Effective Date: 01/01/2026
Last Updated: June 2026
 

Alliance Behavioral Health Integrated, PLLC Clinic respects the privacy, confidentiality, security, and integrity of patient health information. This Medical Data Policy and Notice of Privacy Practices explains how we collect, use, disclose, store, protect, retain, and manage medical data, protected health information, behavioral health records, referral information, electronic forms, uploaded documents, electronic signatures, and related records.
 

This policy applies to patients, prospective patients, parents, guardians, authorized representatives, healthcare referral partners, court partners, DMV-related partners, community organizations, vendors, and any person or entity that submits, receives, or interacts with health-related information through Alliance Behavioral Health Integrated, PLLC Clinic.
 

Alliance Behavioral Health Integrated, PLLC Clinic is located in Arizona. Our services, records, website submissions, forms, communications, privacy practices, and data handling are governed primarily by applicable United States federal law, including HIPAA, and applicable Arizona law. To the fullest extent permitted by law, any legal interpretation, dispute, claim, or enforcement matter related to this policy, our services, medical data, referral submissions, website forms, or records shall be governed by the laws of the State of Arizona and applicable federal law of the United States.
 

1. Our Privacy Commitment
 

We are required by law to maintain the privacy and security of protected health information. We are also required to provide notice of our legal duties and privacy practices and to notify affected individuals when required by law if a breach of unsecured protected health information occurs.
 

We use and disclose protected health information only as permitted by law, required by law, authorized by the patient or legal representative, or described in this policy.
 

We do not sell protected health information. We do not use protected health information for marketing purposes without authorization when authorization is required by law. We do not disclose psychotherapy notes without written authorization except where permitted or required by law.
 

2. Information Covered by This Policy
 

This policy applies to all protected health information and medical data that Alliance Behavioral Health Integrated, PLLC Clinic creates, receives, maintains, stores, transmits, processes, or discloses.
 

This may include:
 

• Patient name, date of birth, address, phone number, email address, and identifying information

• Medical history and treatment information

• Behavioral health and mental health records

• Therapy, counseling, and psychotherapy-related information

• Psychiatric evaluations and medication management information

• Addiction treatment and substance use disorder information

• MAT treatment information when applicable

• DUI screening and DUI education information

• Court, DMV, probation, or compliance-related documentation

• Crisis prevention planning records

• Personal injury documentation

• Limited primary care records

• Insurance and payment information

• Referral forms and provider submissions

• Community partner, court partner, and organization referrals

• Uploaded documents

• Electronic signatures

• Website forms and appointment requests

• Communication records by phone, email, fax, text, online form, patient portal, or other electronic systems
   

3. How We May Use and Disclose Information
 

Treatment
 

We may use and disclose health information to provide, coordinate, or manage care. This may include communicating with healthcare providers, therapists, prescribers, pharmacies, hospitals, laboratories, care coordinators, crisis resources, addiction treatment providers, IOP or rehab programs, court-authorized contacts, or other professionals involved in the patient’s care.
 

Payment
 

We may use and disclose information to verify insurance, submit claims, process payments, respond to payer requests, collect balances, and perform billing-related activities.
 

Healthcare Operations
 

We may use and disclose information for clinic operations, including scheduling, referral review, quality improvement, staff training, compliance, audits, credentialing, care coordination, business administration, risk management, documentation review, legal compliance, and technology operations.
 

Required or Permitted by Law
 

We may use or disclose information when required or permitted by federal, Arizona, or other applicable law, including for public health, health oversight, abuse or neglect reporting, serious threats to health or safety, medical emergencies, court orders, subpoenas, law enforcement requests, workers’ compensation, regulatory investigations, and other legally authorized purposes.
 

4. Behavioral Health and Mental Health Records
 

Behavioral health and mental health information is treated with heightened care. Alliance Behavioral Health Integrated, PLLC Clinic may use and disclose behavioral health information for treatment, payment, and healthcare operations, and as otherwise permitted or required by law.
 

Certain behavioral health records may be subject to additional protections under Arizona law, HIPAA, federal confidentiality rules, court rules, professional standards, or other applicable privacy requirements.

