Referred
to in this document as "the agency"
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.
This
Notice of Privacy Practices is being provided to you as a requirement
of the Health Insurance Portability and Accountability ACT (HIPAA).
In accordance with federal regulations, this Notice describes how
we may use and disclose your protected health information (PHI)
to carry out treatment, payment or health care operations and for
other purposes that are permitted or required by law. It also describes
your rights to access and control your protected health information
in some cases. Your "protected health information" means
any of your written and oral health information, including demographic
data that can be used to identify you. This is health information
that is created or received by your health care provider, and that
relates to your past, present or future physical or mental health
or condition.
1. Uses and Disclosures of Protected Health Information
The
agency 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 the agency has
obtained your authorization or the use or disclosure is otherwise
permitted by the HIPAA Privacy Regulations or State law. Disclosures
of your protected health information for the purposes described
in this Notice may be made in writing, orally, or by facsimile.
A.
Treatment.
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services.
This includes the coordination or management of your health care
with a third party for treatment purposes. For example, we may disclose
your protected health information to a pharmacy for supplies and/or
medications your physician has ordered or to a laboratory to perform
a test. We may also disclose protected health information to your
primary physician and other health care providers involved in your
care.
B.
Payment.
Your protected health information will be used, as needed, to obtain
payment for the services that we provide. This may include certain
communications to your health insurer to get approval for the treatment
ordered by your physician. For example, we may also disclose protected
health information to your insurance company to determine whether
you are eligible for home care benefits or whether a particular
service is covered under your health plan. In order to get payment
for your services, we may also need to disclose your protected health
information to your insurance company to demonstrate the medical
necessity of the services or, as required by your insurance company,
for utilization review. We may also disclose patient information
to another provider involved in your care for the other provider's
payment activities.
C.
Operations.
We may disclose your protected health information, as necessary,
for our own health care operations in order to facilitate the function
of the practice and to provide quality care to all patients. Health
care operations include such activities as:
- Quality
assessment and improvement activities.
- Employee
review activities.
- Training
programs including those in which students, trainees, or practitioners
in health care learn under supervision.
- Accreditation,
certification, licensing or credentialing activities.
- Review
and auditing, including compliance reviews, medical review, legal
services and maintaining compliance programs.
- Business
management and general administrative activities.
In
certain situations, we may also disclose patient information to
another provider or health plan for their health care operations.
Other
Uses and Disclosures - We may make certain other uses and disclosures
of your PHI without your authorization.
- We
may use or disclose your PHI for any purpose required by law.
For example, the agency may be required by law to use or disclose
your PHI to respond to a court order.
- We
may disclose your PHI for public health activities, such as reporting
of disease, injury, birth and death, and for public health investigations.
- We
may disclose your PHI to the proper authorities if we suspect
child abuse or neglect; we may also disclose your PHI if we believe
you to be a victim of abuse, neglect, or domestic violence.
- We
may disclose your PHI if authorized by law to a government oversight
agency (e.g., a state surveyor) conducting audits, investigations,
or civil or criminal proceedings.
- We
may disclose your PHI in the course of a judicial or administrative
proceeding (e.g., to respond to a subpoena or discovery request).
- We
may disclose your PHI to the proper authorities for law enforcement
purposes.
- We
may disclose your PHI to coroners, medical examiners, and/or funeral
directors consistent with law.
- We
may use or disclose your PHI for cadaveric organ, eye or tissue
donation.
- We
may use or disclose your Phi for research purposes, but only as
permitted by law.
- We
may use or disclose PHI to avert a serious threat to health or
safety.
- We
may use or disclose your PHI if you are a member of the military
as required by armed forces services, and we may also disclose
your PHI for other specialized government functions such as national
security or intelligence activities.
- We
may disclose your PHI to workers' compensation agencies for your
workers' compensation benefit determination.
- We
will, if required by law, release your PHI to the Secretary of
the Department of Health and Human Services for enforcement of
HIPAA.
RIGHTS
THAT YOU HAVE
Access
to Your PHI - You have the right to copy and/or inspect certain
of your PHI that we maintain. Certain requests for access to your
PHI must be in writing, must state that you want access to your
PHI and must be signed by you or your representative. Access request
forms are available from the agency at the address below. We may
charge you a fee for copying and postage.
Amendments
to Your PHI - You have the right to request that PHI that we
maintain about you be amended or corrected. We are not obligated
to make all requested amendments but will give each request careful
consideration. To be considered, your amendment request must be
in writing, must be signed by you or you r representative, and must
state the reasons for the amendment/correction request. Amendment
request forms are available from the agency at the address below.
Accounting
for Disclosures of Your PHI - You have the right to receive
an accounting of certain disclosures made by us of your PHI. Examples
of disclosures that we are required to account for include those
to state insurance departments, pursuant to valid legal process,
or for law enforcement purposes. To be considered, your accounting
requests must be in writing and signed by you or your representative.
Accounting request forms are available from the address below. The
first accounting in any 12-month period is free; however, we may
charge you a fee for each subsequent accounting you request within
the same 12-month period.
Restrictions
on Use and Disclosure of Your PHI - You have the right to request
restrictions on certain of our uses and disclosures of your PHI
for insurance payment or health care operations, disclosures made
to persons involved in your care, and disclosures for disaster relief
purposes. For example, you may request that we not disclose PHI
to your spouse. Your request must describe in detail the restriction
you are requesting. HIPAA does not require us to agree to your personal
request but we will accommodate reasonable requests when appropriate.
We retain the right to terminate an agreed-to restriction if we
believe such termination is appropriate. In the event of a termination
by us, we will notify you of such termination. You also have the
right to terminate, in writing or orally, any agreed-to restriction.
Requests for a restriction (or termination of an existing restriction)
may be made by contacting the agency at the telephone number or
address below.
Request
for Confidential Communications - You have the right to request
that communications regarding your PHI be made by alternative means
or at alternative locations. For example, you may request that messages
not be left on voice mail or sent to a particular address. We are
required to accommodate reasonable requests if you inform us that
disclosure of all or part of your information could place you in
danger. Requests for confidential communications must be in writing,
signed by you or your representative, and sent to the agency at
the address below.
Right
to Copy of the Notice - You have the right to a paper copy of
this Notice upon request by contacting the agency at the telephone
number or address below.
Complaints - If you believe your privacy rights have been violated, you can
file a complaint with the agency in writing at the address below.
You may also file a complaint in writing with the Secretary of the
U.S. Department of Health and Human Services in Washington, D.C.,
within 180 days of a violation of your rights. There will be no
retaliation for filing a complaint.
CONTACT
PERSON
The agencies' contact person for all issues regarding patient privacy
and your rights under the Federal privacy standards is the Privacy
Officer. Information regarding matters covered by this Notice can
be requested by contacting the Privacy Officer. Complaints against
the agencies can be mailed to the Privacy Officer at:
Harbor
Health Services, Inc./Harbor Health Private Care, Inc.
430 S. Water Street
Marine City, MI 48039
ATTN: Privacy Officer
The
Privacy Officer can be contacted by telephone at: 1-888-418-2273,
1-810-765-7144
Effective
Date
This
Notice is effective April 14, 2003.
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