of your health information. We follow federal and state laws that govern your health information. We use your health information (and allow others to have it) only as permitted by federal and state laws.

What Are Your Rights

You may:

  • Inspect and obtain a copy of your medical or billing records (including an electronic copy if we maintain the records electronically), as allowed by law, usually within 30 days of your written request.
  • Request and receive a paper copy of our current Notice of Privacy Practices.
  • Require us to communicate with you using an alternate address or phone number.
  • Require that we not send information about a healthcare service or related item to your health plan if you or someone else pays in full for that service or item and if you notify us in advance that you — and not your health plan — are going to pay for this service or item (so we don’t automatically bill your health plan).
  • Request in writing that restrictions be placed on how your health information is used or shared for treatment or other purposes.
  • Request an accounting of when your identifiable health information is shared outside of Hospice at Home of Arizona for a purpose other than treatment or payment.
  • Receive notice if we or our business associates have breached the confidentiality of your health information.
  • Report a privacy concern and be assured that we will investigate your concern thoroughly, support you appropriately, and not retaliate against you in any way. You may report a privacy concern to our Compliance Officer at (480) 478-0643 or to the Office for Civil Rights, U.S. Department of Health and Human Services, Denver Office.
  • Request in writing that your health information be amended if you think there is an error.

How We Will Use and Disclose Your Health Information

Common Uses of Health Information. When we care for you, we will gather your health information. The law allows us to use or share this health information to:

Treatment: Understand your health condition and to treat you when you are sick. For example, we may look at your x-rays or share x-rays we take of you with your treating doctor, who may be outside of the hospice.

Family or Others: Disclose information to family or representatives who are involved in your care. You may notify us if you do not want information disclosed to family or others involved.

Payment: Bill for your healthcare services and receive payment for our services; for example, we share your health insurance information with other healthcare providers who treat you — like your attending physician so they can bill for those services.

Eligibility: Determine if a patient is eligible for hospice services with Medicaid by submitting personally identifiable information to the Medicaid program or other insurance programs.

Operations: Improve our care. For example, we may contact you to understand what you thought of our care and to learn how to enhance our services to you.

Business Partners: Improve our services to you by allowing companies with whom we contract, called “business associates,” to perform certain specialized work for us. The law requires these business associates to protect your health information and obey the same privacy laws that we do.

Research: Perform limited health-data research, where the researcher keeps patient-identifiable information confidential. Hospice reviews every research request to make sure privacy is appropriately protected before sharing health information. Law enforcement, but only as authorized by law.

Required by Law: Investigate a crime against hospice or any of its patients or to law enforcement officials to prevent serious threat to health or safety. Hospice will share your information as required by federal, state or local law.

Required Uses of Health Information. The law sometimes requires us to share information for specific purposes, with:

  • The Department of Health, to report communicable diseases
  • A funeral director or an organ-donation agency, when a patient dies, or with a medical examiner when appropriate to investigate a death
  • The appropriate governmental agency, if an injury or unexpected death occurs
  • State authorities, to report child or elderly abuse
  • Law enforcement, for certain types of crime-related injuries, such as gunshot wounds
  • Governmental inspectors, who, for example, make sure our facility is safe
  • Military command authorities or the Department of Veterans Affairs, when we treat patients who are in the military or are veterans.
  • A correctional institution, if a patient is an inmate
  • A medical device’s manufacturer, as required by the FDA.
  • Court officers, as required by law, in response to a court order or a valid subpoena
  • Governmental authorities, to prevent serious threats to the public’s health or safety
  • Governmental agencies and other affected parties, to report a breach of health-information privacy
  • An employer, but only if the employer contracts with us to help the employer meet OSHA requirements about workplace and employee safety
  • A worker’s compensation program, if a person is injured at work and claims benefits under that program

Uses According to Your Requests. If you let us know how you want us to disclose your information in the following situations, we will follow your directions.

  • If you want us to share any health or payment information related to your care with your family members or friends. Please let our employees know what you want us to share. If you can’t tell us what health or payment information you want us to share, we may use our professional judgment to decide what to share with your family or friends for them to be able to help you.
  • Who we should contact in an emergency. If you are not able to tell us who to contact, we may ask the public authorities to help. For example, we may ask the police to help find your family, or in a disaster, we may help the Red Cross reconnect you with your family.
  • If you want to indicate your religious preference when you are admitted to hospice. If you indicate your religious preference, we may provide your name to a visiting representative of your religion. If you don’t want us to do so, tell our staff at any time that you do not want us to share your name with a religious representative.

Uses of Health Information with Your Authorization. Any sharing of your health information, other than as explained above, requires your written authorization. For example, we will not use your health information unless you authorize us in writing to:

  • Send copies of your health information to a life insurance company.
  • Sell your identifiable health information.

If you authorize us to share your health information but then change your mind, please notify the hospice in writing. We will honor your decision, but we will not be able to get back the health information that you authorized us to send before your revocation.

If You Still Have Questions

Hospice employees are trained to help you with any questions you may have about the privacy of your health information. They can also address any privacy concerns you may have about your health information and help you fill out any forms that are needed to exercise your privacy rights. You may contact our Compliance Officer at (480) 478-0643.

Effective July 1, 2013. We may change this privacy notice at any time. You can see our current privacy notice on our website or you can also obtain a copy of this notice from any of our staff by asking for a copy.


If you believe that your privacy rights have been violated, you may file a grievance with the hospice or the U.S. Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint. For further information contact:

Privacy Officer

1423 S Higley Rd. Ste 121

Mesa, Arizona 85206

(480) 478-0643