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Effective Date of Notice: April 14, 2003
Straith Clinic, P.C. Notice of Privacy Practices
This notice will tell you about the ways we may use and disclose
medical information about you and how you can get access to this
information. It will also describe your rights and certain
obligations we have regarding the use and disclosure of medical
information. Please review it carefully.
This Notice of Privacy Practices is being provided to you as a
requirement of the Health Insurance Portability and Accountability
Act (HIPAA). We are required by law to make sure that medical
information that identifies you is kept private and to give you
notice of our legal duties and privacy practices with respect to
this medical information. We call this information "protected health
information", or "PHI", and it includes information that can be used
to identify you that we've created or received about your past,
present, or future health or condition, the provision of health care
to you, or the payment for this health care.
Uses and Disclosures of Protected Health Information
Straith Clinic employees and staff understand that medical
information about you and your health is personal. We are committed
to protecting medical information about you. We create a medical
record that details the care and services you receive. We need that
record in order to provide you with quality care and to comply with
certain legal requirements. This notice applies to any medical
records generated by and stored at Straith Clinic. While we may
sometimes care for you during a hospital stay, the hospital(s) may
have different policies and/or notices about your medical
information.
Straith Clinic may use your protected health information for
purposes of providing treatment, obtaining payment for treatment,
and conducting health care operations. Your protected health
information may be used or disclosed only for these purposes unless
Straith Clinic has obtained your authorization or the use or
disclosure is otherwise permitted by the HIPAA Privacy Regulations
or State Law.
How We May Use and Disclose Medical
Information About You.
I. Routine Use and Disclosure
A. Treatment - Your physician or a Straith Clinic staff member may
use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services.
This includes the coordination and management of your health care
with a third party that is involved in your care and treatment. We
may disclose medical information about you to hospitals, doctors,
nurses, technicians, medical students, or their personnel who are
taking care of you.
For example, we may disclose your protected health information to a
pharmacy to fill a prescription, to a laboratory to order blood
work, or to an internist for your pre-operative physical. We may
also call you by name in the waiting room when your physician is
ready to see you. We may use or disclose your protected health
information, 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 provide information that
describes or recommends treatment alternatives regarding your care.
Also, we may contact you to provide information about health-related
benefits and services offered by this office.
We may disclose your protected health information to your family
member or a close personal friend if it is directly relevant to your
care or payment related to your care. We can also disclose your
information in connection with trying to locate or notify family
member or others involved in your care concerning your location and
condition. You may object to these disclosures. If you do not
object, or we determine in our professional judgment that it is in
your best interest, we may disclose your protected health
information.
B. Payment - We may use and disclose medical information about you
so that the treatment and services you receive from Straith Clinic
may be billed, and collected for you, to an insurance company or a
third party. We may tell an insurance company or a third party about
care you are going to receive in order to obtain prior approval for
treatment or in order to determine your coverage. We may also
disclose patient information to another provider involved in your
care for the other provider's payment activities.
C. Individuals Involved In Your Care or Payment For Your Care - If a
family member, friend, or service is involved in your medical care,
we may release medical information about you including your
condition and treatment.
D. Healthcare Operations - We may use or disclose your protected
health information, as needed, for our own health care operations in
order to run our practice in a way that ensures that our patients
receive quality care. This includes, but is not limited to:
Review our treatment and services to evaluate the performance of our
staff in caring for you;
Quality assessment and improvement activities;
Accreditation or credentialing activities;
Combine your medical information with medical information about
other patients to determine if we need to offer additional services
to patients;
Disclose medical information to doctors, nurses, technicians, and
medical students for review and learning purposes;
Combine the medical information we have with medical information
from other practices to see where we can make improvements in our
care and services;
Remove information that identifies you from a set of health
information so that others can use it to study health care without
learning who the specific patients are.
E. Marketing - We may use mailings or newsletters regarding products
or services that may be of benefit to you.
F. As Required By Law - We will disclose medical information about
you when we are required to do so by federal, state, or local law.
II. Non-Routine Use and Disclosure
A. To Avert A Serious Threat To Health Or Safety - We may use or
disclose your medical information about you when it is necessary to
prevent a serious threat to your health and safety or the health and
safety of the public or of another person. Any disclosure will be to
someone who is able to help prevent the threat.
B. Public Health Risks - We may disclose medical information about
you for public health activities. These activities generally include
the following:
To prevent or control disease, injury, or disability;
To report births and deaths;
To report child or elder abuse or neglect;
To report reactions to medications or problems with medical
products;
To notify people of recalls of products;
To notify a person who may have been exposed to a disease or may be
at risk for contacting or spreading a disease or condition;
C. To Report Abuse, Neglect, or Domestic Violence - We may use or
disclose medical information to government authorities if we believe
that a patient is the victim of abuse, neglect, or domestic
violence. We will only make this disclosure if you agree or when
required or authorized by law.
D. To Conduct Health Oversight Activities - We may use or disclose
your medical information to a health information to a health
oversight agency for activities including audits; civil,
administrative, or criminal investigations, proceedings, or actions;
inspections; licensure or disciplinary actions; or other activities
necessary for appropriate oversight as authorized by law.
E. Lawsuits and Disputes - If you are involved in a lawsuit or a
dispute, we may disclose medical information about you in response
to a court or administrative order. We may disclose medical
information about you in response to a subpoena, discovery request,
or other lawful process by someone else involved in the dispute.
