NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Created as a result of the Health Insurance Portability and Accountability Act of 1996(HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
OUR COMMITMENT TO YOUR PRIVACY. Our practice is dedicated to maintaining the privacy of your health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your medical information. The terms of this notice apply to all records containing your medical information that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Our practice will post a copay of our current Notice in our offices in a visible location at all times. If you have any questions about this notice, please contact: Privacy Officer of Ann Arbor Dermatology 706 W. Huron St. Ann Arbor MI 48103 or 734-996-8757
The following categories describe the different ways in which we may use and disclose your medical information:
- Treatment. Our practice may use your medical information to treat you. For example, laboratory tests, prescriptions, or direct care with another doctor or nurse that needs to treat you or assist in treating you. Additionally, we may disclose your medical information in accordance to state and federal laws.
- Payment. Our practice may use and disclose your medical information in order to bill and collect payment for the services and items you may receive from us. We also may use and disclose our medical information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may used your medical information to bill you directly for services and items. We may disclose your medical information to other health care providers and entities to assist in their billing and collections efforts.
- Health Care Operations. Our practice may use and disclose your medical information to operate our business. For example, to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your medical information to other health care providers and entities to assist in their health care operations.
- Appointment Reminders. Our practice may use and disclose your medical information to contact you by mail or phone and remind you of a scheduled appointment or to make an appointment.
- Treatment Options. Our practice may use and disclose your medical information to inform you of potential treatment options or alternatives.
- Health-Related Benefits and Services. Our Practice may use and disclose your medical information to inform you of health-related benefits or services that may be of interest to you.
- Release of Information to Family/Friends. Our practice may release your medical information to a friend or family member that is involved in your care, or who assists in taking care of you. For example, parent, guardian, babysitter.
- Disclosures Required by Law. Our practice will used and disclose your medical information when we are required to do so by federal, state or local laws.
The following categories describe unique scenarios in which we may use or disclose your medical information.
- Public Health Risks. Our practice may disclose your medical information to public health authorities that are authorized by law to collect information for the purpose of: (a) Maintaining vital records. (b) Reporting child abuse or neglect. (c) Preventing or controlling disease, injury or disability (d) Notifying a person regarding potential exposure to a communicable disease (e) Notifying a person regarding a potential risk for spreading or contracting a disease or condition. (f) Reporting reactions to drugs or problems with products or devices (g) Notifying individuals if a product or device they may be using has been recalled (h) Notifying appropriate government agencies and authorities regarding the potential abuse or neglect or an adult patient; however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information. (i) Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
- Health Oversight Activities. Our practice may disclose your medical information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
- Lawsuits and Similar Proceedings. Our practice may use and disclose your medical information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your medical information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
- Law Enforcement. We may release medical information if asked to do so by a law enforcement official: (a) Regarding a crime (b) Concerning a death. (c) Regarding criminal conduct at our office (d) In response to a warrant, summons, court order, subpoena or similar legal process (e) To identify/locate a suspect, witness, fugitive or missing person (f) In an emergency, to report a crime.
- Deceased Patients. Our practice may release medical information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
- Organ and Tissue Donation. Our practice may release your medical information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks if you are an organ donor.
- Research. Our practice may use and disclose your medical information for research purposes in certain limited circumstances. We will obtain your written authorization to use your medical information for research purposes except when: (a) the use or disclosure involves no more than a minimal risk to your privacy. (b) the research could not practicably be conducted without the waiver and © the research could not practicably be conducted without access to and use of the medical information.
- Serious Threats to Health or Safety. Our practice may use and disclose your medical information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
- Military. Our practice may disclose your medical information if you are a member of U.S. or foreign military forces if required by the appropriate authorities.
- National Security. Our practice may disclose your medical information to federal officials for intelligence, national security activities authorized by law.
- Inmates. Our practice may disclose your medical information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement, for three purposes: 1) health care services to you 2) for the safety and security of the institution, and 3) to protect your health and safety or the health and safety of other individuals.
- Workers' Compensation. Our practice may release your medical information for workers' compensation and similar programs.
You have the following rights regarding the medical information that we maintain about you:
- Confidential Communications. You have the right to request our practice to contact you in a particular manner. For instance, home phone or work phone. You must make such a request in writing and our practice will accommodate reasonable requests. Otherwise, we will use the phone numbers you have provided to us.
- Requesting Restrictions. You have the right to request a restriction in our use or disclosure of you medical information for treatment, payment or health care operations. You have the right to request that we restrict our disclosure of your medical information to only certain individuals involved in your care of the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. You must make your request in writing and describe in a clear and concise fashion: (a) the information you wish restricted (b) whether you are requesting to limit our practice's use, disclosure or both; and (c) to whom you want the limits to apply.
- Inspections and Copies. You have the right to inspect and obtain a copy of the medical information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing in order to inspect any/or obtain a copy of your medical information in the form and format requested by you, including electronically if readily producible. Our practice may deny your request in certain limited circumstances.
- Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. You must make your request in writing. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request in writing or if we feel the information is accurate and complete.
- Accounting of Disclosures. All of our patients have the right to request an "accounting of disclosures". Documentation of our use of your medical information as part of the routine patient care in our practice is not required. You must submit your request in writing. All requests must state a time period, which may not be longer than 6 years from the date of disclosure and may not include dates before 4/14/2003.
- Right to a Paper Copy of this notice. You are entitled to receive a paper copy of our notice of privacy practices at any time.
- Right to File a Complaint. If you believe your privacy rights have/been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the PRIVACY OFFICER at 706 W. Huron St., Ann Arbor, MI 48103 or by phone at 734-996-8757.
- Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your medical information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your medical information for the reasons described in the authorization. Your authorization is required for most uses and disclosures of psychotherapy notes, PHI for marketing purposes, and the sale of PHI.
- Breach of PHI. Individuals will be notified following a breach of unsecured PHI.
- Fund raising. We may contact you to raise funds but you do have a right to opt out of receiving such communications.
- Restriction of Disclosures. You have to right to restrict certain disclosures of PHI to a health plan when you pay out of pocket in full for the item or service.