Psychotherapy notes, when maintained separately from the medical record, receive special protection and generally require written authorization before disclosure unless an exception applies.
 

5. Substance Use Disorder and Addiction Treatment Records
 

Alliance Behavioral Health Integrated, PLLC Clinic provides addiction-related services. Certain substance use disorder records may be subject to additional federal confidentiality protections, including 42 CFR Part 2, when applicable.

When these heightened protections apply, substance use disorder records will not be disclosed except as permitted by law, with valid written consent, pursuant to a valid court order, for treatment/payment/healthcare operations when legally permitted, or as otherwise authorized by applicable federal regulations.
 

If a disclosure includes substance use disorder information subject to special protections, Alliance Behavioral Health Integrated, PLLC Clinic will follow the more protective applicable requirement.
 

6. Court, DMV, DUI, Probation, and Legal Partner Records
 

Alliance Behavioral Health Integrated, PLLC Clinic may receive referrals or requests from courts, probation programs, DMV-related programs, DUI programs, attorneys, legal advocates, community agencies, or authorized partners.
 

With proper consent, authorization, legal authority, or court order, we may provide appropriate documentation related to:
 

• Referral status

• Appointment attendance

• DUI screening or education participation

• Treatment participation

• Care coordination

• Compliance reporting when applicable

• DMV or court-related reporting when applicable

• Requested documentation within the scope permitted by law
   

We do not guarantee legal outcomes, DMV outcomes, license reinstatement, probation outcomes, compliance determinations, court decisions, custody decisions, settlement outcomes, or case results.
 

7. Website Forms, Online Referrals, Uploaded Documents, and Electronic Signatures
 

Our website may collect appointment requests, referral forms, court referrals, community referrals, uploaded documents, electronic signatures, contact information, and related health or referral information.
 

By submitting information electronically, the submitting person confirms that they are authorized to submit the information and that they have obtained patient consent or legal authority when required.
 

Electronic signatures collected through our website or electronic systems are intended to have the same effect as handwritten signatures to the fullest extent permitted by applicable law.

Electronic submissions may become part of the patient record, referral record, compliance record, or clinic administrative record.
 

Online forms are not monitored as a 24/7 emergency service. If there is immediate danger, call 911 or go to the nearest emergency room. For suicidal thoughts, emotional distress, mental health crisis support, or substance-related crisis support, call or text 988.
 

8. Data Security Safeguards
 

Alliance Behavioral Health Integrated, PLLC Clinic uses reasonable administrative, physical, and technical safeguards designed to protect the confidentiality, integrity, and availability of protected health information and electronic protected health information.
 

Safeguards may include:
 

• Workforce privacy and security training

• Role-based access controls

• Password protection

• Secure electronic systems

• Physical security for records and devices

• Secure faxing and document handling procedures

• Business Associate Agreements when required

• Minimum necessary access standards

• Identity verification before disclosure

• Incident response and breach review procedures

• Secure disposal of paper and electronic records

• Vendor review and access limitation

• Staff confidentiality obligations

• Documentation of privacy and security practices
   

No website, email system, electronic platform, or internet-based transmission can be guaranteed to be completely secure. However, Alliance Behavioral Health Integrated, PLLC Clinic takes reasonable steps to protect submitted information and reduce unauthorized access, use, disclosure, alteration, or loss.
 

9. Business Associates, Vendors, and Technology Providers
 

We may use vendors and service providers to support clinic operations. These may include electronic health record systems, billing providers, scheduling platforms, website providers, form platforms, secure messaging systems, cloud storage providers, payment processors, IT support, legal or compliance consultants, laboratories, transcription services, analytics providers, and other service providers.
 

When required by HIPAA, we enter into Business Associate Agreements or comparable written agreements requiring vendors to safeguard protected health information and use or disclose it only as permitted by law and contract.

We do not authorize vendors to use patient medical data for their own unrelated purposes.
 

