Gallus Detox Centers
134 S Granite Street Prescott, Arizona 86303
This Agency is dedicated to protect your nonpublic personal health information. This notice is to tell you how and why we collect that information, and who has access in that information.
HOW WE COLLECT YOUR INFORMATION:
Your personal demographic information, such as name, address, birth, date social security number, and medical insurance information is obtained from you. This is why we ask you to fill out the client information sheet and why we ask for a copy of your insurance card. This ensures that the information we collect is correct.
If you came to our practice through another agency, we may obtain that information from the agency. However, on your first visit to this clinic, we will ask you to complete a release of information in order to obtain this information.
We may also ask another individual/agency who referred you to this agency to give us information that will enable us to better treat you. This benefits you in that we will have information that has already been obtained by the referring entity.
WHY WE COLLECT THIS INFORMATION:
We collect this information so that we can treat your medical condition and obtain payment from you or your health insurance.
MAINTAINING ACCURATE AND TIMELY INFORMATION:
To ensure that the information we maintain is accurate, you will be asked if any of your information needs to be updated during subsequent visits.
WHO HAS ACCESS TO THIS INFORMATION:
Any person or persons you designate in writing are entities that have access to your Protected Health Information. Some of these people may include people directly involved in your treatment, people creating and maintaining your medical record, and those entities that need your information to process health care claims and obtain payment for our services.
HOW WE PROTECT YOUR INFORMATION:
We release your information only to those people who need your information to provide adequate treatment for you. We maintain physical and procedural safeguards so that no one but persons involved in your case, or entities that need this information for claims processing, have access to your Protected Health Information.
You have the right to inspect your Protected Health Information. You also have the right to amend any errors you may find in your record. When you leave this agency, your Protected Health Information will continue to receive the protections outlined in this notice.
If you have any complaints concerning our privacy practices, please contact a privacy officer at this agency at (928) 227-2300. You may also contact: The Secretary of the Department of Health and Human Services, 200 Independence Ave. S.W. Room 509F, HHH Building. Washington D.C. 20201.
This notice is effective as of April 1, 2011.
This and other documents produced and published by Gallus Detox may not be copied, recopied, reproduced or redistributed without the express written consent from Gallus Detox. The use or misuse of this document without the express written consent may be in violation of United States Copyright law.