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5087 North Royal Drive, Suite B (231) 935-0440 Monday - Friday: |
PULMONARY AND CRITICAL CARE OF NORTHWEST MICHIGAN,
P.C. 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. If you have any questions about this Notice please contact: our Privacy Contact
who is Patti Goodreau, C.M.A. This Notice of Privacy Practices describes how we may use and disclose your
protected health information 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. "Protected health
information" is information about you, including demographic information, that may
identify you and that relates to your past, present or future physical or mental health or
condition and related health care services. We are required to abide by the terms of this Notice of Privacy Practices. We
may change the terms of our notice, at any time. The new notice will be effective for all
protected health information that we maintain at that time. Upon your request, we will
provide you with any revised Notice of Privacy Practices by calling the office and
requesting that a revised copy be sent to you in the mail or asking for one at the time of
your next appointment. 1. Uses and Disclosures of Protected Health Information Uses and Disclosures of Protected Health Information Based Upon Your Written
Consent You may be asked by your physician to sign a consent form. Your physician may
use or disclose your protected health information for treatment, payment and health care
operations as described in this Section 1, notwithstanding your written consent to the use
and disclosure of that protected health information. Your protected health information may
be used and disclosed by your physician, our office staff and others outside of our office
that are involved in your care and treatment for the purpose of providing health care
services to you. Your protected health information may also be used and disclosed to pay
your health care bills and to support the operation of the physician's practice. Following are examples of the types of uses and disclosures of your protected
health care information that the physician's office is permitted to make. These examples are
not meant to be exhaustive, but to describe the types of uses and disclosures that may be
made by our office. 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 that has already obtained
your permission to have access to your protected health information. For example, we may
disclose your protected health information, as necessary, to a home health agency that
provides care to you. We may also disclose protected health information to other physicians
who may be treating you. For example, your protected health information may be provided to a
physician to whom you have been referred to ensure that the physician has the necessary
information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time
to another physician or health care provider (e.g., a specialist or laboratory) who, at the
request of your physician, becomes involved in your care by providing assistance with your
health care diagnosis or treatment to your physician. Payment: Your protected health information may be used, as needed, to
obtain payment for your health care services. This may include certain activities that your
health insurance plan may undertake before it approves or pays for the health care services
we recommend for you, such as: making a determination of eligibility or coverage for
insurance benefits, reviewing services provided to you for medical necessity, and
undertaking utilization review activities. For example, obtaining approval for a hospital
stay may require that your relevant protected health information be disclosed to the health
plan to obtain approval for the hospital admission. Healthcare Operations: We may use or disclose, as needed, your protected
health information in order to support the business activities of your physician's practice.
These activities include, but are not limited to, quality assessment activities, employee
review activities, training of medical students, licensing, marketing and fundraising
activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school
students that see patients at our office. In addition, we may use a sign-in sheet at the
registration desk where you will be asked to sign your name and indicate your physician. 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 share your protected health information with third party "business
associates" that perform various activities (e.g., billing, transcription services) for
the practice. Whenever an arrangement between our office and a business associate involves
the use or disclosure of your protected health information, we will have a written contract
that contains terms that will protect the privacy of your protected health information. We may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other health-related benefits
and services that may be of interest to you. We may also use and disclose your protected
health information for other marketing activities. For example, your name and address may be
used to send you a newsletter about our practice and the services we offer. We may also send
you information about products or services that we believe may be beneficial to you. You may
contact our Privacy Contact to request that these materials not be sent to you. Uses and Disclosures of Protected Health Information Based upon Your Written
Authorization Other uses and disclosures of your protected health information will be made
only with your written authorization, unless otherwise permitted or required by law as
described below. You may revoke this authorization, at any time, in writing, except to the
extent that your physician or the physician's practice has taken an action in reliance on
the use or disclosure indicated in the authorization, or if the authorization was obtained
as a condition of your receipt of insurance coverage, and other law gives the insurer the
right to contest the claim or the insurance policy. Other Permitted and Required Uses and Disclosures That May Be Made With Your
Consent, Authorization or Opportunity to Object We may use and disclose your protected health information in the following
instances. You have the opportunity to agree or object to the use or disclosure of all or
part of your protected health information. If you are not present or able to agree or object
to the use or disclosure of the protected health information, then your physician may, using
professional judgment, determine whether the disclosure is in your best interest. In this
case, only the protected health information that is relevant to your health care will be
disclosed. Others Involved in Your Healthcare: Unless you object, we may disclose to
a member of your family, a relative, a close friend or any other person you identify, your
protected health information that directly relates to that person's involvement in your
health care. If you are unable to agree or object to such a disclosure, we may disclose such
information as necessary if we determine that it is in your best interest based on our
professional judgment. We may use or disclose protected health information to notify or
assist in notifying a family member, personal representative or any other person that is
responsible for your care of your location, general condition or death. Finally, we may use
or disclose your protected health information to an authorized public or private entity to
assist in disaster relief efforts and to coordinate uses and disclosures to family or other
individuals involved in your health care. Other Permitted and Required Uses and Disclosures That May Be Made Without
Your Consent, Authorization or Opportunity to Object We may use or disclose your protected health information in the following
situations without your consent or authorization. These situations include: Required By Law: We may use or disclose your protected health information
to the extent that the use or disclosure is required by law. The use or disclosure will be
made in compliance with the law and will be limited to the relevant requirements of the law.
