MUNSON HEALTHCARE DIALYSIS CENTER
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.
Munson Healthcare Dialysis Center (MHCDC) 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.
MHCDC 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 MHCDC will use and disclose your PHI.
This Notice applies to the delivery of health care
by MHCDC. This Notice also applies to the utilization review and
quality assessment activities of Munson Healthcare and MHCDC as
a member of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: MHCDC will use and disclose
your PHI in the provision and coordination of health care to carry
out treatment functions.
MHCDC will disclose all or any portion of your patient medical
record information to your consulting physician(s), nurses, pharmacists,
technicians, medical students and other health care providers
who have a legitimate need for such information in your care and
continued treatment.
Different departments will share medical information
about you in order to coordinate specific services, such as lab
work, x-rays and prescriptions.
MHCDC also will disclose your medical information
to people or entities outside MHCDC who will be involved in your
medical care after you leave MHCDC, such as family members and
other care providers who will provide services that are part of
your care.
MHCDC 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
providers.
MHCDC will use and disclose your PHI to inform you
of, or recommend possible treatment options or alternatives that
will be of interest to you.
MHCDC may use and disclose PHI to contact you regarding
your appointment schedule, particularly when requesting changes
to it.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, MHCDC will
disclose your PHI to the correctional institution or law enforcement
official.
B. Payment: MHCDC 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.
MHCDC will disclose PHI to collection agencies and
other subcontractors engaged in obtaining payment for care.
C. Health Care Operations: MHCDC will use
and disclose your PHI during routine health care operations including
quality review, utilization review, medical review, internal auditing,
accreditation, certification, licensing or credentialing activities,
and for educational purposes.
For instance, MHCDC 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.
MHCDC may also use and disclose your PHI to support
the sale, transfer, or other corporate restructuring of Munson
Healthcare's assets or Northern Michigan Hospital's assests.
D. Other Uses and Disclosures: As part of
treatment, payment and health care operations, we may also use
your PHI for the following purposes:
Medical Research: MHCDC may disclose your
PHI without your Authorization to medical researchers who request
it for approved medical research projects; however, with very
limited exceptions such disclosures must be cleared through a
special approval process before any PHI is disclosed to the researchers.
Researchers will be required to safeguard the PHI they receive.
Information and Health Promotion Activities:
MHCDC will 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. MHCDC
will also send you information based on your own health concerns.
MHCDC 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 your health.
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.
MHCDC 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 abuse treatment.
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: MHCDC will disclose PHI
about you to a friend or family member who is involved in your
medical care. MHCDC will also give information to someone who
helps you pay for your care. In addition, MHCDC 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: MHCDC 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. MHCDC does maintain a
database of individuals for promotional communications, disease
management, and health promotion purposes. MHCDC sends information
to the individuals in this database about the programs and services
of MHCDC. If you wish to be deleted from this database, you may
notify the Privacy Official of Munson Healthcare.
C. Media Conditions Reports: MHCDC may release
information for an update to the media if the media requests information
about you using your full name and after we have given you an
opportunity to agree or object. The following information may
then be disclosed: your condition described in general terms that
do not communicate specific medical information, such as "good",
"fair", "serious", or "critical".
III. Use or Disclosure Requiring Your Authorization
A. Marketing: MHCDC is not permitted to provide
your PHI to any other person or company for marketing to you of
any products or services other than MHCDC's products or services
without a signed authorization from you.
B. Research: MHCDC will use or disclose your
PHI as part of research that includes providing you with treatment.
For example, if you are part of a research study that includes
treatment, MHCDC may require that you sign an authorization to
allow the researchers to use or disclose your PHI for this research.
C. 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
MHCDC has taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public Policy
or Law without your Authorization
A. Law Enforcement Purposes: MHCDC 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: MHCDC will disclose PHI
about you when required by federal, state or local law to make
reports or other disclosures. MHCDC also will make disclosures
for judicial and administrative proceedings such as lawsuits or
other disputes in response to a court order or subpoena. MHCDC
will disclose your medical information to government agencies
concerning victims of abuse, neglect or domestic violence. MHCDC
will report drug diversion and information related to fraudulent
prescription activity to law enforcement and regulatory agencies.
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. MHCDC will make
certain disclosures that are required in order to comply with
workers' compensation or similar programs.
