Notice of Privacy Practices - AFF

• • How health information about you may be used and disclosed
  • Your rights with respect to your health information
  • How to file a complaint concerning a violation of the privacy or security of your health information, or of your rights concerning your information

You have a right to a copy of this Notice (in paper or electronic form) and to discuss it with the Senior Director of Quality and Risk at 602-285-1999 or This email address is being protected from spambots. You need JavaScript enabled to view it. if you have any questions.

1. Records, or testimony relaying the content of such records, shall not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against the patient unless based on specific written consent or a court order.
2. Records shall only be used or disclosed based on a court order after notice and an opportunity to be heard is provided to the patient or the holder of the record, where required by 42 U.S.C. 290dd-2 and this part.
3. A court order authorizing use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before the record is used or disclosed.

Note: If you are seeking or receiving services from My Sisters’ Place, your information is subject to a different Notice of Privacy Practices. You may find a copy of that Notice at www.catholiccharitiesaz.org, or you may request a copy from the Quality and Risk Administrator at 602-285-1999.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information.

Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for health care is protected health information (PHI) subject to the Health Insurance Portability and Accountability Act and its implementing regulations (HIPAA). Some PHI may be subject to other laws that are more restrictive than HIPAA. We maintain PHI in accordance with all applicable laws.

This Notice explains how, when, and why we may use or disclose your PHI. We are required to follow the privacy practices described in this Notice. We reserve the right to change our privacy practices and the terms of this Notice as permitted by law. If changes occur, a new Notice will be posted at the reception desk. You may request a copy from the Quality and Risk Administrator at 602-285-1999. The new Notice will apply to all PHI we maintain.

We may use and disclose your PHI for a variety of reasons. For most uses and disclosures, we will obtain your written authorization. In some situations, we may use or disclose your PHI without written authorization, as described below.

Uses and Disclosures Relating to Treatment, Payment, or Operations

For treatment: We may use and disclose your PHI to treat you and provide requested health care services. Staff, volunteers, and service delivery personnel may access your PHI to provide services. We may also share PHI with other providers to coordinate care.

To obtain payment: If we bill or collect payment for services, we may use or disclose PHI for payment purposes, such as releasing information to Medicaid, private insurance, or state offices.

For our operations: We may use or disclose PHI to operate our programs, evaluate service quality, or share information with accountants or attorneys for audit or legal purposes.

Other Uses and Disclosures Not Requiring Authorization

• • When required by law
  • For public health activities
  • For health oversight activities
  • For judicial or administrative proceedings
  • For limited law enforcement purposes
  • For decedents, including coroners and funeral directors
  • For research purposes in certain circumstances
  • To avert a serious threat to health or safety
  • For specific government functions
  • For workers’ compensation purposes

Uses and Disclosures Requiring an Opportunity to Object

We may use or disclose your PHI if we inform you in advance and you do not object.

Facility directories: Your name, location, general condition, and religious affiliation may be included for clergy or visitors who ask for you by name.

Family, friends, or others involved in your care: We may share PHI directly related to their involvement in your care or payment, or to notify them of your location, condition, or death.

In emergencies where you cannot object, disclosures may be made if consistent with your prior wishes and in your best interest. You will be informed and given an opportunity to object as soon as possible.

Uses and Disclosures Requiring Authorization

Any use or disclosure not described in this Notice requires your written authorization, including most marketing uses. You may revoke authorization at any time, except where action has already been taken based on your authorization.

• • Request restrictions: You may ask in writing to limit how we use or disclose PHI. We are not required to agree, except when you pay in full for a service and request that it not be disclosed to your health plan.
  • Inspect and copy: You may request access to your PHI. We will respond within 30 days. Fees may apply for copies.
  • Request amendment: You may request corrections to your PHI. We will respond within 60 days.
  • Accounting of disclosures: You may request a list of certain disclosures. The first list each year is free.
  • Choose how we contact you: You may request alternative contact methods. Unsecure email or text carries risk of interception.
  • Receive this Notice: You may request a paper or electronic copy. Email delivery requires signed consent.
  • Breach notification: You will be notified of any breach of unsecured PHI.

If you believe your privacy rights were violated, you may file a complaint with the contact listed below or with the U.S. Department of Health and Human Services at https://www.hhs.gov/hipaa/for-individuals/index.html. We will not retaliate against you for filing a complaint.

For questions or complaints, submit a Client Grievance form through your case worker or contact:

Quality and Risk Administrator
5151 N 19th Avenue
Phoenix, AZ 85015
602-285-1999

Effective Date: February 11, 2026