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.
The Department of Health and Human Services (HHS) has enacted the Health Insurance Portability and
Accountability Act (HIPAA). The law was passed to promote standardization and efficiency within the
health care industry. It created what is known as Protected Health Information (PHI), which is any
health care information that may specifically identify you, including demographic information, information
about your past, present or future medical conditions, including physical and mental health, or any
treatment or related health care services. Avella would like to make you
aware of your rights and our responsibilities, as identified by HIPAA.
CLICK TO DOWNLOAD THE HIPAA AUTHORIZATION FOR DISCLOSURE FORM
Uses and Disclosures
Avella may use your PHI in the preparation of your order. This may include prescription and over-the-counter medication, as well as medical devices and educational programs. We may use your information
to contact you, your representative, your physician or your third party payor (i.e. insurance company) to
prepare your order or provide services. We collect information from you or your representative in order to accurately and beneficially provide you
with care. None of your information is ever sold, neither during nor after your treatment with Avella.
Occasionally, we may contact you, your representative, your health care provider, or your third party payor
to suggest treatment options, offer reminders of therapy, find alternatives for care, or resolve payment
issues. Your physician may be contacted in order for us to clarify or discuss treatment, as well as ask for
refills and changes, per your request. Your third party payor may be contacted to determine coverage or
eligibility, discuss payment or reimbursement, or gather additional information in an attempt to submit
Any communication necessary to provide and maintain our high standard of care would be carried out as
needed; however, it would always be executed within the limits of HIPAA and constrained to the release
or collection of the minimum amount of information.
Business Associates (i.e. insurance companies, pharmacy benefits managers, etc.) of Avella may have
access to your PHI from time to time. These companies are either covered by the laws of HIPAA or have
agreed to abide by these laws through Business Associate Contracts they have signed with us. We will
hold all entities with which we do business to the standards of our privacy practices and HIPAA laws. Any
company wavering from these policies will be given notice of their shortcomings with an opportunity to
correct their mistakes. Associations will be severed with associates who are unable to continually
maintain these privacy standards.
Be assured that at all times, Avella will release or collect only the minimum amount of information
necessary to accomplish its objective. We apply the most stringent standard of law, whether state or
federal, to the protection of your PHI.
Orders may be placed, altered and picked-up, and PHI may be given to or changed by someone other
than yourself, with your permission. For current patients, Avella would apply historical standards to
your care. For instance, if a spouse or care-giver has regularly attended to your orders and PHI, this
would be considered the standard. To ensure seamless service, please list all persons allowed to access
your information at the end of this notice.
Information may be disclosed without your consent in certain circumstances, as required by law. These
include requests from the Department of Health and Human Services, state departments of insurance,
law enforcement agencies and court orders, as well as other public health, military and judicial agencies.
We will comply with all requests by authorized agencies, but will only release the information necessary to
fulfill the request, as required by law. In these instances, you would be notified of any such disclosures, in
accordance with the law.
It is required that a written release be obtained by Avella in order to use or disclose any PHI not
otherwise described in this notice. You may revoke this authorization at any time with a written request.
A request for access to your information may be made to our Privacy Officer during business hours. You have the right to request that any information in your record which you believe to be
incorrect or incomplete be corrected or added to, once complete and accurate information is verified. You
may make an amendment to your PHI at any time, although this amendment may or may not influence
the content or release of your information, but it will be kept as a permanent part of your record. You may
request that any correspondence with regard to your PHI be delivered to you by means other than in
person. A written request must be received, acknowledging the fact that you would possibly endanger
yourself or your information, before such information is delivered by alternative means.
You may request that your information not be shared with Business Associates or other HIPAA Covered
Entities, such as third party payors, pharmacy benefits managers or physicians. Also, you may request a
list of all disclosures of your health information that we have made to others. We do not routinely monitor
these disclosures, with some exceptions as required by law, but will accommodate the request to the best
of our ability. Avella will consider all of the above requests, but we are not legally required to fulfill them.
Avella has a legal duty to protect the privacy of your information, to provide and make available our
Notice of Privacy Practices and legal duties, including updates and revisions, and to abide by the terms of
Should you disagree with a decision that has been made with regard to your records, or believe that your
rights have been violated, you may contact our Privacy Officer, listed below. Also, you may contact the
State of Arizona Board of Pharmacy. Finally, you have the right to file a complaint with the Secretary of
the Department of Health and Human Services. In accordance with Federal Regulation 160.306, your
complaint must be filed in writing within 180 days of the violation, unless good cause is found to waive
this time limit. The complaint must list the entity thought to be in violation and the subject of the violation,
as well as describe the standards, requirements or specifications believed to have been violated.
Avella will not retaliate against any person who files a complaint.
Requests and Information
We are dedicated to protecting your privacy. This Notice of Privacy Practices may be updated and
revised over time. For the most up to date version of this document, please visit our website at
www.avella.com or contact our Privacy Officer. To submit requests for records or
disclosures, to correct or add information to your record, or to receive more details about HIPAA and
Avella’s privacy practices, please contact our Privacy Officer by telephone at (480) 203-0677 or by
mailing your request to:
Attn: Privacy Officer
23620 North 20th Drive, Ste. 12
Phoenix, Arizona 85085