MICHIGAN ORTHOPEDIC SPECIALISTS it to study health care and health care delivery audits, investigations, inspections, and licensure
HOW THIS OFFICE MAY USE AND DISCLOSE without learning the identity of the specific renewals, etc.
YOUR MEDICAL INFORMATION patients.
Lawsuits and Disputes. If you are involved in a
The following describes the different ways that your Appointment Reminders. We may use and lawsuit or a dispute, we may use your medical
medical information may be used or disclosed by this disclose medical information to contact you as a information to defend the office or to respond to a
office. For clarification we have included some reminder that you have an appointment for court order.
examples. Not every possible use or disclosure is treatment or medical care at this office.
Law Enforcement. We may release medical
specifically mentioned. However, all of the ways we
are permitted to use and disclose medical information
Treatment Alternatives. We may use and information about you if required by law when
will fit within one of these general categories: disclose medical information to tell you about or asked to do so by a law enforcement official.
recommend possible treatment options or
For Treatment. We will use medical Coroners and Medical Examiners. We may
alternatives that may be of interest to you.
information about you to provide you with release medical information to a coroner or
medical treatment and services. We may disclose Health Related Benefits and Services. We may medical examiner to identify a deceased person or
medical information about you to doctors, nurses, use and disclose medical information to inform determine the cause of death.
technicians and other office personnel who are you about health-related benefits or services that
YOUR RIGHTS REGARDING YOUR
involved in providing you medical treatment. may be of interest to you.
For payment. We may use and disclose medical Research. Under certain circumstances, we may
use and disclose medical information about you You have the following rights regarding the
information about you so that the treatment and medical information this office maintains about
services you receive at this office may be billed for research purposes. For example, a research
project may involve comparing the health and you:
and payment may be collected from you, an
insurance company or a third party. For example, recovery of all patients who received one Right to Inspect and Copy. You have the right
we may need to give your health plan information medication to those who received another for the to inspect and copy your medical information
about treatment you received at our office, so you same condition. with the exception of any psychotherapy notes.
health plan will pay us or reimburse you for the As Required by Law. We will disclose medical To inspect and copy your medical information,
treatment. We may also notify your health plan information about you when required to do so by you must submit your request in writing to the
about a treatment you are going to receive to federal, state or local law. For example, Office Manager. If you request a copy of the
obtain prior approval or to determine whether disclosure may be required by Worker’s information, we may charge a fee for the costs of
your plan will cover the treatment. Compensation statutes and various public health copying, mailing or other supplies associated with
statutes in connection with required reporting of your request. We ma deny your request to inspect
For Health Care Operations. We may use and and copy in certain very limited circumstances.
disclose medical information about you for office certain diseases, child abuse and neglect, domestic
operations. These uses and disclosures are violence, adverse drug reactions, etc. If you are denied access to your medical
necessary to operate our office and make sure that To Avert a Serious Threat to Health or Safety. information, you may request that the denial be
all of our patients receive quality care. For We may use and disclose medical information reviewed. For information regarding such a
example, we may use medical information to about you when necessary to prevent a serious review contact the Office Manager.
review our treatment and services and to evaluate threat to your health and safety or the health and Right to Amend. If you feel that medical
the performance of our staff in caring for you. safety of the public or another person. Any information we have about you is incorrect or
We may also combine medical information about disclosure, however, would only be to someone incomplete, you may ask us to amend the
many of our patients to decide what additional able to help prevent the treatment. information. You have the right to request an
services should be offered; what services are not amendment for as long as the information is kept
needed; and whether certain new treatments are Health Oversight Activities. We may disclose
medical information to a governmental or other by this office.
effective. We may also disclose information to
doctors, nurses, technicians and other office oversight agency for activities authorized by law. To request an amendment, your request must be
personnel for review and learning purposes. We For example, disclosures of your medical made in writing and submitted to the Office
may remove information that identifies you from information may be made in connection with Manager. In addition, you must provide a reason
this set of medical information so others may use that supports your request.
We may deny your request for an amendment if it Right to a Paper Copy of This Notice. You
is not in writing or does not include a reason to have the right to a paper copy of this Notice.
support the request. In addition, we may deny Even if you have agreed to receive this Notice
THIS NOTICE DESCRIBES HOW
your request if you ask us to amend information electronically, you are still entitled to a paper copy MEDICAL INFORMATION ABOUT
that: of this Notice. YOU MAY BE USED AND
(a) was not created by this office; You may obtain a copy of this Notice at our DISCLOSED AND HOW YOU CAN
website: GET ACCESS TO THIS
(b) is not part of the medical information
kept by this office; www.michiganorthopedicspecialists.com INFORMATION. PLEASE REVIEW
(c) is not part of the information, which you To obtain a paper copy of this Notice, contact the
would be permitted to inspect and copy; Office Manager. IF YOU HAVE ANY QUESTIONS
or Revisions to This Notice ABOUT THIS NOTICE, PLEASE
(d) is not accurate and complete.
We reserve the right to revise this Notice. Any
CONTACT THE OFFICE MANAGER
Right to an Accounting of Disclosures. You revised Notice will be effective for medical AT 313-277-6700.
have the right to request an “accounting of information we already have about you, as well as
disclosures.” This is a list of the disclosures this any information we receive in the future. We will
office has made of your medical information. To post a copy of any revised Notice in this office. Your medical information is personal. We are
request this accounting of disclosures, you must Any revised Notice will contain the effective date committed to protecting your medical information.
submit your request in writing to the Office on the first page, in the top right-hand corner. In We create a record of the care and services you
Manager. addition, each time you visit the office we will receive at this office. We need this record to provide
Your request must state a time period, which may make a copy of the current Notice in effect you with quality care and to comply with certain legal
available to you. requirements. This Notice applies to all of the records
not be longer than six years and may not include
dates before April 14, 2003. Complaints of your care generated by this office whether made by
your personal physician or one of the office’s
Right to Request Restrictions. You have the If you believe your privacy rights have been employees.
right to request a restriction or limitation of the violated, you may file a complaint with this office
use or disclosure we make of your medical or with the Secretary of the Department of Health This Notice will tell you about the ways in
information. and Human Services. To file a complaint with which we may use and disclose your medical
this office, contact the Office Manager. All information. This Notice will also describe
We are not required to agree to your request for a your rights, and certain obligations we have
complaints must be submitted in writing.
restriction. If we do agree, we will comply with regarding the use and disclosure of your
your request unless the information is needed to THIS OFFICE WILL NOT PENALIZE YOU IN medical information.
provide you emergency treatment. ANY WAY FOR FILING A COMPLAINT.
This office is required by law to:
To request restrictions, you must make your Other Uses of Medical Information
request in writing to the Office Manager. (a) ensure that medical information that
Other uses and disclosures of your medical information
identifies you is kept private;
Right to Request Confidential not covered by this Notice of Privacy Practices will be
Communications. You have the right to request made only with your written authorization. If you (b) give you this Notice of our legal
that we communicate with you only in a certain provide us such an authorization in writing to use or duties and privacy practices with
disclose medical information about you, you may respect to medical information about
manner. For example, you may ask that we only
revoke that authorization, in writing, at any time. If you you; and
contact you at work or by mail. To request revoke your authorization, we will no longer use or
confidential communications, you must make disclose medical information about your for the reasons (c) follow the terms of the Notice that is
your request in writing to the Office Manager. covered by your written authorization. currently in effect.
We will accommodate all reasonable requests.