|
|
 |
 |
Effective Date: April 14, 2003
This
notice describe how medical information about you may be used and disclosed and
how you can get access to this information.
Understanding Your Health
Record/Information
Each time you visit our Office, or another physician
or health care provider contacts us concerning your medical needs or history, a
record is made by our Office. This record contains medical information
generated during your visits to our Office, received by our Office from other
health care providers, or provided by you. In this "Notice of Health
Information Practices," we shall refer to the information contained in your
record as your "health information." This term shall have the same meaning as
"protected health information" defined in the Health Insurance Portability and
Accountability Act of 1996, as amended ("HIPAA").
Your Health
Information Rights
Within the limits provided by federal and state law,
you have the right to:
- Request restrictions on certain uses and
disclosures of your health information;
- Receive confidential communications of your health
information. You may request that we communicate with you about your health
information by alternative means or at an alternative location;
- Inspect and obtain a copy of your health
information, except with regard to psychotherapy notes or information compiled
in reasonable anticipation of certain civil, criminal or administrative
proceedings;
- Request an amendment to your health information
that we have created, except with regard to those portions of your health
information that you are precluded from inspecting and copying as set forth
above;
- Obtain an accounting of certain disclosures of your
health information; and
- Receive a paper copy of this Notice in addition to
any electronic copy you may receive.
You may exercise any of the above rights by
submitting a signed letter detailing your request and mailing or delivering the
letter to our Office Manager. However, we encourage you to call first so that
we can help you be as specific as possible with your request. We will promptly
provide you with forms needed to process your request.
Our
Responsibility
This Office is required by law to:
- Maintain the privacy of your health
information;
- Provide you with this Notice of our legal duties
and privacy practices with respect to health information we collect and
maintain about you;
- Abide by the terms of this Notice, currently in
effect, and as amended from time to time;
- Notify you if we are unable to honor your request
to restrict a use of disclosure of, or to amend, your health information;
and
- Accommodate reasonable requests you may have to
communicate your health information by alternative means or at alternative
locations.
We reserve the rights to change our privacy
practices and to make the new provisions effective for all of your health
information we already have, as well as any health information we receive or
create in the future. Should our privacy practices change, we will post a copy
of the revised Notice in our waiting area, which indicates the effective date
of the amended Notice. you may request and obtain a copy of our Notice of
Privacy Practices anytime you visit our office.
If a use or disclosure
of your health information is not permitted under law without a written
authorization, we will not use or disclose your health information without that
written authorization. You may at any time revoke a written authorization in
writing, except to the extent that we have already taken action in reliance of
you authorization.
For More Information or to Report a
Problem
If you have questions and would like additional information
concerning this Notice, please call Diane Ruhlman, Office Manager at
989-872-8070. If you believe that we have violated any of your privacy
rights, you may file a written complaint with our Office Manager, or mail your
written complaint to Thumb MRI Center 6320 Van Dyke Road, Cass City, MI.
48726. You may also file your complaint with the Secretary of Health and
Human Services. There will be no penalty or retaliation for filing a
complaint.
Examples of Uses and Disclosures for Treatment, Payment
and Health Operations
We will us your health information for
treatment.
We will us your information to provide medical services to
you. Any of our staff involved in your care will have access to your health
information. We may also provide your health information to other care
providers involved in your care to assist them in providing services to
you.
We will use your health information for payment.
Your
Health plan or health insurer will require certain information about your
condition and the services you receive from us, before payment will be made, or
for pre-authorization purposes. Accordingly, for billing purposes, we may
disclose your health information to your health plan or health insurer. We also
may disclose health information to your health plan or health insurer when they
require pre-authorization of a recommended procedure.
We will use
your health information for regular health care operations.
Members of
our staff may review and use health information from your record to assess the
care and outcomes in your case and others like it. This information will then
be used by us in an effort to continually improve the quality and effectiveness
our our services.
