Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed, and how you cangain access to this information. Please review it carefully.
Protected health information (PHI), about you, is maintained as a written and/or electronic record of yourcontacts or visits for healthcare services with our practice. Specifically, PHI is information about you, includingdemographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past,present or future physical or mental health condition and related healthcare services.
Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information,and disclosing or sharing this information with other healthcare professionals involved in your care andtreatment. This Notice describes your rights to access and control your PHI. It also describes how we followapplicable rules and use and disclose your PHI to provide your treatment, obtain payment for services youreceive, manage our healthcare operations and for other purposes that are permitted or required by law.
Your Rights Under The Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free todiscuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of PrivacyPractices – We are required to follow the terms of this notice. We reserve the right to change the terms of ournotice, at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if youcall our office and request that a revised copy be sent to you in the mail or ask for one at the time of yournext appointment. The Notice will also be posted in a conspicuous location within the practice.
You have the right to authorize other use and disclosure – This means you have the right to authorize any use ordisclosure of PHI that is not specified within this notice. For example, we would need your written authorizationto use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if weintended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent thatyour healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated inthe authorization.
You have the right to request an alternative means of confidential communication This means you have theright to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), andto a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us inwriting, using a form provided by our practice, how you wish to be contacted if other than the address/phonenumber that we have on file. We will follow all reasonable requests.
You have the right to inspect and copy your PHI – This means you may inspect, and obtain a copy of your completehealth record. If your health record is maintained electronically, you will also have the right to requesta copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies asestablished by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI – This means you may ask us, in writing, not to use ordisclose any part of your protected health information for the purposes of treatment, payment or healthcareoperations. If we agree to the requested restriction, we will abide by it, except in emergency circumstanceswhen the information is needed for your treatment. In certain cases, we may deny your request for a restriction.
You will have the right to request, in writing, that we restrict communication to your health plan regardinga specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We arenot permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information – This means you mayrequest an amendment of your PHI for as long as we maintain this information. In certain cases, we may denyyour request for an amendment.
You have the right to request a disclosure accountability – This means that you may request a listing of disclosuresthat we have made, of your PHI, to entities or persons outside of our office.
You have the right to receive a privacy breach notice – You have the right to receive written notification if thepractice discovers a breach of your unsecured PHI, and determines through a risk assessment that notificationis required.
If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact Kathy @ Livonia Office Phone Number (248) 888-8383.
How We May Use or Disclose Protected Health Information
Following are examples of uses and disclosures of your protected health information that we are permitted tomake. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and anyrelated services. This includes the coordination or management of your healthcare with a third party that isinvolved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacythat would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may be involved inyour care and treatment.
Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.
We may contact you by phone or other means to provide results from exams or tests and to provideinformation that describes or recommends treatment alternatives regarding your care. Also, we may contactyou to provide information about health-related benefits and services offered by our office, for fund-raising activities,or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.
Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may includecertain activities that your health insurance plan may undertake before it approves or pays for the healthcareservices we recommend for you such as, making a determination of eligibility or coverage for insurancebenefits.
Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activitiesof our practice. This includes, but is not limited to business planning and development, quality assessment andimprovement, medical review, legal services, auditing functions and patient safety activities.
Health Information Organization – The practice may elect to use a health information organization, or othersuch organization to facilitate the electronic exchange of information for the purposes of treatment, payment,or healthcare operations.
To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, arelative, a close friend or any other person, that you identify, your PHI that directly relates to that person’sinvolvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclosesuch information as necessary if we determine that it is in your best interest based on our professional judgment.
We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any otherperson that is responsible for your care, of your general condition or death. If you are not present or able toagree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment,determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will bedisclosed.
Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI withoutyour written authorization for the following purposes: as required by law; for public health activities; healthoversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements;research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation;criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctionalfacility; and if requested by the Department of Health and Human Services in order to investigate or determineour compliance with the requirements of the Privacy Rule.
You have the right to complain to us, or directly to the Secretary of the Department of Health and Human Servicesif you believe your privacy rights have been violated by us. You may file a complaint with us by notifyingthe Privacy Manager at: Livonia Office Phone Number (248) 888-8383
We will not retaliate against you for filing a complaint.
Effective Date 10/28/2015