Notice of Privacy Policy
We are required by law to:
- Maintain the privacy of your protected health information.
- Provide you with certain rights with respect to your protected health information.
- Provide you with a copy( at your request) of this Notice of our legal duties and privacy practices with respect to your protected health information.
- Follow the terms of the Notice that is currently in effect.
Please read our Privacy Policy and notify us with any questions.
Notice of Privacy Practices
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 are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices concerning protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in the Notice while it is in effect. This Notice took effect on 10/31/2024 and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided applicable law permits such changes, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request. You may request a copy of our Notice at any time. For more information about our privacy practice or additional copies of the Notice, please contact us using the information listed at the end of this Notice.
· How we may use and disclose health information about you: We may use and disclose your health information for different purposes, including treatment, payment, and healthcare operations.
· Treatment: We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you. Payment is to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collection, claims management, and determination of eligibility and coverage to obtain payment for you, an insurance company, or another third party. Individuals involved in your care/ patient representative for payment for your care.
· Required by law: We may use or disclose your health information when we are required to do so by law.
· Public Health Activities: We may disclose your health information for public health activities, including disclosures to:
o Prevent or control disease, injury, or disability.
o Report child abuse or neglect
o Report reaction to medication or problem with products or devices
o Notify a person who may have been exposed to a disease or condition
o Notify an appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
· National Security: We will disclose other information to other entities, including but not limited to law enforcement, correctional facilities, and the military, as required by law. In addition, when applicable information for Law Enforcement in response to subpoenas and court orders
· Secretary of the HHS: We will disclose your health information to the U.S. Department of Health and Human Services Secretary when required to investigate or determine compliance with HIPAA.
· Workers' Compensation: We may disclose PHI to the extent authorized by and to extend necessary to comply with laws related to worker's compensation or other similar programs.
· Health Oversight Activities: We may disclose PHI to an oversight agency for activities authorized by law, such as Licensure, for the government to monitor healthcare systems, government programs, and compliance with civil rights laws.
· Judicial Proceeding: If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena or other lawful process.
· Coroners, Medical Examiners, and Funeral Directors: We may release PHI to Coroners and Medical examiners, for example, to identify a deceased person or determine the cause of death. We may also release it to Funeral Directors under applicable law to enable them to carry out their duties.
· Your Health Information Rights Access: You have the right to look at or get copies of your health information, with limited exceptions. You must request in writing. You may obtain a form to request access by using the contact information listed at the end of the Notice. We will use the form and format your request if readily producible. We will charge you a reasonable cost-based fee for the cost of supplies, labor, copying, and postage if you would like copies mailed to you.
· Disclosure Accounting: You have the right to receive an accounting of disclosures of your health information per applicable laws and regulations. To request your information, you must submit your request in writing to the Privacy Official. If you request this information more than once in 12 months. We may charge you a reasonable, cost-based fee for responding to additional requests.
· Electronic Notice: you may receive a paper copy of this notice upon request, even if you have agreed to receive this Notice electronically on our Website or by electronic mail (email or via text)
· Right to request a restriction. You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official. Your written request must include (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. We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which you or a person on your behalf has paid our practice in full.
· Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location and provide a satisfactory explanation of how payment will be handled under the alternative means or location you request. We will accommodate all reasonable requests. However, if we are unable to contact you using the ways or locations you have requested we may contact you using the information we have.
· Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances. If we agree to your request, we will amend your record(s) and notify you of such. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it and explain your rights.
· Questions and Complaints: If you have questions or concerns, please contact us. If you are concerned that we may have violated your right, or if you disagree with a decision, we made about access to your PHI, you may complain to us using the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Our Privacy Official: Jessica Nielsen Telephone: 989-894-4611
Address: 1049 N. Pine Road
Essexville, MI 48632 Email: JNielsenPHI@gmail.com