National Alliance on
Mental Illness Southern Arizona

Notice of Privacy Practices

NAMI Southern Arizona, Effective Date: 09/25/13

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. Any questions about this notice should be addressed to the Compliance/Privacy Officer at (520) 622-5582. NAMI Southern Arizona, (hereinafter referred to as NAMISA) is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this notice of our legal duties and privacy practices with respect to protected health information. NAMISA is required by law to abide by the terms of this notice; however, NAMISA does reserve the right to change the terms of this notice. NAMISA is required to follow the terms of the notice currently in effect. Any revisions to this notice will be posted at all sites with the effective date indicated, and paper copies of this notice will be provided upon request.

The U.S. Surgeon General reports that 10 percent of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers.

NAMISA may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, NAMISA would disclose your protected health information to other physicians who may be treating you, to a physician to whom you have been referred, or to any other physician or health care provider who, at the request of your primary physician, becomes involved in your care by providing assistance with your diagnosis or treatment to your primary physician.

NAMISA may use and disclose your protected health information to obtain payment for your health care services. This may include the disclosure of medical information to obtain prior authorization, for making a determination of eligibility or coverage, for reviewing services for medical necessity, and for utilization review activities.


NAMISA may use and disclose protected health information about you for internal operations. These uses and disclosures can include quality assessment activities, employee review activities, licensing and accreditation activities, and conducting or arranging for other business activities.

NAMISA may share your information with third party “business associates” that perform various activities (e.g., records storage) for NAMISA. Whenever an arrangement between our office and a business associate involves that use or disclosure (or potential use or disclosure) of your protected health information, NAMISA will have a written agreement that contains the terms that will protect the privacy of your health information.

NAMISA may use and disclose protected health information to contact you as a reminder that you have an appointment at one of our facilities/programs.

NAMISA will disclose protected health information about you when required to do so by federal, state, or local law.


NAMISA may use and disclose protected health information about you when necessary to prevent a serious threat to your health or safety or the health and safety of the public or another person.


Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.

NAMISA may disclose protected health information if asked to do so by law enforcement officials:

·        In response to a court order, subpoena, warrant, summons, or similar process.

·        About the victim of a crime if, under certain limited circumstances, NAMISA is unable to obtain the person’s agreement.

·        About criminal conduct at any NAMISA program/facility.

·        In emergency situations.

NAMISA may disclose protected health information to a coroner or medical examiner if necessary to identify a deceased person or to determine the cause of death. Information may also be disclosed to funeral home directors in order to carry out their duties.

NAMISA may disclose your protected health information to researchers when their research has been approved by the NAMI Southern Arizona, Institutional Review Board. Such approval ensures that protocols have been established to ensure the privacy of your protected health information.

NAMISA may disclose your protected health information to an authority that is authorized by law to receive reports of abuse or neglect (e.g., CPS, APS). In addition, NAMISA may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable laws.

You have the following rights regarding protected health information NAMISA maintains about you:



You have the right to inspect and copy protected health information that may be used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes. If you request a copy of your records, NAMISA may charge a fee for the cost of copying, mailing, or other supplies associated with your request. You will not be allowed to remove your original record. In certain very limited circumstances your request to inspect a copy of your record may be denied. If this occurs, you can request a review of the denial.

If you feel that protected health information we have about you is incorrect or incomplete, you may ask that the information be amended. Your request must be submitted in writing to the Executive Director. Additionally, you must provide a reason that supports such a request.

If your request is not in writing or does not include a reason to support the request, NAMISA may deny the request. In addition, NAMISA may deny the request if you ask for information that was not compiled by NAMISA, or information that is not part of the protected health information maintained by NAMISA. NAMISA may deny the request if the maintained protected health information is complete and accurate.

You have a right to request a list of disclosures NAMISA has made of protected health information about you to others except for purposes of treatment, payment, and operations specified above.

Any request for a list of disclosures must be made in writing to the Executive Director. Your request must state a time period that cannot be longer than 6 years and cannot include dates prior to February 18, 2014. Your written request should dictate the form in which you wish to receive this list. The first list requested in a 12 month period will be provided free of charge to you. For any additional lists requested you will be charged the cost of providing this information to you.

You have the right to request a restriction or limitation on the protected health information NAMISA would use or disclose about you for treatment, payment, or health care operations.

To request restrictions, you must make your request in writing to the Privacy Officer. The request must define what information you want to limit, whether to want to limit use, disclosure, or both, and to whom you want the limits to apply.

If the request is granted, NAMISA will comply with your request unless the information is needed to provide emergency treatment or to meet orders of the court.

You have the right to request that NAMISA communicate with you about medical matters in a certain way or at a certain location. For example, you can ask NAMISA to only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Privacy Officer. We will accommodate all reasonable requests.

You have the right to a paper copy of this privacy notice. You may ask us to give you a copy of this privacy notice at any time by requesting a copy from any NAMISA staff member. PRINTABLE VERSION of our Privacy Policy

If you believe your privacy rights have been violated, you may contact or submit your complaint in writing to the Privacy Officer at 6122 E 22nd St, Tucson, AZ 85711.

You can also file a complaint with the Secretary of the U.S. Department of Health and Human Services.

The quality of your care will not be jeopardized nor will you be penalized for filing a complaint.

Other uses and disclosures of protected health information not covered by this notice or the laws that apply to NAMI Southern Arizona, will be made only with your written permission. If you provide NAMISA permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, NAMISA will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that NAMISA is unable to take back any disclosures already made with your permission and that NAMISA is required to retain our records of the care that is provided to you.

NAMI Southern Arizona does not sell or share names, contact information or any personally identifiable information with any third party unless permission has been granted.

If you desire to remove your name from our postal mailing list, email us at or call (520) 622-5582 and request to be removed. You can unsubscribe from email communications by clicking on the unsubscribe link present in all our messages.

Circumstances that fall outside the policies stated above will fall under the jurisdiction of the CPSA/HIPPA guidelines found HERE.  

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