THIS NOTICE DESCRIBES HOW MEDICAL AND BEHAVIORAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Life Changing Wellness and Treatment Center is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice, and to follow the terms of the Notice currently in effect.
How We May Use and Disclose Your Health Information
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your behavioral health care and related services. For example, your therapist may share information with your case manager to coordinate your ISP.
Payment
We may use and disclose your PHI to bill and collect payment for services rendered, including submitting claims to AHCCCS or other insurers.
Healthcare Operations
We may use your PHI for quality assessment, chart audits, staff training, compliance reviews, and accreditation activities as permitted under A.A.C. R9-10.
Required by Law
We will disclose your PHI when required to do so by federal or Arizona state law, including mandatory reporting obligations under A.R.S. Title 36.
Uses and Disclosures Requiring Your Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, including psychotherapy notes, marketing, sale of health information, and substance use disorder records protected under 42 C.F.R. Part 2.
Your Rights Regarding Your Health Information
- Right to Inspect and Copy: You may request access to your medical and billing records.
- Right to Amend: You may request corrections to your health information.
- Right to an Accounting of Disclosures: You may request a list of disclosures we have made.
- Right to Request Restrictions: You may request restrictions on certain uses of your PHI.
- Right to Confidential Communications: You may request we communicate with you in a specific way.
- Right to a Copy of This Notice: You may request a paper copy at any time.
- Right to Breach Notification: You will be notified if your PHI is breached.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights at ocrportal.hhs.gov. We will not retaliate against you for filing a complaint.
Changes to This Notice
We reserve the right to change this Notice. We will post the revised Notice in our facility and on our website. The new Notice will apply to all PHI we maintain.
Contact Our Privacy Officer
Privacy Officer — Life Changing Wellness and Treatment Center
4831 N 35th Avenue, Phoenix, Arizona 85017
Phone: (602) 319-5155
Email: