MERCY REHABILITATION SERVICES
NOTICE OF PRIVACY PRACTICES
Effective Date: 4/14/2003
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.
Mercy Rehabilitation Services is required
by law to maintain the privacy of individually identifiable patient
health information (this information is "protected health
information" and is referred to herein as "PHI").
We are also required to provide patients with a Notice of Privacy
Practices regarding PHI. We are required to post this Notice in
a prominent place within our facility. We will only use or disclose
your PHI as permitted or required by applicable state law. This
Notice applies to your PHI in our possession including the medical
records generated by us.
Mercy Rehabilitation Services understands
that your health information is highly personal, and we are committed
to safeguarding your privacy. Please read this Notice of Privacy
Practices thoroughly. It describes how we will use and disclose
This Notice applies to the delivery of health
care by Mercy Rehabilitation Services. This Notice also applies
to the utilization review and quality assessment activities of
Munson Healthcare and Mercy Rehabilitation Services as a strategic
partner of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: Mercy Rehabilitation
Services will use and disclose your PHI in the provision and coordination
of heath care to carry out treatment functions.
Mercy Rehabilitation Services will disclose
all or any portion of your patient medical record information
to your consulting physician(s), nurses, pharmacists, technicians,
case managers, students and other health care providers who have
a legitimate need for such information in your care and continued
Different departments will share medical information
about you in order to coordinate specific services, such as x-rays
Mercy Rehabilitation Services also will disclose
your medical information to people or entities outside Mercy Rehabilitation
Services who will be involved in your medical care after you leave
Mercy Rehabilitation Services, such as other care providers who
will provide services that are part of your care.
We will share certain information such as
your name, address, employment, insurance carrier, emergency contact
information and appointment scheduling information in an effort
to coordinate your treatment with us and with other health care
Mercy Rehabilitation Services will use and
disclose your PHI to inform you of, or recommend possible treatment
options or alternatives that will be of interest to you.
Mercy Rehabilitation Services will use and disclose PHI to contact
you as a reminder that you have an appointment for medical care
at Mercy Rehabilitation Services.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, Mercy Rehabilitation
Services will disclose your PHI to the correctional institution
or law enforcement official.
B. Payment: Mercy Rehabilitation Services
will disclose PHI about you for the purposes of determining coverage,
eligibility, funding, billing, claims management, medical data
processing, stop loss/reinsurance and reimbursement.
The medical information will be disclosed
to an insurance company, third party payer, third party administrator,
health plan or other health care provider (or their duly authorized
representatives) involved in the payment of your medical bill
and will include copies or excerpts of your medical records which
are necessary for payment of your account. It will also include
sharing the necessary information to obtain pre-approval for payment
for treatment from your health plan.
We will disclose PHI to collection agencies
and other subcontractors engaged in obtaining payment for care.
C. Health Care Operations: Mercy Rehabilitation
Services will use and disclose your PHI during routine health
care operations including quality review, utilization review,
outcomes analysis, internal auditing, accreditation, certification,
and for educational purposes.
For instance, Mercy Rehabilitation Services
will need to share your demographic information, diagnosis, treatment
plan and health status for population based activities relating
to improving health or reducing health care costs, protocol development,
case management and care coordination, and contacting health care
providers and patients with information about treatment alternatives,
in order for us to operate our business in an efficient, safe
and legal manner.
We may also use and disclose your PHI to support
the sale, transfer, or other corporate restructuring of our assets.
D. Other Uses and Disclosures: As part
of treatment, payment and health care operations, we may also
use your PHI for the following purposes:
Information and Health Promotion Activities:
Mercy Rehabilitation Services may use and disclose some of
your PHI for certain health promotion activities. For example,
your name and address will be used to send you newsletters or
general communications. We will also send you information based
on your own health concerns. Mercy Rehabilitation Services may
send you this information if it has determined that a product
or service may help you. The communication will explain how the
product or service relates to your well-being and can improve
E. More Stringent State and Federal Laws:
The State law of Michigan is more stringent than HIPAA in several
areas. State law is more stringent when the individual is entitled
to greater access to records than under HIPAA and when under state
law the records are more protected from disclosure than under
HIPAA. Certain federal laws also are more stringent than HIPAA.
Mercy Rehabilitation Services will continue to abide by these
more stringent state and federal laws. The federal laws include
applicable internet privacy laws, such as the Children's Online
Privacy Protection Act and the federal laws and regulations governing
the confidentiality of health information regarding substance
In Michigan patients have more rights of access
to behavioral health information under Michigan law than under
HIPAA and the state law defines a minimum necessary standard for
release of mental health information. Disclosure is permitted
with consent and for treatment without consent but only in an
emergency. Minors in Michigan have more rights to confidentiality
and protection of certain information (reproductive health, behavioral
health and substance abuse) than under HIPAA. State law requires
facilities to adopt policies regarding release of information
outside the facility. If the facility policy requires consent
for release, then consent will be required. State law genetic
and HIV testing and disclosure consents remain in place.
II. Permitted Use or Disclosure with an
Opportunity for You to Agree or Object
A. Family/Friends: With your permission,
Mercy Rehabilitation Services will disclose PHI about you to a
friend or family member who is involved in your medical care.
We will also give information to someone who helps you pay for
your care. In addition, we will disclose PHI about you to an agency
assisting in a disaster relief effort so that your family can
be notified about your condition, status and location. You have
a right to request that your PHI not be shared with some or all
of your family or friends.
B. Promotional Communications: Mercy
Rehabilitation Services does not share or sell your PHI to companies
that market health care products or services directly to consumers
for use by those companies to contact you, such as drug companies.
Mercy Rehabilitation Services does maintain a database of individuals
for promotional communications, disease management, and health
promotion purposes. We send information to the individuals in
this database about the programs and services of Mercy Rehabilitation
Services. If you wish to be deleted from this database, you may
notify the Director of Mercy Rehabilitation Services.
III. Use or Disclosure Requiring Your Authorization
A. Marketing: We are not permitted
to provide your PHI to any other person or company for marketing
to you of any products or services other than Mercy Rehabilitation
Services's products or services without a signed authorization
B. Other Uses: Any uses or disclosures
that are not for treatment, payment or operations and that are
not permitted or required for public policy purposes or by law
will be made only with your written authorization. Written authorizations
will let you know why we are using your PHI. You have the right
to revoke an authorization at any time, except to the extent that
we have taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public
Policy or Law without your Authorization
A. Law Enforcement Purposes: Mercy
Rehabilitation Services will disclose your PHI for law enforcement
purposes as required by law, such as responding to a court order
or subpoena, identifying a criminal suspect or a missing person,
or providing information about a crime victim or possible criminal
conduct as part of a criminal investigation.
Required by Law: Mercy Rehabilitation
Services will disclose PHI about you when required by federal,
state or local law to make reports or other disclosures. Mercy
Rehabilitation Services also will make disclosures for judicial
and administrative proceedings such as lawsuits or other disputes
in response to a court order or subpoena. We will disclose your
medical information to government agencies concerning victims
of abuse, neglect or domestic violence. Specialized government
functions will warrant the use and disclosure of PHI. These government
functions will include military and veteran's activities, national
security and intelligence activities, and protective services
for the President and others. Mercy Rehabilitation Services will
make certain disclosures that are required in order to comply
with workers' compensation or similar programs.
B. Health or Safety: Following the
requirements of the Michigan Department of Commerce, Mercy Rehabilitation
Services will use and disclose PHI to avert a serious threat to
health and safety of a person or the public. We will use and disclose
PHI to Public Health Agencies for immunizations, communicable
diseases, etc. Mercy Rehabilitation Services will use and disclose
PHI for activities related to the quality, safety or effectiveness
of FDA-regulated products or activities, including collecting
and reporting adverse events, tracking and facilitating product
recalls, etc. and post marketing surveillance. Any patient receiving
a medical device subject to FDA tracking requirements may refuse
to disclose, or refuse permission to disclose, their name, address,
telephone number and social security number, or other identifying
information for the purpose of tracking.
V. Your Health Information Rights
Although we must maintain all records concerning
your treatment by Mercy Rehabilitation Services, you have the
following rights concerning your PHI:
A. Right to Inspect and Copy: You have
the right to access your PHI and to inspect and have a copy made
of your PHI as long as we maintain it except for information that
may be used in anticipation of, or that will be used in a civil,
criminal or administrative action or proceeding, and where prohibited
or protected by law.
We will deny your request for access to your
PHI without giving you an opportunity to review that decision
- You don't have the right to inspect the
information; or it is otherwise prohibited or protected by law;
- You are an inmate at a correctional institution
and obtaining a copy of the information would risk the health,
safety, security, custody or rehabilitation of you or other
- The disclosure of the information would
threaten the safety of any officer, employee or other person
at the correctional institution or who is responsible for transporting
- You are involved in a clinical research
project and Mercy Rehabilitation Services created or obtained
the PHI during that research. Your access to the information
will be temporarily suspended for as long as the research is
- Mercy Rehabilitation Services obtained
the information that you seek access to from someone other than
the health care provider under a promise of confidentiality
and your access request is likely to reveal the source of the
- Under other limited circumstances. In these
instances, however, Mercy Rehabilitation Services will allow
the review of its decision by a health care professional that
Mercy Rehabilitation Services has chosen. This person will not
have been involved in the original decision to deny your request.
You agree to pay a reasonable copying charge.
You must make your requests to access and copy your PHI in writing
to Mercy Rehabilitation Services. We will respond to your request
within 30 days of its receipt. If we cannot, we will notify you
in writing to explain the delay and the date by which we will
act on your request. In any event, we will act on your request
within 60 days of its receipt.
B. Right to Amend: You have the right
to amend your PHI for as long as we maintain it. However, we will
deny your request for amendment if:
- Mercy Rehabilitation Services did not create
- The information is not part of the designated
- The information would not be available
for your inspection (due to its condition or nature); or
- The information is accurate and complete.
If Mercy Rehabilitation Services denies your
request for changes in your PHI, we will notify you in writing
with the reason for the denial. We will also inform you of your
right to submit a written statement disagreeing with the denial.
You may ask that we include your request for amendment and the
denial any time that Mercy Rehabilitation Services discloses the
information that you wanted changed. We may prepare a rebuttal
to your statement of disagreement and will provide you with a
copy of that rebuttal.
You must make your request for amendment of
your PHI in writing to Mercy Rehabilitation Services, including
your reason to support the requested amendment. Mercy Rehabilitation
Services will respond to your request within 60 days of its receipt.
If we cannot, we will notify you in writing to explain the delay
and the date by which we will act on your request. In any event,
we will act on your request within 90 days of its receipt.
C. Right to an Accounting: You have
a right to receive an accounting of the disclosures of your PHI
that Mercy Rehabilitation Services made, except for the following
- To carry out treatment, payment or health
- To you;
- To persons involved in your care;
- For national security or intelligence purposes;
- To correctional institutions or law enforcement
- That occurred prior to April 14, 2003.
For each disclosure, you will receive: the
date of the disclosure, the name of the receiving organization
and address if known, a brief description of the PHI disclosed
and a brief statement of the purpose of the disclosure or a copy
of the written request for the information, if there was one.
You must make your request for an accounting
of disclosures of your PHI in writing to Mercy Rehabilitation
Services. You must include the time period of the accounting,
which may not be longer than 6 years. We will respond to your
request within 60 days from its receipt. If we cannot, we will
notify you in writing to explain the delay and the date by which
we will act on your request. In any event we will act on your
request within 90 days of its receipt.
In any given 12-month period, we will provide you with an accounting
of the disclosures of your PHI at no charge. Any additional requests
for an accounting within that time period will be subject to a
reasonable fee for preparing the accounting.
D. Right to Request Restrictions: You
have the right to request restrictions on certain uses and disclosures
of your PHI:
- To carry out treatment, payment or health
care operations functions; or
- Restricting specific information to only
specified family members, relatives, close personal friends
or other individuals involved in your care.
For example, you may ask that your name not
be used in the waiting room or that information about your condition
not be shared with your family. Mercy Rehabilitation Services
will consider your request but is not required to agree to the
E. Right to Confidential Communications:
You have the right to receive confidential communications of your
PHI by alternative means or at alternative locations. For example,
you may request that we only contact you at work or by mail. We
will make every attempt to honor your request, but we reserve
the right to deny unreasonable requests.
F. Right to Receive a Copy of this Notice:
You have the right to receive a paper copy of this Notice of Privacy
Practices, upon request.
If you believe your privacy rights have been
violated, you may file a complaint with Mercy Rehabilitation Services
or with the Secretary of the Department of Health and Human Services.
To file a complaint with Mercy Rehabilitation Services, please
contact the Director of Mercy Rehabilitation Services at:
1406 North Mitchell
Cadillac, MI 49601
All complaints must be submitted in writing
directly to the Director of Mercy Rehabilitation Services. Mercy
Rehabilitation Services assures you that there will be no retaliation
for filing a complaint.
VII. Sharing and joint use of your Health
In the course of providing care to you and
in furtherance of the Munson Healthcare's mission to improve the
health of the community, Mercy Rehabilitation Services will share
your PHI with other organizations as described below who have
agreed to abide by the terms described below:
A. Business Associates: Mercy Rehabilitation
Services will use and disclose your PHI to business associates
contracted to perform business functions on its behalf including
Munson Healthcare, its strategic partner who performs certain
business functions for Mercy Rehabilitation Services. Whenever
an arrangement between Mercy Rehabilitation Services and another
company involves the use or disclosure of your PHI, that business
associate will be required to keep your information confidential.
B. Membership in Munson Healthcare:
Mercy Rehabilitation Services, other members of Munson Healthcare
and Munson Healthcare participate together in an organized health
care arrangement for utilization review and quality assessment
activities. We have agreed to abide by the terms of this Notice
with respect to PHI created or received as part of utilization
review and quality assessment activities of Munson Healthcare
and its members. Members of Munson Healthcare will abide by the
terms of their own Notice of Privacy Practices in using your PHI
for treatment, payment or healthcare operations. As a strategic
partner of Munson Healthcare, Mercy Rehabilitation Services and
the various hospitals, nursing homes, and health care providers
in Munson Healthcare share your PHI for utilization review and
quality assessment activities of Munson Healthcare and its members.
Members of Munson Healthcare also use your PHI for your treatment,
payment to Mercy Rehabilitation Services and/or for the health
care operations permitted by HIPAA with respect to our mutual
VIII. Additional Information
For further information regarding the subjects
covered in this Notice of Privacy Practices, please contact Mercy
Rehabilitation Services at (231) 876-7443.
IX. Changes to this Notice
Mercy Rehabilitation Services will abide by
the terms of the Notice currently in effect. Mercy Rehabilitation
Services reserves the right to change the terms of its Notice
and to make the new Notice provisions effective for all PHI that
it maintains. Mercy Rehabilitation Services will provide you with
the revised Notice at your first visit following the revision
of the Notice.
If you have any unresolved concerns about patient care and safety at Mercy Hospital Cadillac, please contact our Patient
Relations Office at (231) 876-7473.
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