You will be notified, as required by law, of any such uses or disclosures. Public Health: We may disclose your protected health information for
public health activities and purposes to a public health authority that is permitted by law
to collect or receive the information. The disclosure will be made for the purpose of
controlling disease, injury or disability. We may also disclose your protected health
information, if directed by the public health authority, to a foreign government agency that
is collaborating with the public health authority. Communicable Diseases: We may disclose your protected health information,
if authorized by law, to a person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading the disease or condition. Health Oversight: We may disclose protected health information to a
health oversight agency for activities authorized by law, such as audits, investigations,
and inspections. Oversight agencies seeking this information include government agencies
that oversee the health care system, government benefit programs, other government
regulatory programs and civil rights laws. Abuse or Neglect: We may disclose your protected health information to a
public health authority that is authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose your protected health information if we believe that
you have been a victim of abuse, neglect or domestic violence to the governmental entity or
agency authorized to receive such information. In this case, the disclosure will be made
consistent with the requirements of applicable federal and state laws. Legal Proceedings: We may disclose protected health information in the
course of any judicial or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request or other lawful process. Law Enforcement: We may also disclose protected health information, so
long as applicable legal requirements are met, for law enforcement purposes. These law
enforcement purposes include (1) legal processes and otherwise required by law, (2) limited
information requests for identification and location purposes, (3) pertaining to victims of
a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the
event that a crime occurs on the premises of the practice, and (6) medical emergency (not on
the Practice's premises) and it is likely that a crime has occurred. Coroners, Funeral Directors, and Organ Donation: We may disclose
protected health information to a coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral director to carry out their duties. We
may disclose such information in reasonable anticipation of death. Protected health
information may be used and disclosed for cadaveric organ, eye or tissue donation
purposes. Research: We may disclose your protected health information to
researchers when their research has been approved by an institutional review board that has
reviewed the research proposal and established protocols to ensure the privacy of your
protected health information. Criminal Activity: Consistent with applicable federal and state laws, we
may disclose your protected health information, if we believe that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. We may also disclose protected health information if it is necessary
for law enforcement authorities to identify or apprehend an individual. Military Activity and National Security: When the appropriate conditions
apply, we may use or disclose protected health information of individuals who are Armed
Forces personnel (1) for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of
your eligibility for benefits, or (3) to foreign military authority if you are a member of
that foreign military services. We may also disclose your protected health information to
authorized federal officials for conducting national security and intelligence activities,
including for the provision of protective services to the President or others legally
authorized. Workers' Compensation: Your protected health information may be disclosed
by us as authorized to comply with workers' compensation laws and other similar
legally-established programs. Inmates: We may use or disclose your protected health information if you
are an inmate of a correctional facility and your physician created or received your
protected health information in the course of providing care to you. Required Uses and Disclosures: Under the law, we must make disclosures to
you and when required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section 164.500 et.
seq. 2. Your Rights Following is a statement of your rights with respect to your protected health
information and a brief description of how you may exercise these rights. You have the right to inspect and copy your protected health information. This
means you may inspect and obtain a copy of protected health information about you that is
contained in a designated record set for as long as we maintain the protected health
information. A "designated record set" contains medical and billing records and
any other records that your physician and the practice use for making decisions about
you. Under federal law, however, you may not inspect or copy the following records;
psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected health information that is
subject to law that prohibits access to protected health information. Depending on the
circumstances, a decision to deny access may be reviewable. In some circumstances, you may
have a right to have this decision reviewed. Please contact our Privacy Contact if you have
questions about access to your medical record. You have the right to request a restriction of your protected health
information. This means you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or healthcare operations. You may
also request that any part of your protected health information not be disclosed to family
members or friends who may be involved in your care or for notification purposes as
described in this Notice of Privacy Practices. Your written request must state the specific
restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that you may request.
If physician believes it is in your best interest to permit use and disclosure of your
protected health information, your protected health information will not be restricted. If
your physician does agree to the requested restriction, we may not use or disclose your
protected health information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction you wish to request
with your physician. After discussing, you must submit a written request clearly identifying
the restriction. You have the right to request to receive confidential communications from us by
alternative means or at an alternative location. We will accommodate reasonable requests. We
may also condition this accommodation by asking you for information as to how payment will
be handled or specification of an alternative address or other method of contact. We will
not request an explanation from you as to the basis for the request. Please make this
request in writing to our Privacy Contact. You may have the right to have your physician amend your protected health
information. This means you may request an amendment of protected health information about
you in a designated record set for as long as we maintain this information. In certain
cases, we may deny your request for an amendment. If we deny your request for amendment, you
have the right to file a statement of disagreement with us and we may prepare a rebuttal to
your statement and will provide you with a copy of any such rebuttal. Please contact our
Privacy Contact to determine if you have questions about amending your medical record. You have the right to receive an accounting of certain disclosures we have made,
if any, of your protected health information. This right applies to some, but not all,
disclosures for purposes other than treatment, payment or healthcare operations as described
in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a
facility directory, to family members or friends involved in your care, for national
security or intelligence purposes, to correctional institutions or law enforcement
officials, as part of a limited data set (that is, with certain identifying data removed),
for certain purposes incidental to other permissible uses or disclosures, to any party
pursuant to a valid authorization, or for notification purposes. You have the right to
receive specific information regarding these disclosures that occurred after April 14, 2003.
You may request a shorter timeframe. The right to receive this information is subject to
certain exceptions, restrictions and limitations. You have the right to obtain a paper copy of this notice from us, 3. Complaints You may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint with us by
notifying our privacy contact of your complaint. We will not retaliate against you for
filing a complaint. You may contact our Privacy Contact, Patti Goodreau, C.M.A. at
This notice was published and becomes effective on 1/1/03. |