Additional Uses and
Disclosure
Business Associates: Certain or our business
operations may be performed by other businesses. We refer to these companies as
"business associates." In order for these business associates to perform the
required services (billing, accounting services, etc.), we may need to disclose
your health information to them so that they can perform the job we've asked
them to do. To protect you, we require our business associates to appropriately
safeguard your health information.
Communication with Persons
Involved in Your Care: Unless you object, we may release PHI about you to a
family member, other relative, or a close personal friend of yours or any other
person identified by you. We will disclose only PHI that is directly relevant
to the person's involvement with your health care or payment related to your
healthcare.
Required by Law: We may use or disclose your health
information to the extent such use or disclosure is required by law and is
limited to the relevant requirements of such law.
Public Health,
Health Oversight and the Food and Drug Administration (FDA): As required by
law, we may disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury, or
disability. We may also be required by law to disclose your health information
to health oversight agencies responsible for regulating the health care system,
government benefits programs, and civil rights law, so that they may conduct,
among other things, audits, investigations, and inspections. For the purpose of
activities relating to the quality, safety or effectiveness of inspections. For
the purpose of activities relating to the quality, safety or effectiveness of a
FDA-regulated product or activity, we may disclose to the FDA your health
information relating to adverse events with drugs, supplements, and other
products, as well as information needed to enable product recalls, repairs, or
replacements.
Victims of Abuse, Neglect or Domestic Violence: If
we reasonably believe that you are the victim of abuse, neglect or domestic
violence, we may disclose your health information to a governmental authority
responsible for receiving these types of reports, to the extent the disclosure
is required by law, or you agree to the disclosure. If the disclosure is
authorized by law, but not required, we may disclose your information if we
determine the disclosure is necessary to prevent serious harm to you or
others.
Judicial and administrative Proceedings: If you are
involved in a judicial or administrative proceeding, we may, in response to an
order of a court or administrative tribunal, or in response to a subpoena,
information that are request, or other lawful process, disclose the specific
portions of your health information that are requested. If the subpoena,
discovery request or other lawful process is not accompanied by a court or
administrative tribunal order, we may disclose your health information only
after we are assured that reasonable efforts have been made to notify you of
the request, and the time for you to raise objections to the request has
expired, or reasonable efforts have been made by the requestor to seek a
protective order concerning the requested health information.
Law
Enforcement: We may disclose your health information to a law enforcement
official for law enforcement purposes as required by law, a court ordered
subpoena or summons, a grand jury subpoena or summons, or an administrative
subpoena or summons, under certain circumstances. In specific situations, the
law also permits us to disclose limited pieces of you health information, when
the information is needed by law enforcement officials to:
- identify a suspect, fugitive, material witness, or
missing person;
- identify a victim of a crime
- alert law enforcement officials concerning your
death;
- notify law enforcement officials when a crime has
been committed on our premises; or
- in an emergency, when necessary to alert law
enforcement officials about a crime, its location, or the identity of a
perpetrator.
Inmates and Individuals in Custody: If
you are an inmate or otherwise in custody, we may disclose your health
information to the correctional facility or law enforcement officials having
lawful custody of you.
Coroners Medical Examiners and Funeral
Directors: We may disclose your health information to a coroner or medical
examiner for the purpose of identifying you upon you passing, or to determine a
cause of death. We may also disclose your health information to your funeral
director if needed to complete his or her authorized duties.
Avert a
Serious Threat to Health Safety: Consistent with applicable law and
standards of ethical conduct, we may, in limited circumstances, use or disclose
your health information if we, in good faith, believe such use or disclosure is
necessary to prevent or lessen a serious and imminent to health or safety or a
person or the public.
Worker's Compensation: We may disclose your
health information to the extent authorized and necessary to comply with laws
relating to workers' compensation or other similar programs established by
law.
Appointment Reminders and Information on Treatment
Alternatives: We may contact you to provide appointment reminders,
information concerning treatment alternatives or other health-related benefits,
alternatives and services that may be of interest to you. |
|
|
 |
|
|
