MA1602

Identify who is requesting the information:

• When the request is made in person, check the person’s identification.

• When the request is made by phone, ask the person questions and compare the answers to the information in the customer’s case file; or

• When the request is made by mail, compare the signature request with the one on file.

Is the person asking for information someone other than the customer, authorized or legal guardian, spouse, or parent of a minor child customer?

• If YES, request written authorization to release the information. The written authorization must include;

  • Signature from a person who can give permission to release the information;

  • Who can release the information (AHCCCS or DES)

  • Who the information should be release to;

  • The specific information that can be released; and

• The period of time the authorization is valid, or it expires one year from the date of authorization.

• If NO, no written authorization is needed.

Continue to step 3.

Does the person have authorization to receive the requested information?

• If YES, continue to step 4.

• If NO, STOP. Deny the request. If the person persists, submit a PCR.

Does the information contain anyone else’s protected health information (PHI)?

• If YES, the other person’s PHI must be made unreadable before release. Continue to step 5.

• If NO, continue to step 5.

Does the information contain any information from the Office of the General Counsel (OGC), another legal agency or attorney’s office that is providing guidance to AHCCCS or DES?

• If YES, the information containing attorney guidance must be removed before release. Continue to step 6.

• If NO, continue to step 6.

Does the information have special protections such as HIV or AIDS, Alcohol or Drug Abuse, Communicable Disease, Genetic Testing, or Mental Health?

• If YES, STOP. Submit a PCR.

• If NO, continue to step 7.

Does the information contain Developmental Disability information and the request is from someone other than the customer (when there is no legal guardian), the customer’s legal guardian, or the parent of the customer under age 18?

• If YES, STOP. Submit a PCR.

• If NO, continue to step 8.

Is the authorized person requesting non-medical or PAS information that was created by AHCCCS and needed to perform the task of obtaining eligibility or for an appeal?

• If YES, STOP. The information that is needed for purposes of eligibility or an appeal can be released to the authorized person.

• If NO, continue to step 9.

Review the information that is being requested with your supervisor.

Is the information directly related to the administration of an AHCCCS program (official purposes)?

• If YES, STOP. The information may be released once it is reviewed to ensure that releasing the information is appropriate. When in doubt, submit a PCR.

• If NO, STOP. Submit a PCR.

NOTE     DES staff should submit policy clarification requests to PST

Review the Request for Information. Is the request submitted by the media, public interest groups, advocates, and/or requests from the legal community?  

• If YES, do not scan the request into DocuWare. Continue to step 2.

• If NO, STOP. Use MAP1602C.1 to respond to the request.  

Email the Request for Information and supporting documents to Valerie Peterson at valerie.peterson@azahcccs.gov

NOTE     Both AHCCCS and FAA staff can email Valeria Peterson directly.

Add a case note in HEAplus documenting the Request for Information. The note should contain the following: 

• Date received, 

• Who is requesting the information, and  

• Date and delivery method the request was sent to Valerie Peterson.