NOTICE OF PRIVACY PRACTICES

Effective April 14, 2003
Revised: June 16, 2010

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

We create a record of all the medical or dental services that you receive at the Family Health Center.  This record contains information about your symptoms, examinations, test results, x-rays, diagnoses, treatment, our plan for future care and the services we have provided.

At the Family Health Center, we respect our patients and their personal information.  We are committed to protecting the privacy of our medical and dental records.  We are also required by state and federal laws to maintain the privacy of protected health information.

One of the requirements of the federal Privacy Rules is to provide patients with a Notice of Privacy Practices.  This notice tells how we may use your patient information and how it may be disclosed to others.  It also explains your rights and some of our legal obligations regarding your medical or dental records.

Uses and disclosures of health information

Family Health Center employees may use or disclose your patient information to provide treatment, obtain payment and carry out health care operations.

Treatment:  Your patient information is used by the people taking care of you at our office.  We may also share information with others who are helping us provide treatment for you, such as a medical specialist, hospital, laboratory or pharmacy.

Payment:  Your patient information may be used as we bill and collect payment for the treatment and services you receive.  We may contact your insurance company to verify coverage, and we may share the information with them to obtain payment for services we have provided or to request authorization for treatment.  Information may be disclosed to our collection agency in case of non-payment for services.

Operations:  We may use your health information as we operate and manage our practice and to make sure that you and our other patients receive quality care.  This includes using patient information to evaluate the performance of our staff, to find ways to become more efficient and to decide what services to offer.  When information is shared with others who provide business services for our organization, they are also required to protect the privacy of our patient information.

Appointment reminders and leaving messages:  We may contact you or leave a message on an answering machine or with a household member to remind you of your appointment.  We may also leave messages about the status of services we are providing for you or to request return calls to our office.

Treatment alternatives:  We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Emergency situations:  In the case of a medical emergency, your information may be disclosed without obtaining a signed authorization to prevent delays in treatment.  We may not be able to honor any normal restrictions on use or disclosure if emergency treatment is required.  We may notify your family members, caregivers, relatives and/or close personal friends in case of a medical emergency or if you are incapacitated.  We may also disclose additional information to them as it relates to their involvement in your health care based on our professional judgment if we determine it is in your best interest.

Disclosures permitted by law:  We may disclose information about you without your permission if permitted or required by law.  This includes the following situations:

• Immunization records -- Childhood immunization records will be reported to the Michigan Care Improvement Registry (MCIR) and may be forwarded to your child's school, preschool, Headstart program or daycare.
• Public health authorities -- We will disclose information to your county health department if you have one of the communicable diseases that must be reported under Michigan law.  Information may be reported to state or federal agencies regarding preventing or controlling disease, workplace injuries and adverse events related to food or medical products.
• Controlled substance reports – If we prescribe a controlled substance for you, we may disclose your social security number to your pharmacy for reporting to the state of Michigan.
• Court order -- We will release any information requested in a court order or a subpoena issued by an official of the courts.
• Minor’s confidential information – If you are a minor seeking your own care as allowed by law, we may contact your parents with information about your condition if it is determined medically necessary by a health care provider.  Your parents may also become aware of the treatment if they are responsible for payment for the services.
• Abuse or neglect -- We will report cases of suspected abuse or neglect to Child Protective Services or Adult Protective Services as required by law.
• Domestic abuse -- We will report cases of domestic abuse to the authorities as required by law.
• Law enforcement -- We may release information to law enforcement as needed to avert a serious health or safety threat or to locate a suspect, fugitive, material witness or missing person.  We may release information to law enforcement for investigation of illegal activities involving controlled substances.
• Dental records – Dental records may be released to law enforcement to identify a deceased or missing person.
• Deceased patients -- Information about deceased patients may be disclosed to the medical examiner, funeral director or an institutional review board such as the Fetal Infant Mortality Review.

Integrated Health Partners (IHP):  We are a member of this hospital physician organization whose activities include medical insurance support, quality improvement and a community collaborative for chronic disease and case management.  Your information may be shared with the IHP staff and partnering providers for those purposes.

Other uses and disclosures:  We will obtain written authorization from you or your legal representative for any uses or disclosures that are not described above, are not permitted by law or are not related to treatment, payment or health care operations.  You may revoke a previously made authorization by providing written notice.

Patient rights

You have the following rights regarding your medical or dental records.

• Right to request restrictions on uses or disclosures – You have the right to request that we place limitations on our use or disclosure of your patient information.  We have the right to choose not to agree to the requested restriction.
• Right to receive confidential communications – You have the right to request that we use alternative methods to contact you.  We have the right to choose not to agree to the request.
• Right to inspect and copy – You have the right to make an appointment to review your medical or dental records.  You may also request to receive a copy of your records at a reasonable fee.
• Right to amend – You have the right to add a written statement to your records to clarify or correct the information within your medical or dental chart.
• Right to receive an accounting of disclosures – You have the right to request a list of all disclosures made without your written authorization that were not made for the purposes of treatment, payment or health care operations.

Changes to this notice

We reserve the right to revise this notice when there has been a material change in our privacy practices.  We will abide by the terms of the notice currently in effect.  The current version of the notice will be posted at the Family Health Center and on our website.  You may contact us to receive a written copy.

Questions or complaints

If you have questions about this notice or Family Health Center’s privacy practices, please contact our Privacy Officer at (269) 965-8866.  If you believe your privacy rights have been violated, you may contact our Privacy Officer.  You may also file a written complaint with the Department of Health and Human Services.  You will not be retaliated against for filing a complaint.