Legal

Notice of Privacy Practices

Effective date: [effective date]

This notice describes how health information about you may be used and shared, and how you can get access to it. Please review it carefully.

A&M Care, LLC (“A&M Care,” “we,” or “us”) provides attendant care, habilitation, respite, and homemaker services in Maricopa County, Arizona. The law requires us to protect the privacy of your health information and to give you this notice. In this notice, “you” means the person receiving our services. If you’re a parent of a minor child or a legal guardian, you can use these rights on that person’s behalf.

Your rights

When it comes to your health information, you have the rights below. Contact our Privacy Officer (listed at the end of this notice) to use any of them.

Get a copy of your records

You can ask to see or get a paper or electronic copy of your health information.
We’ll give you a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your records

You can ask us to correct information you think is wrong or incomplete.
We may say no, but we’ll tell you why in writing within 60 days.

Ask us to contact you privately

You can ask us to reach you in a specific way, such as a certain phone number or mailing address.
We’ll say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain information for your services, payment, or our operations. We don’t have to agree, and we may say no if it would affect your care.
If you pay for a service in full yourself, you can ask us not to share that information with your health plan. We’ll say yes unless a law requires us to share it.

Get a list of who we’ve shared your information with

You can ask for a list of the times we’ve shared your health information in the six years before your request, who we shared it with, and why.
The list won’t include sharing for services, payment, or our operations, or sharing you asked us to do. We’ll provide one list a year for free and may charge a reasonable, cost-based fee for more.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you agreed to get it electronically.

Choose someone to act for you

If you have a legal guardian or have given someone medical power of attorney, that person can use your rights and make choices about your health information.
Parents can use these rights for their minor children, with some exceptions set by law.
We’ll make sure the person has this authority before we act on their request.

File a complaint if you think your rights were violated

You can complain to our Privacy Officer using the contact information at the end of this notice.
You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue S.W., Washington, D.C. 20201, 1-877-696-6775, or www.hhs.gov/ocr/complaints.
We won’t retaliate against you for filing a complaint.

Your choices

For some health information, you can tell us what you want us to share. Tell us your preference and we’ll follow it.

You can tell us whether to share information with:

Family, close friends, or others involved in your care
Disaster relief organizations

If you can’t tell us your preference, for example in an emergency, we may share your information if we believe it’s in your best interest. We may also share it when needed to prevent a serious and immediate threat to someone’s health or safety.

We never share your information for these purposes unless you give us written permission:

Marketing
Selling your information

We don’t use your health information for fundraising.

We typically use or share your health information in these ways.

To provide your services

We use your information to plan and provide your care, and we share it with others involved in it, such as your DDD support coordinator and your other providers. For example, your caregiver needs to know about your routines and health needs.

To run our organization

We use your information to manage your services, train staff, and check the quality of our care. This includes recording visits in the electronic visit verification system that AHCCCS requires for the services we provide.

To bill for your services

We share information with the Arizona Division of Developmental Disabilities (DDD), AHCCCS, and health plans so we can be paid for your services.

Other ways we can use or share your information

The law allows or requires us to share information in other ways, usually for the public good. We have to meet conditions in the law before we can share it for these reasons:

Public health and safety, such as reporting suspected abuse, neglect, or exploitation, which Arizona law requires us to report
Health oversight, such as audits and reviews by DDD, AHCCCS, and other agencies that oversee our services
Legal requirements, including when state or federal law requires it, or when the Department of Health and Human Services checks that we’re following federal privacy law
Lawsuits and legal actions, in response to a court or administrative order or a subpoena
Law enforcement and government requests, such as for workers’ compensation claims or to law enforcement officials when the law allows
Research, only when the law’s conditions are met
When someone dies, with a medical examiner, funeral director, or organ donation organization

Information with extra protection

Some information, such as HIV status, genetic test results, substance use treatment, and some behavioral health records, has extra protection under Arizona or federal law. When those stricter rules apply, we follow them.

Our responsibilities

The law requires us to protect the privacy and security of your health information.
If a breach may have exposed your information, we’ll tell you promptly, and no later than 60 days after we discover it.
We must follow the practices in this notice and give you a copy of it.
We won’t use or share your information in any way not described here unless you give us written permission. You can change your mind at any time by telling us in writing.

For more information, see www.hhs.gov/hipaa/for-individuals/notice-privacy-practices.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available on request, in our office, and on our website.

Contact our Privacy Officer

For questions about this notice or to use your rights:

A&M Care, LLC
Attention: Privacy Officer, [name]
[Mailing address]
hello@AMCareArizona.com
[Phone number]