Patient Information

Protocol for the Secure Storage, Transfer and Access of Your Records

In Accordance with Arizona House Bill 2786, we are required to inform you of how your records will be securely stored and transferred and how you may access your records. When your evaluation is completed, records are kept on site, in a secure area, for a minimum of two years, after which time, the records may be moved to a secure off site location. Your records will be maintained by KANS for a period of at least 7 years after the completion of your evaluation. If the client is a minor at the time of evaluation, then records will be maintained for a period of 7 years after the 18th birthday of the client. After the minimum record maintenance period then records will be destroyed by means of shredding of documents, unless you wish to claim the records for your own property. If you would like copies of or access to your records then you must submit a request in writing. Request for copies or access will be granted within 30 days of receipt of such request, unless there is reason to believe that release of such records may be harmful to your emotional wellbeing or otherwise not in your best interest. You will be charged a reasonable copy fee for copies and professional time required to satisfy your request.

Your Privacy, Protected Health Information, Confidentiality and Rights

In accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we are required by law to maintain the confidentiality of your health information. Some circumstances may require us to use and disclose your protected health information (PHI), such as:

For purposes of diagnosis, treatment, or referral and obtaining payment for services rendered to you
For the treatment, payment, or health care operations activities of another health care provider who treats you
For healthcare and legal compliance activities
To a relative, friend, or other individual included in your care if I obtain your verbal agreements to do so and in certain other circumstances where I am unable to obtain your agreement and believe that disclosure is in your best interest
To a public health authority in certain situations as required by law (such as to report abuse, neglect, or domestic violence)
For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system
For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process
For law enforcement activities in limited situations, such as when responding to a warrant or if you are under custody of a law enforcement official
For military, national defense and security, and other special government functions
To avert a serious threat to your health and safety or that of another person or the public at large
For worker’s compensation and similar purposes

Also in accordance with HIPAA, you have the following rights:

You may inspect and obtain a copy of most of the health information that we have about you. Your request must be in writing. Normally you will have this information within 30 days of your request. You will be charged a reasonable fee for copies of information. In certain circumstances, you may be denied access to your medical information if it is considered to be harmful to your wellbeing or otherwise not in your best interest.
You have the right to ask for an amendment to your health information if you believe that something is inaccurate in your record. Your request must be in writing and must include the reason(s) for your request. We are permitted by law to deny your request to amend your medical information in certain circumstances, such as when it is believed that the information you requested to amend is correct.
You have the right to request that we restrict how we use and disclose the medical information we have about you. We are not required to agree to any restrictions you request, but any restrictions agreed to by us in writing are binding.
You may file a complaint if you believe your privacy rights have been violated. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
You have the right to be notified and provide your written authorization for uses and disclosures not stated in this agreement or permitted by law. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information per that authorization.
You may obtain a copy of this notice and may ask questions regarding this notice or our privacy practices.
You have a right to refuse any procedure
You have a right to refuse any medication regimen
You have a right to discuss all medical treatments with your clinician
You have a right to discontinue treatment at any time

In Case of Fire or Natural Disaster

Should you be in the building when a fire or natural disaster occurs, then immediately exit the room you are in and follow the exit signs to the nearest safe exit.