Notice of Privacy Practices

Effective date: 2026-11-04

Our Commitment to Your Privacy

Sapphire Hospice ("we," "us") is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to maintain the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach of your unsecured PHI occurs.

How We May Use and Disclose Your Health Information

• Treatment. We use and share your information to provide, coordinate and manage your hospice care, including with your attending physician, our medical director, nurses, aides, social workers, chaplains, pharmacies, equipment suppliers and the facility where you reside.
• Payment. We use and share your information to bill and collect payment from Medicare, Medicaid (AHCCCS), insurers or other payers.
• Health care operations. We use your information for quality improvement, staff training, licensing, accreditation, auditing and business management, including the CAHPS® Hospice Survey administered by an approved vendor.
• Family and caregivers. Unless you object, we may share information relevant to their involvement in your care with family members, friends or others you identify, and with those involved in your care after death unless you told us otherwise.
• Bereavement. We may contact your family or caregivers after a death to offer bereavement support.
• Appointment reminders and care options. We may contact you about visits, services or treatment alternatives.
• As required or permitted by law. Including public health activities; reports of abuse, neglect or domestic violence; health oversight (such as CMS and the Arizona Department of Health Services); judicial and administrative proceedings; law enforcement; coroners, medical examiners and funeral directors; organ and tissue donation; research approved by a privacy board; to avert a serious threat to health or safety; specialized government functions; and workers' compensation.

Uses That Require Your Written Authorization

We will not use or share your PHI for marketing, sell your PHI, or share psychotherapy notes without your written authorization. Other uses not described in this notice will be made only with your written authorization, which you may revoke at any time in writing (except to the extent we have already acted on it).

Your Rights

• Inspect and copy your health record, including an electronic copy, usually within 30 days. We may charge a reasonable cost-based fee.
• Request an amendment if you believe information is incorrect or incomplete. We may deny the request in certain circumstances and will explain why in writing.
• Receive an accounting of disclosures made for purposes other than treatment, payment, operations and certain other exceptions, for the six years before your request.
• Request restrictions on how we use or share your information. We are not required to agree, except we must agree not to share information with your health plan about a service you paid for in full out of pocket.
• Request confidential communications at an alternative location or by an alternative means.
• Be notified of a breach of your unsecured PHI.
• Receive a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you (a medical power of attorney or legal guardian) who can exercise these rights on your behalf.

Changes to This Notice

We reserve the right to change this notice and make the new notice apply to information we already have as well as information we receive in the future. The current notice is posted on this website and at our office, and a copy is provided to every patient at admission.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, 1-800-368-1019 (TDD 1-800-537-7697), or online at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Contact Our Privacy Officer

Privacy Officer, Sapphire Hospice
4701 S Lakeshore Dr, Ste 2, Tempe, AZ 85282
Phone: (480) 347-9866 · Email: admin@sapphirehospice.com