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5087 North Royal Drive, Suite B (231) 935-0440 Monday - Friday:
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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.
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