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 PRIVACY OF YOUR MEDICAL INFORMATION IS
IMPORTANT TO US.
requires us to keep your protected health information (“PHI”) private in
accordance with this Notice of Privacy Practices (“Notice”), as long as this
Notice remains in effect. We are
also required to provide you with a paper copy of this Notice, which contains
our privacy practices, our legal duties, and your rights concerning your PHI.
From time to time, we may revise our privacy practices and the terms of our
Notice at any time, as permitted or required by applicable law. Such revisions to our privacy practices
and our Notice may be retroactive. Our Notice will be updated and made available
to our patients prior to any significant revisions of our privacy practices and
Covered by this Notice
contains the privacy practices for HMO’s/Managed Care Plans listed below, with
sites they maintain for delivery of health care products and
services. Each of these
organizations participates in an organized health care arrangement and may use
and disclose your PHI among themselves as they shall deem appropriate for your
treatment, payment or health care operations. (BCN, HAP, M’Care, Care Choices, Total Health
Disclosure. We may use or disclose your PHI for
treatment, payment, or health care operations. For your convenience, we have provided
the following examples of such potential uses or
Your PHI may
be used by or disclosed to any physicians or other health care providers
involved with the medical services provided to you.
Payment. Your PHI may
be used or disclosed in order to collect payment for the
medical services provided to you.
Operations. Your PHI may be used or disclosed as
part of our internal health care operations. Such health care operations may
include, among other things, quality of care audits of our staff and affiliates,
conducting training programs, accreditation, certification, licensing, or
Authorizations. We will not use or disclose your medical
information for any reason except those described in this Notice, unless you
provide us with a written authorization to do so. We may request such an authorization to
use or disclose your PHI for any purpose, but you are not required to give us
such authorization as a condition of your treatment. Any written authorization from you may
be revoked by you in writing at any time, but such revocation will not affect
any prior authorized uses or disclosures.
Access. We will provide you with access to your
PHI, as described below in the Individual Rights section of this Notice. With your permission, or in some
emergencies, we may disclose your PHI to your family members, friends, or other
people to aid in your treatment or the collection of payment. A disclosure of your PHI may also be
made if we determine it is reasonably necessary or in your best interests for
such purposes as allowing a person acting on your behalf to
receive filled prescriptions, medical supplies, X rays,
Responsible Parties. Your PHI may be disclosed in order to
locate, identify or notify a family member, your personal representative, or
other person responsible for your care.
If we determine in our reasonable professional judgment that you are
capable of doing so, you will be given the opportunity to consent to or to
prohibit or restrict the extent or recipients of such disclosure. If we
determine that you are unable to provide such consent, we will limit the PHI
disclosed to the minimum necessary.
Care. Based upon your
PHI, we may provide you with appointment reminders or information concerning
health issues, benefits and services, or treatment alternatives that we believe
may be of interest to you.
Disasters. We may use or disclose your PHI to any
public or private entity authorized by law or by its charter to assist in
disaster relief efforts.
Law. We may use or disclose your medical
information when we are required to do so by law. For example, your PHI may be
released when required by privacy laws, workers' compensation or similar laws,
public health laws, court or administrative orders, subpoenas, certain discovery
requests, or other laws, regulations or legal processes. Under certain circumstances, we may make
limited disclosures of PHI directly to law enforcement officials or correctional
institutions regarding an inmate, lawful detainee, suspect, fugitive, material
witness, missing person, or a victim or suspected victim of abuse, neglect,
domestic violence or other crimes.
We may disclose your PHI to the extent reasonably necessary to avert a
serious threat to your health or safety or the health or safety of others. We
may disclose your PHI when necessary to assist law enforcement officials to
capture a third party who has admitted to a crime against you or who has escaped
from lawful custody.
Persons. After your death, we may disclose your
PHI to a coroner, medical examiner, funeral director, or organ procurement organization in limited circumstances.
Research. Your PHI may also be used or disclosed
for research purposes only in those limited circumstances not requiring your
written authorization, such as those which have been approved by an
institutional review board that has established procedures for ensuring the
privacy of your PHI.
National Security. We may disclose to military authorities
the medical information of Armed Forces personnel under certain circumstances.
When required by law, we may disclose your PHI for intelligence,
counterintelligence, and other national security
Copies. In most cases, you have the right to
review or to purchase copies of your PHI by requesting access or copies in
writing to our Privacy Officer.
Please contact our Privacy Officer regarding our copying
Accounting. You have the right to receive an
accounting of the instances, if any, in which your PHI was disclosed for
purposes other than those described in the following sections above: Use and Disclosures, Facility
Directories, Patient Access, and Locating Responsible Parties. For each 12-month period, you have the
right to receive one free copy of an accounting certain details surrounding such
disclosures that occurred after April 13,
2003. If you request a disclosure accounting
more than once in a 12-month period, we will charge you a reasonable, cost-based
fee for each additional request. Please contact our Privacy Officer regarding
Restrictions. You have the right to request that we
place additional restrictions on our use or disclosure of
your PHI, but we are not required to honor such a request. We will be bound by such restrictions
only if we agree to do so in writing signed by our Privacy
Communications. You have the right to request that we
communicate with you about your PHI by alternative means or in alternative
locations. We will accommodate any
reasonable request if it specifies in writing the alternative means or location,
and provides a satisfactory explanation of how future payments will be handled.
to PHI. You have the right to request that we
amend your PHI. Any such request
must be in writing and contain a detailed explanation for the requested
amendment. Under certain
circumstances, we may deny your request but will provide you a written
explanation of the denial. You have the right to send us a statement of
disagreement to which we may prepare a rebuttal, a copy of which will be
provided to you at no cost. Please
contact our Privacy Officer with any further questions about amending your
believe we have violated your privacy rights, you may complain to us or to the Secretary of the U.S. Department of Health and Human
Services. You may file a complaint with us by notifying our Privacy Officer. We
support your right to protect the privacy of your medical information. We will
not retaliate in any way if you choose to file a complaint with us or with the
U.S. Department of Health and Human Services.
Judith A. Heinz, Practice
17940 Farmington Rd., Suite 140
Livonia, MI 48152