Grosse Pointe Physicians X-Ray Center, P.C.
NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about
you may be used and disclosed and how you can get access to this information.
Please read it carefully.
Our Legal
Duty
We are required by applicable
federal and state law to maintain the privacy of your health information. We are also required to give you this notice
about our privacy practices, our legal duties, and your rights concerning your health
information. We must follow the privacy
practices that are described in this notice while it is in effect. This notice takes effect 04/13/03 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 such
changes are permitted by applicable law.
We reserve the right to make the changes in our privacy practices and
the new terms of our notice effective for all health information that we
maintain, including health information we created or received before we made
the changes. Before we make a
significant change in our privacy practices, we will change this notice and
make the new notice available upon request.
You may request a copy of our
notice at any time. For more
information about our privacy practices, or for additional copies of this
notice, please contact us.
This Notice of Privacy
Practices describes how we may use and disclose your protected health
information (PHI) to carry out treatment, payment or health care operations
(TPO) and for other purposes that are permitted or required by law. It also describes your right 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.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
[1]
We may use and disclose
personal and identifiable health information about you in different ways. All of the ways in which we may use and
disclose information will fall within one of the following categories, but not
every use or disclosure in a category will be listed.
For Treatment. We will use health information about you to
furnish services and supplies to you, in accordance with our policy and
procedures. For example, we will use
your medical history, such as any presence or absence of heart disease , to
assess your health and perform requested ultrasound or other diagnostic
services.
For Payment. We will use and disclose health information
about you to bill for our services and to collect payment from you or your
insurance company. For example, we may
need to give a payer information about your current medical condition so that
it will pay us for the ultrasound examinations or other services that we have
furnished you. We may also need to
inform your payer of the tests that you are going to receive in order to obtain
prior approval or to determine whether the service is covered.
For Health Care Operations. We may use
and disclose information about you for the general operation of our
business. For example, we sometimes
arrange for accreditation organizations, auditors or other consultants to
review our practice, evaluate our operations, and tell us how to improve our
services.
Required by
Law. We may use or disclose your
health information without your consent or authorization in certain situations.
These situations include: Required By Law; Public Health; Communicable Disease;
Health Oversight; Abuse or Neglect; Food and Drug Administration; Legal
Proceedings; Law Enforcement; Coroners; Funeral Directors, and Organ Donation;
Research; Criminal Activity; Military or National Security; Workers
Compensation; Inmates; Required uses and Disclosure. The use or disclosure will be made in compliance with the law and
will be limited to the relevant requirements of the law.
Our Business Associates. We sometimes
work with outside individuals and businesses who help us operate our business
successfully.
We may disclose your health
information to these business associates so that they can perform the tasks
that we hire them to do. Our business associates must guarantee to us that they
will respect the confidentiality of your personal and identifiable health
information.
Individuals Involved in
Your Care or Payment for Your Care. We may disclose information to individuals
involved in your care or in
the payment for your care, but we will obtain your
agreement before doing so. This
includes people and organizations that
are part of your "circle of care" -- such
as your spouse, your other doctors, or an aide who may be providing services to
you. Although we must be able to speak with your
other physicians or health care providers, you can let us know if we
should not speak with other individuals, such as your
spouse or family.
Appointment
Reminders. We may use and disclose medical information to contact you
as a reminder that you have an appointment or
that you should schedule an
appointment.
Treatment Alternatives. We may use
and disclose your personal health information in order to tell you about or
recommend
possible
treatment options, alternatives or health-related services that may be of
interest to you.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
We
are required to obtain written authorization from you for any other uses and disclosures
of medical information other than those described above. If you provide us with such permission, you
may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose
personal information about you for the reasons covered by your written
authorization. We will be unable to
take back any disclosures already made based upon your original permission.
INDIVIDUAL RIGHTS
You have the right to
ask for restrictions on the ways in which we use and disclose your medical
information beyond those imposed by law.
We will consider your request, but we are not required, to accept it.
You have the right to
request that you receive communications containing your protected health
information from us by alternative means or at alternative locations. For example, you may ask that we only
contact you at home or by mail.
Except under certain
circumstances, you have the right to inspect and copy medical and billing
records about you, such requests for access to protected health information
must be made by written request. If you
ask for copies of this information, we may charge you a fee for copying and
mailing.
If you believe that
information in your records is incorrect or incomplete, you have the right to ask
us to correct the existing information or correct the missing information. Under certain circumstances, we may deny
your request.
You have a right to
ask for a list of instances when we have used or disclosed your medical
information for reasons other than your treatment, payment for services
furnished to you, our health care operations, or disclosures you give us
authorization to make. If you ask for
this information from us more than once every twelve months, we may charge you
a fee.
You have the right to
a copy of this Notice in paper form.
You may ask us for a copy at any time.
To exercise any of your rights,
please contact us in writing Ms. Sheryl
M. Vickers
Administrator, Eastpointe Radiologists, P.C. , 36175 Harper Ave., Clinton
Township, MI. 48035
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice at any
time. We reserve the right to make
the revised notice effective for personal health information
we have about you as well as any
information we
receive in the future. In the event
there is a material change to this
Notice the
revised Notice will be posted. In addition, you may request a copy of the revised Notice at any
time.
If you have any complaints concerning our Privacy Policy,
you may contact the Secretary of the
Department of Health and Human Services, at 200 Independence
Avenue, S.W., Room 509F,
HHH Building, Washington, D.C. 20201 (e-mail:
ocrmail@hhs.gov). You also may
contact us
at Ms Sheryl M.
Vickers, 586 741 3772.
To obtain more information concerning this Notice of Privacy
Practices, you may contact our
Privacy Officer at Dr. Joseph J. Metes, Eastpointe
Radiologists, P.C., 36175 Harper Ave.
Clinton Township, MI 48035
This Privacy Policy is
effective April 13 , 2003.