Flagstaff Medical Center • Verde Valley Medical Center • Northern Arizona Provider Group and all licensed healthcare institutions owned by these entities.
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.
This notice applies to all patients of Flagstaff Medical Center, Northern Arizona Provider Group and Verde Valley Medical Center (collectively and individually referred to as “Facility”).
We are committed to protecting the confidentiality of your medical information and are required by law to do so. This notice describes how we may use your medical information within the Facility and how we may disclose it to others outside the Facility. This notice describes the rights you have concerning your own medical information. Please review it carefully and let your healthcare provider know if you have questions.
Use and disclosure of medical information
Treatment: We may use your medical information to provide you with medical services and supplies. We may also disclose your medical information to others who need that information to treat you, such as doctors, physician assistants, nurses, healthcare professions students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers and others involved in your care. For example, we will allow your physician to have access to your Facility medical record to assist in your treatment at the Facility and for follow-up care. We may also use and disclose your medical information to contact you to remind you of an upcoming appointment, to inform you about possible treatment options or alternatives, or to tell you about health-related services available to you.
Patient directory: To assist family members and other visitors in locating you while you are in the Facility, the Facility maintains a patient directory. This directory includes your name, room number, religious affiliation (if any) and may include your general condition such as good, fair, serious or critical. We may disclose this information to someone who asks for you by name, including but not limited to family members, visitors and the media. However, we may disclose your religious affiliation only to clergy members. If you do not want to be included in the patient directory, notify your patient registrar or nurse, who will explain the implications and have you sign a “Notice to Patients Requesting No Information/Special Confidentiality” form.
Family members and others involved in your care: We may disclose your medical information to a family member or friend who is involved in your medical care or to someone who helps to pay for your care. We may also disclose your medical information to disaster relief organizations to help locate a family member or friend in a disaster. If you do not want the Facility to disclose your medical information to family members or others who will visit you, please notify your nurse.
Payment: We may use and disclose your medical information to get paid for the medical services and supplies we provide to you. For example, your health plan or health insurance company may ask to see parts of your medical record before they will pay us for your treatment.
Facility operations: We may use and disclose medical information if it is necessary to improve the quality of care we provide to patients or to run the Facility. We may use your medical information to conduct quality improvement activities, to obtain audit, accounting or legal services or to conduct business management and planning. For example, we may look at your medical record to evaluate whether Facility personnel, your doctors or other healthcare professionals did a good job.
Many of our patients like to make contributions to the Facility. The Facility or its Foundation may contact you to raise money for the Facility. If you do not want to be contacted for fundraising purposes, please notify the Foundation in writing.
Research: We may use or disclose your medical information for research projects, such as studying the effectiveness of a treatment you received. These research projects must go through a special process that protects the confidentiality of your medical information.
Required by law: Federal, state or local laws sometimes require us to disclose patients’ medical information. For instance, we are required to report child abuse or neglect and must provide certain information to law enforcement officials in domestic violence cases. We also are required to give information to the Arizona Workers’ Compensation Program for work-related injuries.
Public health: We may report certain medical information for public health purposes. For instance, we are required to report births, deaths and communicable diseases to the State of Arizona. We may also need to report patient problems with medications or medical products to the FDA, or may notify patients of recalls of products they are using.
Public Safety: We may disclose medical information for public safety purposes in limited circumstances. We may disclose medical information to law enforcement officials in response to a search warrant or a grand jury subpoena. We may also disclose medical information to assist law enforcement officials in identifying or locating a person; to prosecute a crime of violence; to report deaths that may have resulted from criminal conduct; and to report criminal conduct at the Facility. We may disclose your medical information to law enforcement officials and others to prevent a serious threat to health or safety.
Health oversight activities: We may disclose medical information to a government agency that oversees the Facility or its personnel, such as the Arizona Department of Health Services, federal agencies that oversee Medicare, Arizona Medical Board or the Board of Nursing. These agencies need medical information to monitor the Facility’s compliance with state and federal laws.
Coroners, medical examiners and funeral directors: We may disclose medical information concerning deceased patients to coroners, medical examiners and funeral directors to assist them in carrying out their duties.
Organ and tissue donation: We may disclose medical information to organizations that handle organ, eye or tissue donation or transplantation.
Military, veterans, national security and government purposes: If you are a member of the Armed Forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. The Facility may disclose medical information to federal officials for intelligence and national security purposes or for presidential protective services.
