623-217-2000 623-500-5099 hearttoheartgrouphome@gmail.com
Notice of Privacy Practices

To provide quality healthcare services, Heart To Heart Behavioral Health Group Home must obtain and maintain protected health information (PHI) from you. This Notice of Privacy Practices describes the types of information collected and your rights with regards to that information. Heart To Heart Behavioral Health Group Home is required by law to maintain the privacy of PHI and provide you with this notice of our privacy practices and our legal duties with respect to that PHI.


Protected health information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or conditions and related healthcare services. PHI includes the following:

  • Your health history
  • Your medical records
  • Your name, address, and date of birth
  • Your marital status
  • Your gender
  • Your social security number
  • Other similar information that relates to past, present, or future medical care
Health Information

Health information is any information, whether oral or recorded in any form or medium, that:
is created or received by a healthcare provider, health plan, public health authority, employer, life insurer, or health care clearinghouse; relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.

Who Will Follow This Notice?

The following people will be required to follow the requirements of this Policy Notice:

  • All employees of Heart To Heart Behavioral Health Group Home
  • Any Business Associate allowed access to your PHI
Sources of Protected Medical Information

Your protected medical information is obtained from a variety of places. These sources include (but are not limited to):

  • Applications you have completed for health care coverage
  • Reports and correspondence from your physician(s) or other health care provider
  • Information obtained from your pharmacist
  • Information from you, obtained in writing or over the telephone, or in-person
  • Information from your health insurance company/plan or their representative
  • Information obtained from your support coordinator
  • Information obtained from anyone involved in your referral to our agency
  • Information from other entities involved in your health care
  • Information from the Arizona Division of Developmental Disabilities
  • Information from the Social Security Administration
  • Information from AHCCCS
  • Information from ALTCS
  • Information from other service providers
Uses and Disclosures of PHI

Heart To Heart Behavioral Health Group Home will, as allowed by privacy regulations, use and disclose your personal health information for the treatment, payment, and healthcare operations. The following categories describe different ways that we may use and disclose medical information about you. For each category of use/disclosure, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Use and disclosures for treatment and services: We may use medical information about you to provide you with treatment and services. Your PHI may be disclosed to healthcare providers’ personnel involved in your services. It will be disclosed to the agencies funding your service and your support coordinator. It may also be disclosed to other service providers involved in your care.

Uses and disclosures for payment: Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan or funding source may undertake before it approves or pays for health care and other services. This includes making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and eligibility, and undertaking utilization review activities. For example, the approval for a therapy service may require that your relevant PHI be disclosed to your health plan. The approval for your services here at Heart To Heart Behavioral Health Group Home may require the disclosure of your PHI to funding sources and your support coordinator. Your PHI may be used, as needed, to obtain payment through AHCCCS, ALTCS, or other funding sources.

Uses and disclosures for health care operations: We may use and disclose medical information about you for operational and business purposes. These uses and disclosures are necessary to provide our services and make sure all the people we serve receive quality care. The information may be used and disclosed for assessments, evaluations, business planning, staffing, ISP meetings, monitoring by funding sources and their agents, conferences with Support Coordinators, supervisor/peer review of member files for accuracy, audits, legal services, Managers’ meetings, nursing assessments, medication reviews, or administrative services. We may include your name and demographic information in the list of people served, which are shared with other personnel in the agency.

We may share your PHI with our business associates who are hired by us to perform various services for us. These business associates include accreditation agencies, consultants, auditors, attorneys, software and computer support, and others as necessary to carry out treatment, billing, and health care operations. Whenever an arrangement between our agency and a business associate involves the use or disclosure of your PHI, we will require the business associate to sign an agreement that contains terms that will protect the privacy of your PHI. We may combine your medical information with other medical information so others may use it to study health care, health care delivery, and services without being able to identify individuals.

Non-routine disclosures of PHI: Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted or required by law as described below. For example, if we use your information for public relations purposes or reporting purposes (such as the monthly newsletter, the staff newsletter, the annual report, brochures), we will obtain your authorization. Heart To Heart Behavioral Health Group Home will not sell your personal health information without obtaining your authorization. Heart To Heart Behavioral Health Group Home will use or disclose information in these circumstances pursuant to the specific purpose contained in your authorization and will only use or disclose the minimum amount of information necessary to perform the non-routine function. You may revoke this authorization, at any time, in writing, except to the extent that Heart To Heart Behavioral Health Group Home has taken action in reliance on the use or disclosure indicated in the authorization, or if the authorization was obtained as a condition of obtaining insurance coverage, other laws provide the insurer with the right to contest a claim under the policy or the policy itself. In most circumstances, an authorization may only be made by the person to whom the PHI pertains (or if legally incompetent, the legal guardian). In some circumstances, an authorization may be obtained from a person representing your interests (such as in the case where you may be too incapacitated to make an informed authorization) or in emergency situations where authorization would be impractical to obtain. Other uses or disclosures of personal health information not covered above or below will be made only with your authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object

We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, as in the case of an emergency, we will rely on our professional judgment. In this case, only the PHI that is relevant to your health care will be disclosed.