10. Global Visitors, International Users, and Cross-Border Data
 

Alliance Behavioral Health Integrated, PLLC Clinic is an Arizona-based healthcare provider serving patients and referral partners primarily under United States federal law and Arizona law.
 

Individuals outside Arizona or outside the United States may access our website or submit information through our online forms. By using our website, submitting information, requesting services, or communicating with Alliance Behavioral Health Integrated, PLLC Clinic, the submitting person understands that information may be collected, processed, transmitted, stored, and maintained in the United States.
 

Health information submitted to Alliance Behavioral Health Integrated, PLLC Clinic is handled under HIPAA, applicable United States federal law, applicable Arizona law, and this policy. Where international privacy laws may apply, Alliance Behavioral Health Integrated, PLLC Clinic will make reasonable efforts to respect recognized privacy principles, including transparency, limited collection, purpose limitation, confidentiality, data security, access rights, correction rights, retention limitation, and secure disposal.
 

To the fullest extent permitted by applicable law, Alliance Behavioral Health Integrated, PLLC Clinic does not submit to foreign jurisdiction merely because a person outside the United States accesses the website or submits information electronically. Any dispute or claim related to the clinic, its website, medical data, referral forms, electronic submissions, records, or services shall be governed by applicable United States federal law and the laws of the State of Arizona.
 

11. Minimum Necessary Standard
 

When required by law, Alliance Behavioral Health Integrated, PLLC Clinic makes reasonable efforts to limit the use, disclosure, and request of protected health information to the minimum necessary information needed to accomplish the intended purpose.
 

This does not apply in every situation, including certain treatment disclosures, patient-authorized disclosures, disclosures required by law, or other situations where the minimum necessary rule does not legally apply.

Referral partners and form submitters should submit only information necessary for referral review, treatment coordination, documentation, insurance verification, compliance support, or the specific purpose of the request.
 

12. Patient Rights
 

Patients may have the right to:
 

• Receive a copy of this policy

• Request access to medical records

• Request a copy of medical records

• Request correction or amendment of records

• Request confidential communications

• Request restrictions on certain uses or disclosures

• Request an accounting of certain disclosures

• Revoke a written authorization, except where action has already been taken in reliance on it

• Choose a personal representative

• File a complaint without retaliation
   

Requests may need to be made in writing. We may require identity verification and legal documentation before releasing information.
 

Certain records may be restricted, withheld, redacted, or subject to additional review when required or permitted by law, including psychotherapy notes, substance use disorder records, minor records, court-related records, third-party information, safety-sensitive information, or records subject to legal restrictions.
 

13. Arizona Behavioral Health Confidentiality
 

Alliance Behavioral Health Integrated, PLLC Clinic follows applicable Arizona confidentiality laws for health care and behavioral health records.
 

Arizona law requires health care entities to keep records and information contained in records confidential and not as public records, except as authorized by state or federal law.
 

Behavioral health, mental health, substance use, crisis, therapy, DUI-related, and related treatment information will be disclosed only as permitted or required by HIPAA, Arizona law, patient authorization, court order, treatment purposes, payment purposes, healthcare operations, or another legally authorized basis.
 

When Arizona law, HIPAA, 42 CFR Part 2, or another applicable law provides greater protection, Alliance Behavioral Health Integrated, PLLC Clinic will follow the more protective applicable requirement.
 

14. Arizona Medical Record Retention
 

Alliance Behavioral Health Integrated, PLLC Clinic retains records in accordance with Arizona law, HIPAA, federal law, payer requirements, court requirements, professional standards, and clinic policy.
 

Unless a longer retention period is required by federal law, Arizona law, contract, payer requirement, legal hold, court order, audit requirement, professional standard, or clinic policy, records are generally retained as follows:
 

• Adult patient records: at least six years after the last date the adult patient received medical or health care services from the provider.

• Minor patient records: at least three years after the patient’s eighteenth birthday or at least six years after the last date the minor patient received medical or health care services from the provider, whichever date occurs later.

• Deceased patient records: at least six years after the last date the deceased patient received medical or health care services from the provider, unless a longer period applies.
   

