Summary of Privacy Practices

As of April 14, 2003, new federal laws mandated in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA is concerning patient privacy and access to medical records. The purpose of this brochure is to outline how these new laws affect you as a patient of Arizona Sports Medicine Center (ASMC).

Patient’s Rights to Access Records

• You have a right to request to see your records or to request a copy of your records. Upon receipt of your written request, our Privacy Officer will contact you to make arrangements to review your records in the ASMC office or to copy the records you have requested.
• You have a right to request a written summary or explanation of your records. Upon receipt of your written request, our Privacy Officer will arrange for your physician to review and summarize your records.
• You have a right to inspect and to request an amendment to your records. If, in reviewing your records, you find an inaccuracy in the facts documented or an omission, you have the right to submit an amendment to your record.
• You have a right to request a limited accounting of disclosures of your records. You may request an accounting of any disclosures of your health information to purposes other than treatment, payment, or healthcare administration.

Rights to Privacy

• You may request additional protections for sensitive health information or to limit disclosures of portions of your health information.
• In addition to the protections for Highly Confidential Information specified by HIPAA, you may request, in writing, that other sensitive information be protected. Our Privacy Office will take steps to implement these protections and to inform you of the limits of these steps.
• You may designate a personal health care representative. You may designate someone to act as your personal health representative. This person would have the same rights of access as you, for your healthcare information. You may change your designated personal representative at any time.
• You have a right to request that your personal health information be communicated to you in a different manner or at a different location. You must make this request in writing.

Rights of Parents of Minor Children

As the parent or guardian of a minor child, you have the same rights of access to your child.s records as to your own, with the following exceptions:

• Your rights to access of the minor child.s medical records have been revoked or limited by a court of law.
• Your minor child is an emancipated minor under the law.
• Services are provided to your child under the regulations of the State of Arizona

Your Responsibilities Under HIPAA

In order to safeguard your rights under HIPAA, you have a responsibility to keep ASMC informed of any changes that would affect the disclosure of your personal health information. You have an obligation to:

• Provide accurate information about your address, telephone number, and insurance coverage each time you visit.
• Report any changes in your personal health representative, emergency contact information, and structure of your family. Etc.
• Respect the privacy rights of other patients.

Arizona Sports Medicine Center Responsibilities

Our first responsibility, as always, is to safeguard the health of our patients. If a provider believes any of the provisions of HIPAA could endanger your life or physical safety or that of another individual, the practice must act in accordance with this belief and do what is in the best interest of the patient.

We are also responsible for safeguarding your privacy. We have an obligation to keep you informed of any disclosures of your personal health information outside of those required for treatment, payment of services, and healthcare administration.

We also have an obligation to work with you to ensure your rights under HIPAA. Our Privacy Officer, with the support of all of the physicians and staff, will work directly with you to ensure your rights to privacy and to access under HIPAA. Any patient believing his or her privacy rights have been violated may file a complaint with the Privacy Officer at ASMC or with the Secretary of Health and Human Services. A complete copy of our privacy policy can be obtained at any of the receptions areas in the Scottsdale, Tempe and Gilbert offices, as well as, being posted on our website. ASMC reserves the right to change the terms of this notice and to make the new terms apply to all protected health information it maintains.

Our Privacy Officer can be reached at: 480-558-3744