THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE COLLECTED, USED AND DISCLOSED BY GREAT ELM HEALTHCARE, LLC AND HOW YOU CAN GET ACCESS TO THIS INFORMATION AND WHAT TO DO IF YOU DO NOT WANT YOUR PERSONAL HEALTH INFORMATION COLLECTED. PLEASE REVIEW IT CAREFULLY.
PRIVACY NOTICE EFFECTIVE JANUARY 1, 2006, AND ONLY RELATIVE TO PERSONAL HEALTH INFORMATION UNTIL SUCH TIME AS THIS PRIVACY NOTICE IS AMENDED BY GREAT ELM HEALTHCARE, LLC AND ITS AFFILIATED ENTITIES.
Why we need your personal information:
o To Perform Medical Treatment and to Provide Products and Services - To provide you with medical
treatment or procedures, health care, counseling, products and services and in order to make
future decisions about your treatment or care, we may need information about your past, present or
future physical or mental health or condition. Some of your personal health information that we may
need includes assessments, test results, diagnoses and, prescriptions and other similar
o To Receive Payment - In order for GEH to receive payment for health care, products or services
that we provide to you, we need information about you. We may need your personal health
to determine your eligibility for or coverage under health insurance plans
for billing, claims management and payment collection
for medical necessity review, to determine appropriateness of care or justification of
o For Our Healthcare Operations - We may need your personal health information for our quality
control purposes and professional training, development and evaluation, business planning and
development and administration.
o Related Uses - As part of performing medical treatment and providing you with products and
services, we may contact you to provide appointment and prescription refill reminders, information
about treatment alternatives or other health related benefits, products and services that may be of
interest to you.
Safeguarding your personal information:
Obtaining your consent:
Your rights relative to your personal information:
o Inspect, copy, verify and amend your personal health information (we may ask you to make your
request in writing)
o Ask us to correct your personal health information
o Find out, if not prohibited by law, the names of parties to whom we have disclosed your individually
identifiable health information.
o Request restrictions on certain uses and disclosures of personal health information. Such request
must be submitted in writing. GEH will consider your request but is not obligated to comply with it.
o Notify us that you wish to withdraw your consent after you have given it. There may be some
products, services or treatments that we cannot provide you without your consent -- if this is the
case, we will let you know so that you can make an informed decision.
o Request to receive personal health information from GEH by alternate means or at alternative
locations. GEH will make reasonable accommodations in response to any such request.
If you have any questions or concerns about the privacy of your personal health information or for further information concerning this Privacy Notice or the collection, use, storage or disclosure of your personal health information, you may contact our Privacy Officer. Sheila Roberson, at 480-830-7700.
Or, in writing at:
Great Elm Healthcare, LLC
2330 W. Broadway Road, Ste. 107
Mesa, AZ 85202
Or by email at email@example.com