NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are committed to protecting the confidentiality of your medical information, and are required by law to do so.
This notice describes how we may lawfully use your medical information within the Hospital and how we may
lawfully disclose it to others outside the Hospital. This notice also describes the rights you have concerning your
own health information. Please review it carefully and let us know if you have questions.
HOW WILL WE USE AND DISCLOSE YOUR MEDICAL INFORMATION?
Patient Census: In order to assist family members and other visitors in locating you while you are in the
Hospital, the Hospital maintains a patient census listing. This listing includes your name, room number, your
general condition (such as fair, stable, or critical), and your religious affiliation (if any). We will disclose this
information to someone who asks for you by name, although we will disclose your religious affiliation only to
clergy members. If you do not want to be included in the Hospital’s patient census listing, please inform your
care provider. If you chose to not have information released, none of the information described above will be
disclosed. In addition, you will be responsible to inform your family or friends regarding any information about
you, including your room number. (In order for your family and friends to locate you in the hospital, you must
provide your room number.)
Family Members and Others Involved in Your Care: We may disclose your medical information to a family
member or friend who is involved in your medical care, or to someone who helps to pay for your care. If you do
not want the Hospital to disclose your medical information to family members or others who will visit you, please
inform your care provider. We also may disclose your medical information to disaster relief organizations to help
locate a family member or friend in a disaster.
Treatment: We may use your medical information to provide you with medical services and supplies. We may
also disclose your medical information to others that need that information to treat you, such as doctors,
physician assistants, nurses, medical, nursing and other clinical students, technicians, therapists, emergency
service and medical transportation providers, medical equipment providers, and others involved in your care.
For example, we will allow your physician to have access to your Hospital medical record to assist in your
treatment at the hospital and for follow-up care.
We also may use and disclose your medical information to contact you to remind you of an upcoming
appointment, to inform you about possible treatment options or alternatives, or to tell you about health-related
services available to you.
Payment: We will use and disclose your medical information to get paid for the medical services and supplies
we provide to you. For example, your health plan or health insurance company may request to see parts of your
medical record before they will pay us for your treatment.
Hospital Operations: We may use and disclose your medical information if it is necessary to improve the
quality of care we provide to patients or to run the Hospital. This information may or may not specifically identify
you as a patient receiving care. We may use your medical information to conduct quality improvement activities,
to obtain audit, accounting or legal services, or to conduct business management and planning. Many of our
patients like to make contributions to the Hospital. The Hospital or its foundation may contact you in the future to
raise money for the Hospital. If you do not want the Hospital or its foundation to contact you for fundraising,
please notify The TMC Foundation in writing.Revised April, 2013
Research: We may use or disclose your medical information for research projects, such as studying the
effectiveness of a treatment you received. These research projects must go through a special process that
protects the confidentiality of your medical information.
Required by Law: Federal, state, or local laws sometimes require us to disclose patients’ medical information.
For instance, we are required to report child abuse or neglect and must provide certain information to law
enforcement officials in domestic violence cases. We also are required to give information to the Arizona
Workers’ Compensation Program for work-related injuries.
Public Health: We also may report certain medical information for public health purposes. For instance, we are
required to report births, deaths, and communicable diseases to the State of Arizona. We also may need to
report patient problems with medications or medical products to the FDA, or may notify patients of recalls of
products they are using.
Public Safety: We may disclose medical information for public safety purposes in limited circumstances. We
may disclose medical information to law enforcement officials in response to a search warrant, court order or a
grand jury subpoena. We also may disclose medical information to assist law enforcement officials in identifying
or locating a person, to prosecute a crime, to report deaths that may have resulted from criminal conduct, and to
report criminal conduct at the hospital. We also may disclose your medical information to law enforcement
officials and others to prevent a serious threat to health or safety.
Health Oversight Activities: We may disclose medical information to a government agency that oversees the
Hospital or its personnel, such as the Arizona Department of Health Services, the federal agencies that oversee
Medicare, the Board of Medical Examiners or the Board of Nursing. These agencies need medical information
to monitor the Hospital’s compliance with state and federal laws.
Coroners, Medical Examiners and Funeral Directors: We may disclose medical information concerning
deceased patients to coroners, medical examiners and funeral directors to assist them in carrying out their
Organ and Tissue Donation: We may disclose medical information to organizations that handle organ, eye or
tissue donation or transplantation.
Military, Veterans, National Security and Other Government Purposes: If you are a member of the armed
forces, we may release your medical information as required by military command authorities or to the
Department of Veterans Affairs. The Hospital may also disclose medical information to federal officials for
intelligence and national security purposes, for presidential Protective Services, or to the Department of State for
its security clearances.
Judicial Proceedings: The Hospital may disclose medical information in a lawsuit if the Hospital is ordered to
do so by a court or if the Hospital receives a subpoena or a search warrant. You will receive advance notice
about this disclosure in most situations so that you will have a chance to object to sharing your medical
information. However, if the request is by a grand jury subpoena, you may not necessarily be advised by us.