B. Coroners, Medical Examiners, Funeral Directors:
MHCDC will disclose your PHI to a coroner or medical examiner.
For example, this will be necessary to determine a cause of death.
We will also disclose your medical information to funeral directors
as necessary to carry out their duties.
C. Organ Procurement: MHCDC will disclose
PHI to an organ procurement entity for organ, eye or tissue donation
purposes when donation has been authorized or to verify that appropriate
organ procurement procedures were followed.
D. Health or Safety: Following the requirements
of the Michigan Department of Commerce, MHCDC will use and disclose
PHI to avert a serious threat to health and safety of a person
or the public. MHCDC will use and disclose PHI to Public Health
Agencies for immunizations, communicable diseases, etc. We 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 MHCDC must maintain all records concerning
your treatment by MHCDC, 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: psychotherapy notes,
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.
MHCDC will deny your request for access to your
PHI without giving you an opportunity to review that decision
if:
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
inmates;
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;
You are involved in a clinical research project
and MHCDC created or obtained the PHI during that research.
Your access to the information will be temporarily suspended
for as long as the research is in progress;
MHCDC 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 information; or
Under other limited circumstances. In these instances,
however, we will allow the review of its decision by a health
care professional that MHCDC 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 MHCDC. 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 MHCDC maintains it. However, MHCDC
will deny your request for amendment if:
MHCDC did not create the information;
The information is not part of the designated
record set;
The information would not be available for your
inspection (due to its condition or nature); or
The information is accurate and complete.
If MHCDC 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 we disclose
the information that you wanted changed. MHCDC 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 MHCDC, including your reason to support the
requested amendment. We 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 MHCDC
made, except for the following disclosures:
To carry out treatment, payment or health care
operations;
To you;
To persons involved in your care;
For national security or intelligence purposes;
To correctional institutions or law enforcement
officials; or
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 MHCDC. 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, MHCDC 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. MHCDC will consider your request but
is not required to agree to the requested restrictions.
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 MHCDC 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 copy of this Notice of Privacy
Practices, upon request.
VI. Complaints
If you believe your privacy rights have been violated,
you may file a complaint with MHCDC or with the Secretary of the
Department of Health and Human Services. To file a complaint with
MHCDC, please contact MHCDC's Department Manager or Social Worker
at:
4062 West Royal Drive
Traverse City, MI 49684 (231) 935-0447
All complaints must be submitted in writing. MHCDC
assures you that there will be no retaliation for filing a complaint.
VII. Sharing and joint use of your Health Information
In the course of providing care to you and in furtherance
of the Munson Healthcare's mission to improve the health of the
community, MHCDC will share your PHI with other organizations
as described below who have agreed to abide by the terms described
below:
A. Medical Staff: The medical staff and MHCDC
participate together in an organized health care arrangement to
deliver health care to you. MHCDC and its medical staff have agreed
to abide by the terms of this Notice with respect to PHI created
or received as part of delivery of health care services to you
in MHCDC. Physicians are members of MHCDC's medical staff and
will have access to and use your PHI for treatment, payment and
health care operations purposes related to your care within MHCDC.
MHCDC will disclose your PHI to the medical staff for payment,
treatment and health care operations.
B. Business Associates: MHCDC will use and
disclose your PHI to business associates contracted to perform
business functions on its behalf including Munson Healthcare,
its parent who performs certain business functions for MHCDC.
Whenever an arrangement between MHCDC and another company involves
the use or disclosure of your PHI, that business associate will
be required to keep your information confidential.
C. Membership in Munson Healthcare: MHCDC,
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 part of Munson Healthcare, MHCDC 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, the parent company, and its members. Members
of Munson Healthcare also use your PHI for your treatment, payment
to MHCDC and/or for the health care operations permitted by HIPAA
with respect to our mutual patients.
VIII. Additional Information
For further information regarding the subjects covered
in this Notice of Privacy Practices, please contact Munson Healthcare's
Privacy Official at (231) 935-2335.
IX. Changes to this Notice
MHCDC will abide by the terms of the Notice currently
in effect. MHCDC reserves the right to change the terms of its
Notice and to make the new Notice provisions effective for all
PHI that it maintains. MHCDC will provide you with the revised
Notice at your first visit following the revision of the Notice.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