F. Law Enforcement - We may release medical information if asked to
do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons, or similar
process;
To identify or locate a suspect, fugitive, material witness, or
missing person;
About the victim of a crime if, under certain circumstances, we are
unable to obtain the victim's/patient's agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct in the practice's office;
In emergency circumstances to report a crime, the location of the
crime or victims, or the identify, description or location of the
person who committed the crime.
G. To Coroners, Funeral Directors, and or Organ Donation - We may
disclose protected medical health information to a coroner or
medical examiner, to a funeral director, as authorized by law and
for organ donations.
H. Research - In certain circumstance, we may provide medical
information in order to conduct medical research.
I. For Specified Government Functions - In certain circumstances,
the Federal regulations authorize the practice to use or disclose
your protected health information to facilitate specified government
functions relating to military and veterans activities, national
security and intelligence activities, protective services for the
President and others, medical suitability determinations,
correctional institutions, and law enforcement custodial situations.
J. For Worker's Compensation - The practice may release your
protected health information to comply with the worker's
compensation laws or similar programs.
Your Rights Regarding Medical Information
About You
You have the following rights regarding medical information we
maintain about you:
a. Right to authorize uses and disclosures - You have the right to
authorize the use and disclosure of your protected health
information in ways not mentioned in this notice and the right to
revoke that authorization
b. Right to designate a personal representative - You have the right
to designate a personal representative to act for you.
c. Right to Inspect and Copy - You have the right to inspect and
copy your medical information that may be used to make decisions
about your care. Usually, this includes medical and billing records,
but does not include psychotherapy notes.
To inspect and copy your medical information, you must submit your
request in writing to Perla Forbes, Clinic Administrator. If you
request a copy of the information, we may charge a fee for the costs
of copying, mailing, or other supplies associated with your request.
Your physician may deny your request to inspect and copy in certain
very limited circumstances. If you are denied access to medical
information, you may request that the denial be reviewed. Another
licensed health care professional will review your request and the
denial. The person conducting the review will not be the person who
denied your request. We will comply with the outcome of the review.
d. Right to Amend - If you feel that the medical information we have
about you is incorrect or incomplete, you may ask us to amend the
information. You have the right to request an amendment for as long
as the information is kept by or for this practice.
To request an amendment, your request must be made in writing and
submitted to Perla Forbes, Clinic Administrator. You request should
include the reason that supports your request.
We may deny your request for an amendment if it is not in writing or
does not include a reason to support the request. In addition, we
may deny your request if you ask us to amend information that:
Was not created by Straith Clinic, unless the person or entity that
created the information is no longer available to make the
amendment;
Is not part of the medical information kept by or for Straith
Clinic;
Is not part of the information which you would be permitted to
inspect and copy;
Is accurate and complete.
e. Right to Accounting of Disclosures made by the Straith Clinic -
You have the right to request an "accounting of disclosures". Your
request must state a time period which may not be longer than six
years and may not include dates before April 14, 2003.
The first list you request within a twelve month period will be free
of charge. For additional lists, we may charge you for the cost of
providing the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at the time before any
costs are incurred.
f. Right to Request Restrictions - You have the right to request a
restriction or limitation on the medical information we use or
disclose about you for treatment, payment, or health care
operations. You also have the right to request a limit on the
medical information we disclose about you to someone who is involved
in your care or the payment for your care, like a family member or
friend. For example, you could ask that we not use or disclose
information about a surgery you had.
We are not required to agree to your request. If we do agree, we
will comply with your request unless the information is needed to
provide you with emergency treatment.
To request restrictions, you must make your request in writing to
Perla Forbes, Clinic Administrator. In your request, you must tell
us 1) what information you want to limit, 2) whether you want to
limit our use, disclosure, or both, and 3) to whom you want the
limits to apply, for example, disclosures to your spouse.
g. Right to Request Confidential Communications - You have the right
to request that we communicate with you about medical matters in a
certain way or at a certain location. For example, you can ask that
we only contact you at work or only by mail.
To request confidential communications, you must make your request
in writing to Perla Forbes, Clinic Administrator. We will not ask
you the reason for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to be
contacted.
h. Right to a Paper Copy of This Notice - You have the right to a
paper copy of this notice. You may ask us to give you a copy of this
notice at any time. To obtain a paper copy of this notice, please
ask the receptionist.
You may also obtain a copy of this notice at our Website,
www.straithclinic.com.
Changes To this Notice
We reserve the right to change this notice. We reserve the right to
make the revised or changed notice effective for medical information
we already have about you as well as any information we receive in
the future. We will post a copy of the current notice in the waiting
room. This notice will contain the effective date in the upper right
corner of the first page.
Complaints
If you have any questions about this notice, any complaints about
our privacy practices, or would like to know how to file a complaint
with the Secretary of the Department of Health and Human Services,
please contact:
Straith Clinic, P.C.
32000 Telegraph
Bingham Farms, Michigan 48025
Attn: Privacy Manager
All complaints should be submitted in writing. You will not be
penalized, discriminated against, retaliated against, or intimidated
for filing a complaint.
Other Uses of Medical Information
Other uses and disclosure of medical information not covered by this
notice or the laws that apply to us will be made only with your
written permission. If you provide us permission to use or disclose
medical information about you, you may revoke that permission, in
writing, at any time. If you revoke your permission, we will no
longer use or disclose medical information about you for the reasons
covered by your written authorization. You must understand that we
are unable to take back any disclosure we have already made with
your permission and that we are required to retain our records of
the care that we provided you. |
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