Judicial proceedings: We may disclose medical information if the Facility is ordered to do so by a court or if the Facility receives a subpoena or a search warrant. In most situations, you will receive advance notice about this disclosure from the attorney requesting your record so you can object to sharing your medical information.
Information with additional protection: Certain types of medical information have additional protection under state or federal law. For instance, medical information about communicable diseases, drug and alcohol abuse treatment, genetic testing, and evaluation and treatment for a serious mental illness is treated differently than other types of medical information. For this information, the Facility is required to get permission before disclosing information, in many circumstances.
Other uses and disclosures: If the Facility wishes to use or disclose your medical information for a purpose that is not discussed in this notice, the Facility will seek your permission. If you give your permission to the Facility, you may take back that permission any time, unless we have already relied on your permission to use or disclose the information. If you would ever like to revoke your permission, please notify the Medical Records custodian in writing.
Right to request medical information: You have the right to look at your own medical information and to get a copy of that information. The law requires us to keep the original record for 6 years after your last encounter for adults and until age 21 for minors who have not had an encounter and other records used to make decisions about your care. To request medical information, write to the Medical Records custodian. If you request a copy of your information, we may charge you for our costs to copy the information. We will tell you in advance the cost to copy medical records. You can look at your record on the Patient Portal or at the Facility at no cost.
Right to request amendment of medical information you believe is erroneous or incomplete: If you examine your medical information and believe that some of the information is wrong or incomplete, you may ask us to amend your record. To ask us to amend your medical information, write to the Medical Records custodian. Please note that we may deny the request if we did not create the information or if the record is accurate and complete.
Right to a list of certain disclosures of medical information: You have the right to request a list of many of the disclosures we make of your medical information. If you would like to receive such a list, write to the Medical Records custodian. We will provide the first list to you free, but we will charge you for any additional lists you request during the same year. We will tell you in advance the cost.
Right to request restrictions on facility use or disclosure of medical information for treatment, payment or operations: You have the right to ask us not to make use of or disclose your medical information to treat you, to seek payment for care or to operate the Facility. We are not required to agree to your request, but if we do agree, we will comply with that agreement. If you want to request a restriction, write to the Medical Records custodian and describe your request in detail.
Right to request confidential communications: You have the right to ask us to communicate with you in a way that you feel is more confidential. For example, you can ask us not to call your home, but to communicate only by mail. To do this, write to the Medical Records custodian. You may also ask to speak with your healthcare providers in private outside the presence of other patients.
Right to a paper copy: If you receive this notice electronically, you have the right to a paper copy at any time. You may download a paper copy of the notice from our website at NAHealth.com or you may obtain a paper copy of the notice from Medical Records.
Changes to this notice
We may change our practices concerning how we use or disclose patient medical information, or how we will implement patient rights concerning their information. We reserve the right to change this notice and to make the provisions in our new notice effective for all medical information we maintain. If we change these practices, we will publish a revised notice. You can get a copy of our current Notice of Privacy at any time by downloading it from our website at NAHealth.com or requesting a paper copy from Medical Records.
Healthcare providers covered by this notice
This notice applies to the Facility and its personnel, volunteers, students and trainees. The notice also applies to other healthcare providers that come to the Facility to care for patients, such as physicians, physician assistants, therapists, other healthcare providers not employed by the Facility, emergency service providers and medical transportation companies. The Facility may share your medical information with these providers for treatment purposes, to get paid for treatment or to conduct healthcare operations. These healthcare providers will follow this notice for information they receive about you from the Facility. These other healthcare providers may follow different practices at their own offices or facilities.
Concerns or complaints
Please tell us about any problems or concerns you have with your privacy rights or how the Facility uses or discloses your medical information. If you have a concern, please contact the privacy officer at 928-773-2567.
If for some reason the Facility cannot resolve your concern, you may also file a complaint with the federal government. We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.
The Facility is required by law to give you this notice and to follow the terms of the notice currently in effect. If you have any questions about this notice, or have further questions about how the Facility may use and disclose your medical information, please contact Medical Records at the following numbers:
Flagstaff Medical Center: 928-773-2072
Verde Valley Medical Center: 928-639-6280
Northern Arizona Healthcare Medical Records: 1200 N. Beaver St., Flagstaff, AZ 86001