Notice of Privacy Practices
This statement has an effective date of Jan 1, 2023 and was last updated Feb 26, 2023
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get An Electronic or Paper Copy of Your Medical Record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
We will provide a copy or a summary of your health information, usually within 30 days of your request.
We may charge a reasonable, cost-based fee.
Ask Us to Correct Your Medical Record
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request Confidential Communications
You can ask us to contact you in a specific way (for example, home or office phone) or mail to a different address. We will say “yes” to all reasonable requests.
Ask Us to Limit What We Use or Share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get A List of Those with Whom We’ve Shared Information
You can ask for a list (accounting) of the times we’ve shared your health information for six years before the date you asked about who we shared it with and why.
We will include all the disclosures except those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make).
We’ll provide one accounting a year for free but charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get A Copy of This Privacy Notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will promptly provide you with a paper copy.
Choose Someone to Act for You
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will ensure the person has this authority and can act for you before we act.
File A Complaint If You Feel Your Rights Are Violated
You can complain if you feel we have violated your rights by contacting us using the information on the back page.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue S.W., Washington, D.C. 20201, call 1-877-696-6775, or visit hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.
Your Choices
You can tell us your choices about what we share for certain health information.
Talk to us if you have a clear preference for how we share your information in the situations described below. Let us know what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Contact you for fundraising efforts
If you cannot tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest.
We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
Regarding fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways.
To Treat You
We can use your health information and share it with other professionals treating you. For example, a doctor treating you for an injury can ask another doctor about your overall health condition.
To Run Our Organization
We can use and share your health information to provide our services, improve your care, and contact you when necessary. For example, we use health information about you to manage your treatment and services.
To Bill for Your Services
We can use and share your health information to bill and get payment from health plans or other entities. For example, we give information about you to your health insurance plan so it will pay for your services.
How Else Can We Use or Share Your Health Information?
We are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research.
We must meet many conditions in the law before we can share your information for these purposes.
For more information, visit hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html.
To Help With Public Health And Safety Issues
We can share health information about you for certain situations, such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
To Comply with The Law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we comply with federal privacy law.
To Respond to Organ and Tissue Donation Requests
We can share health information about you with organ procurement organizations.
Work With a Medical Examiner or Funeral Director
When an individual dies, we can share health information with a coroner, medical examiner, or funeral director.
Address Workers’ Compensation, Law Enforcement, And Other Government Requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions, such as military, national security, and presidential protective services
Respond To Lawsuits and Legal Actions
We can share health information about you in response to a court or administrative order or in response to a subpoena.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will promptly let you know if a breach may have compromised your information’s privacy or security.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind anytime. Let us know in writing if you change your mind.
For more information, visit hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html.
Changes to The Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
This notice of privacy practices applies to the Sage Family of Companies (Agape Hospice Care of GA; Elevation Hospice of CO; Elevation Hospice, Primary and Palliative Care of UT; Sage Hospice, Primary and Palliative Care of AZ) across the United States.
Contact Information:
Sage Family of Companies
Attn: Julie Ford, Chief Compliance Officer
Through mail:
5111 N. Scottsdale Rd, #204
Scottsdale, Arizona 85250
By phone:
(480) 777-5117
By Fax:
(480) 304-3155
By email:
julie.ford@sagehospice.org