Information with Additional Protection: Certain types of medical information have additional protection under
state or federal law. For instance, medical information about communicable disease and HIV/AIDS, drug and
alcohol abuse treatment, genetic testing, and court-ordered mental evaluation is treated differently than other
types of medical information. For those types of information, the Hospital is required to get your permission
before disclosing that information to others in most circumstances.
Other Uses and Discolsures: Hospital personnel will obtain patient authorization to use or disclose the
patient’s PHI in the following circumstances: (1) the disclosure is for certain mental health records, (2) the
information disclosed contains communicable disease information, including HIV or AIDS-related information, (3)
the disclosure contains information related to genetic testing, or (4) the disclosure is for marketing purposes.
If you give your permission to the Hospital, you may take back that permission any time, unless we have already
relied on your permission to use or disclose the information. If you would like to revoke your permission, please
submit the request in writing to the TMC Health Information Management department. Revised April, 2013
Privacy Breach Notification: In accordance with Breach Notification for Unsecured Protected Health
Information requirements, as outlined in The Health Information Technology for Economic and Clinical Health
[HITECH] Act, Tucson Medical Center is required by law to provide notification to affected individuals and to the
Secretary of Health and Human Services following the discovery of a breach of unsecured protected health
WHAT ARE YOUR RIGHTS?
Right to Request Your Medical Information: You have the right to look at your own medical information and
to get a copy of that information. (The law requires us to keep the original record.) This includes your medical
record, your billing record, and other records we use to make decisions about your care. You also have the right
to receive confidential communications of your protected health information. To request your medical
information, submit a written request to TMC Medical Records. Depending on the nature of your request we
may charge you for this service. We will tell you in advance what this copying will cost. If your request for
medical information is denied, you have the right to appeal this decision to the TMC Privacy Committee.
Right to Attach an Amendment to Medical Information You Believe Is Erroneous or Incomplete: If you
examine your medical information and believe that some of the information is wrong or incomplete, you may
submit a written explanation of information you believe is wrong or incomplete. This explanation will be included
in your medical record if you so choose. You may submit your written material to TMC Medical Records for
consideration. TMC reserves the right to either accept or deny any change to your medical record.
Right to Get a List of Certain Disclosures of Your Medical Information: You have the right to request a list
of disclosures we make of your medical information subject to Federal Privacy requirements. However,
information released in certain circumstances, such as disclosures for hospital payment, treatment or operations,
will not be included in the list. If you would like to receive such a list, submit a written request to TMC Medical
Records. We will provide the first list to you free, but we may charge you for any additional lists you request
during the same year. We will tell you in advance what this list will cost.
Requesting Restrictions on How the Hospital Will Use or Disclose Your Medical Information for
Treatment, Payment, or Health Care Operations: In the event you request us not to make uses or disclosures
of your medical information to treat you, to seek payment for care, or to operate the Hospital, you may submit
that request in writing to the TMC Compliance & Privacy Officer. We will try to accommodate your request;
however, granting restrictions is not always possible. However, TMC agrees to restrict information disclosed to
your health plan if you pay out of pocket for the entire cost of the service.
Right to a Paper Copy: You may download a paper copy of the notice from our web site, at www.tmcaz.com
or you may obtain a paper copy of the notice at Tucson Medical Center.
CHANGES TO THIS NOTICE
From time to time, we may change our practices concerning how we use or disclose patient medical information,
or how we will implement patient rights concerning their information. We reserve the right to change this Notice
and to make the provisions in our new notice effective for all medical information we maintain. If we change
these practices, we will publish a revised Notice of Privacy Practices. You can get a copy of our current notice of
Privacy Practices at any time by downloading from TMC’s website www.tmcaz.com or obtain a paper copy at
Tucson Medical Center.
WHICH HEALTH CARE PROVIDERS ARE COVERED BY THIS NOTICE?
This Notice of Privacy Practices applies to the Hospital and its personnel, volunteers, students, and trainees.
The notice also applies to other health care providers that come to the Hospital to care for patients, such as
physicians, physician assistants, nurse practitioners, therapists, other health care providers that are not
employed by the Hospital, emergency service providers, medical transportation companies, and suppliers that
come to the hospital. The Hospital may share your medical information with these providers for treatment
purposes, to get paid for treatment, or to conduct health care operations. These health care providers will follow
this notice for information they receive about you from the Hospital. These other health care providers may
follow different practices at their own offices or facilities. Revised April, 2013
DO YOU HAVE CONCERNS OR COMPLAINTS?
Please tell us about any problems or concerns you have with your privacy rights or how the Hospital uses or
discloses your medical information. If you have a concern, please contact the TMC Privacy Officer at 324-1962.
If for some reason the Hospital cannot resolve your concern, you may also file a complaint with the federal
government. We will not penalize you or retaliate against you in any way for filing a complaint with the federal
DO YOU HAVE QUESTIONS?
The Hospital is required by law to give you this Notice and to follow terms of the Notice that is currently in effect.
If you have any questions about this Notice, or have further questions about how the Hospital may use and
disclose your medical information, please contact the TMC Privacy Officer at 324-1962.
Effective date: April 14, 2003
Revised: April, 2013