Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This notice describes how behavioral health, medical, drug and alcohol related information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Copa Health (Copa) is required by law to maintain the privacy and confidentiality of information about you, your health and health care, and payment for the services we provide you. Information regarding your health care, including payment for your care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Confidentiality Law, 42 C.F.R. Part 2 (“Part 2”).¹ There are additional state law protections.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

• You can ask to see or get a paper copy of your medical record and other health information we have about you. Ask us how to do this.
• Copa will provide a copy or a summary of your health information, usually within 30 working days of your request. Copa may charge a reasonable, cost-based fee.

Ask Copa to correct your medical record

• You can ask Copa to correct health information about you that you think is incorrect or incomplete. Ask Copa how to do this.
• Copa may say “no” to your request. You will be informed as to why in writing within 60 days.

Request confidential communications

• You can ask Copa to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• Copa will say “yes” to all reasonable requests.

Ask Copa to limit what is used or shared

• You can ask Copa not to use or share certain health information for treatment, payment, or our operations. Copa is not required to agree to your request and may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask Copa not to share that information for the purpose of payment or our operations with your health insurer. Copa will say “yes” unless a law requires us to share that information. In the case of alcohol or drug treatment services, if you decide not to let us share information for billing purposes, Copa may deny services to you.
• You can ask for a list (accounting) of the times Copa has shared your health information for six years prior to the date you ask, who we shared it with, and why.
• Copa will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you have personally requested). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. Copa will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone Power of Attorney or if someone is your Legal Guardian, that person can exercise your rights and make choices about your health information.
• Copa will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting our Privacy Officer at 480-969-3800 Ext 289.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. A violation of the Confidentiality Law (Part 2) is a crime, and any suspected violations should be reported to the United States Attorney for Arizona.
• Copa will not retaliate against you for filing a complaint.

Right to receive a notice from us if we think your personal health information has been improperly disclosed (often called a “breach”)

Copa will notify you in accordance with state and federal law if we discover a breach has occurred such that your protected health information has been compromised. If we decide this notice is necessary, it will happen after we do an investigation according to the state and federal laws.

Your Choices

For certain health information, you can tell Copa your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell Copa to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, Copa may go ahead and share your information if we believe it is in your best interest. Copa may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, Copa never shares your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
• If you are applying for or receiving services for drug or alcohol abuse, we may not acknowledge to a person outside of our program that you attend our program or in any way that identifies you as attending our program

In the case of fundraising:

• Copa may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures:

Our Responsibilities

• Copa is required by law to maintain the privacy and security of your protected health information.
• Copa will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• Copa must follow the duties and privacy practices described in this notice and give you a copy of it.
• Copa will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

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

¹ HIPAA can be found at 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164. HIPAA protects your health information whether or not you receive services for drug or alcohol services. Part 2 can be found at 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Part 2 does not allow us to acknowledge to anyone outside our program that you receive services for drug or alcohol services except under certain circumstances.