You are now receiving this notice because your healthcare provider participates in a non-profit non-governmental health information exchange (HIE) called 360 AZ Doc. It will not cost you anything and can help your doctor, healthcare providers, and health plans better coordinate your care by securely sharing your health information. This Notice explains how the HIE works and will help you understand your rights regarding the HIE under state and federal law

How does 360 AZ Doc help you get better care?

In a paper-based record system, your health information is mailed or faxed to your doctor but sometimes these records are lost or don’t arrive in time for your appointment. If you allow your health information to be shared through the HIE, your doctors are able to access it electronically in a secure timely manner.

What health information is available through 360 AZ Doc?

The following types of health information may be available:

  • Hospital records
  • Medical history
  • Medications
  • Allergies
  • Lab test results
  • Radiology reports
  • Clinic and doctor visit information
  • Health plan enrollment and eligibility
  • Other information helpful for your treatment
Who can view your health information through 360 AZ Doc and when can it be shared?

People involved in your care will have access to your health information. This may include your doctors, nurses, other healthcare providers and health plan. They may access your information for treatment, conducting quality assessment and improvement activities, developing clinical guidelines and protocols, conducting patient safety activities, and population health services. Medical examiners, public health authorities, organ procurement organization, and others may also access health information for certain approved purposes, such as conducting death investigations, public health investigations and organ, eye or tissue donation and transplantation, as permitted by applicable law.

360 AZ Doc may also use your health information as required by law and as necessary to perform services for healthcare providers, health plans and others participating with 360 AZ Doc.

The 360 AZ Doc Board of Directors can expand the reasons why healthcare providers and others may access your health information in the future as long as the access is permitted by law. That information is on the 360 AZ Doc website at www.360azdoc.com You also may permit others to access your health information by signing an authorization form. They may only access the health information described in the authorization form for the purposes stated on that form.

Does 360 AZ Doc receive behavioral health information and if so, who can access it?

360 AZ Doc does receive behavioral health information, including substance abuse treatment records. Federal law gives special confidentiality protection to substance abuse treatment records from some substance abuse treatment programs. 360 AZ Doc keeps these protected substance abuse treatment records separate from the rest of your health information. 360 AZ Doc will only share these protected substance abuse treatment records it receives from these programs in two cases. One, medical personnel may access this information in a medical emergency. Two, you may sign a consent form giving your healthcare provider or others access to this information.

How is your health information protected?

Federal and state laws, such as HIPAA, protect the confidentiality of your health information. Your information is shared using secure transmission. 360 AZ Doc has security measures in place to prevent someone who is not authorized from having access. Each person has a username and password, and the system records all access to your information.

Your Rights Regarding Secure Electronic Information Sharing

You have the right to:

  1. Ask for a copy of your health information that is available through 360 AZ Doc. To make this request, complete the Request Form and return it to your healthcare provider.
  2. Request to have any information in the HIE corrected. If any information in the HIE is incorrect, you can ask your healthcare provider to correct the information.
  3. Ask for a list of people who have viewed your information through 360 AZ Doc. To make this request, complete the Request Form and return it to your healthcare provider. Please let your healthcare provider know if you think someone has viewed your information who should not have.
You have the right under article 27, section 2 of the Arizona Constitution and Arizona Revised Statutes title 36, section 3802 to keep your health information from being shared electronically through 360 AZ Doc:
  1. Except as otherwise provided by state or federal law, you may “opt out” of having your information shared through 360 AZ Doc. To opt out, ask your healthcare provider for the Opt Out Form. Your information will not be available for sharing through 360 AZ Doc within 30 days of 360 AZ Doc receiving your Opt Out Form from your healthcare provider.

Caution: If you opt out, your health information will NOT be available to your healthcare provider–even in an emergency.

  1. If you opt out today, you can change your mind at any time by completing an Opt Back In Form and returning it to your healthcare provider.
  2. If you do nothing today and allow your health information to be shared through 360 AZ Doc, you may opt out in the future.
IF YOU DO NOTHING, YOUR INFORMATION MAY BE SECURELY SHARED THROUGH HEALTH CURRENT.