Records may be retained longer when necessary for continuity of care, behavioral health documentation, addiction treatment documentation, court or DMV-related documentation, personal injury documentation, billing, audits, legal compliance, litigation holds, payer requirements, or clinic operations.
 

Records subject to legal hold, subpoena, court order, audit, investigation, payer dispute, malpractice claim, personal injury matter, regulatory inquiry, or anticipated legal matter will not be destroyed until the hold or matter is resolved and destruction is legally appropriate.
 

15. Secure Disposal
 

When records are eligible for destruction, Alliance Behavioral Health Integrated, PLLC Clinic uses secure disposal methods appropriate to the format of the record.
 

Paper records may be shredded, pulped, or otherwise destroyed in a manner designed to prevent reconstruction. Electronic records may be deleted, purged, overwritten, encrypted, de-identified, or otherwise disposed of using reasonable methods appropriate for electronic protected health information.
 

16. Breach Notification
 

If Alliance Behavioral Health Integrated, PLLC Clinic discovers a breach of unsecured protected health information, we will investigate and provide notification as required by law.
 

Notifications may be provided to affected individuals, the U.S. Department of Health and Human Services, and other parties when legally required.
 

17. Communication by Phone, Email, Text, Fax, and Online Systems
 

We may communicate with patients, representatives, providers, referral partners, courts, agencies, and authorized parties by phone, voicemail, email, text message, fax, portal, online form, or other electronic system for scheduling, referral review, care coordination, documentation, billing, and administrative purposes.
 

We make reasonable efforts to limit sensitive information in routine communications. Standard email and text messaging may not always be encrypted. Patients may request alternative communication methods.
 

We may require identity verification, written authorization, or legal documentation before releasing sensitive information.

18. External Links and Third-Party Websites
 

Our website may link to external resources, crisis services, government agencies, treatment locators, community resources, or partner organizations. Alliance Behavioral Health Integrated, PLLC Clinic does not control external websites and is not responsible for their privacy practices, security practices, availability, content, eligibility rules, cost, or quality of services.
 

Users should review the privacy policies of any external website before submitting information.
 

19. Complaints and Privacy Contact
 

Patients may file a privacy complaint with Alliance Behavioral Health Integrated, PLLC Clinic or with the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against any person for filing a privacy complaint.
 
Alliance Behavioral Health Integrated, PLLC Clinic
Privacy Officer / Compliance Contact: Karen Caro
Phone: 623-401-2882
Fax: 623-401-2889
Email: alliancebhiclinic@gmail.com
Address: 12801 W Bell Road, Suite 141, Surprise, AZ 85378
 

20. Governing Law, Jurisdiction, and Venue
 

Alliance Behavioral Health Integrated, PLLC Clinic is located in Arizona. To the fullest extent permitted by law, this Medical Data Policy, the clinic’s privacy practices, website submissions, referral forms, electronic signatures, medical records, health information, and related disputes are governed by applicable United States federal law and the laws of the State of Arizona, without regard to conflict-of-law principles.
 

To the fullest extent permitted by law, any claim, dispute, legal action, administrative matter, or proceeding related to this policy, the clinic’s website, data handling, medical records, referral submissions, services, electronic communications, or privacy practices shall be brought in the appropriate state or federal forum located in Arizona.
 

Nothing in this section limits any non-waivable rights that a patient may have under applicable law or prevents a person from filing a complaint with a government agency that has lawful authority.
 

21. Changes to This Policy
 

Alliance Behavioral Health Integrated, PLLC Clinic may revise this policy at any time. Changes may apply to information we already maintain and information we receive in the future.

When we make material changes, we will update the effective date and make the revised policy available as required by law.
 

22. Acknowledgment
 

Patients, referrers, and authorized submitters may be asked to acknowledge receipt or review of this policy. Signing an acknowledgment does not waive privacy rights. It confirms that the person received, reviewed, or had the opportunity to review the policy.

Name: ___________________________________________

Role: ☐ Patient ☐ Parent/Guardian ☐ Authorized Representative ☐ Referrer ☐ Other: ___________

Signature: _______________________________________

Date: ___________________________________________