HIPPA Privacy Policy | Copyright Policy | Terms of Use Policy | Guidelines for Linking to AZChildrens.com

Privacy Policy - HIPAA

ARIZONA CHILDREN’S SURGERY, P.C.

Notice of Privacy Practice

To our Patients: This notice describes how health information about you as a patient of this practice may be used and disclosed and how you can get access to you health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Our commitment to your privacy

Our practice is dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information. We realize that these laws are complicated but we must provide you with the following important information.

Use and disclosure of your health information is certain special circumstances:

The following circumstances may require us to use or disclose your health information:

1. To public health authorities and health oversight agencies that are authorized by law to collect information.

2. Lawsuits and similar proceedings in response to court or administrative order.

3. If required to do so by a law enforcement official.

4. When necessary to reduce or prevent a serious threat to you health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat.

5. If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

6. To Federal Officials for intelligence and national security activities authorized by law.

7. To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.

8. For Workers Compensation and similar programs.

Your rights regarding your health information

1. Communications: you can request that our practice communicate with you abut your health and related issues in a particular manner or a certain location. For instance, you may ask that we contact you at home rather then at work. We will accommodate any reasonable requests.

2. 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 for your health information to only certain individuals involved in your care, such as family members and friends. 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.

3. 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 Arizona Children’s Surgery.

4. 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

Arizona Children’s Surgery

1432 S Dobson Road # 301

Mesa Arizona, 85202

You must supply us with a reason that supports your request for amendment.

5. Right to 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 at any time. To obtain a copy of this notice, please contact our front desk receptionist.

6. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Humana Services. To file a complaint with our practice, contact

Valerie Miller

Arizona Children’s Surgery P. C.

1432 S. Dobson Road # 301

Mesa Arizona, 85202

All complaints must be submitted in writing.
You will not be penalized for filing a complaint.

7. 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.

If you have any question regarding this notice or our health information privacy policies, please contact

Valerie Miller

Arizona Children’s Surgery P. C.

1432 S. Dobson Road # 301

Mesa Arizona, 85202

HIPPA Privacy Policy | Copyright Policy | Terms of Use Policy | Guidelines for Linking to AZChildrens.com