This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it
Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with
our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and
relates to your past, present or future physical or mental health condition and related healthcare services.
Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this
information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It
also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive,
manage our healthcare operations and for other purposes that are permitted or required by law.
Your Rights Under the Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices – We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time and to make the new Notice provisions effective for all PHI that we
maintain. We will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will be posted in a conspicuous location in the practice, and if such is maintained by the practice, on its website.
You have the right to authorize other use and disclosure – This means you have the right to authorize any use or disclosure of PHI that is not specified
within this notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about
medical matters using an alternative method (i.e., email, fax, telephone), and/or to a destination (i.e., cell phone number, alternative address, etc.)
designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.
You have the right to inspect and copy your PHI – This means you may submit a written request to inspect, and obtain a copy of your complete health
record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge
a reasonable fee for paper or electronic copies as established by federal guidelines. In most cases, we will provide requested copies within 30 days.
You have the right to request a restriction of your PHI – This means you may ask us, in writing, not to use or disclose any part of your protected health
information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in
emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have
the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information – This means you may submit a written request to amend your PHI for as long as we maintain this information. In certain cases, we may deny your request.
You have the right to request a disclosure accountability – You may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our practice except for those made upon your request, for purposes of treatment, payment or healthcare operations. We will not charge a fee for the first accounting provided in a 12 month period.
You have the right to receive a privacy breach notice – You have the right to receive written notification if the practice discovers a breach of your
unsecured PHI, and determines through a risk assessment that notification is required. If you have questions regarding your privacy rights, or would like to submit a written request, please feel free to contact our Privacy Manager. Contact information is provided below, under Privacy Complaints.
How We May Use or Disclose Protected Health Information – The following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the
coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may be involved in your care and treatment.
Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or
other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care.
Also, we may contact you to provide information about health-related benefits and services offered by our office; for fund-raising activities; or with
respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each
such notice will include instructions for opting out.
Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.
Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not
limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient
Health Information Organization – The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.
To 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, that you identify, your PHI that directly relates to that person’s involvement in your healthcare. 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 PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, (e.g., in a disaster relief situation), then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI without your written authorization, or providing you an opportunity to object, for the following purposes: if required by state or federal law; for public health activities and safety issues (e.g. product recall); health oversight activities; in cases of abuse, neglect or domestic violence; to avert a serious threat to health or safety; research purposes; in response to a court or administrative order and subpoenas that meet certain requirements; to a coroner, medical examiner or funeral director; organ and tissue donation; to address law enforcement, military activity, national security, worker’s compensation, certain other government requests; with respect to a group health plan, to disclose information to the health plan sponsor for plan administration and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
You have the right to complain to us, or directly to the Secretary of the Department 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 the Privacy Manager at: 248-356-0098 or [email protected].
We will not retaliate against you for filing a complaint.
We only ask for personal information when we truly need it to provide a service to you. We collect it by fair and lawful means, with your knowledge and consent. We also let you know why we’re collecting it and how it will be used.
We only retain collected information for as long as necessary to provide you with your requested service. What data we store, we’ll protect within commercially acceptable means to prevent loss and theft, as well as unauthorized access, disclosure, copying, use or modification.
We don’t share any personally identifying information publicly or with third-parties, except when required to by law.
Our website may link to external sites that are not operated by us. Please be aware that we have no control over the content and practices of these sites, and cannot accept responsibility or liability for their respective privacy policies.
You are free to refuse our request for your personal information, with the understanding that we may be unable to provide you with some of your desired services.
Your continued use of our website will be regarded as acceptance of our practices around privacy and personal information. If you have any questions about how we handle user data and personal information, feel free to contact us.
This policy is effective as of 03/31/2023.