MUNSON FAMILY PRACTICE
CENTER NOTICE OF PRIVACY PRACTICES
Effective Date: 4/9/2003
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 Family Practice Center ("MFPC")
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.
MFPC 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 your PHI.
This Notice applies to the delivery of health
care by MFPC. This Notice also applies to the utilization review
and quality assessment activities of Munson Healthcare and MFPC
as a member of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: MFPC will use and disclose
your PHI in the provision and coordination of health care to carry
out treatment functions.
MFPC 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.
MFPC also will disclose your medical information
to people or entities outside MFPC who will be involved in your
medical care after you leave MFPC, 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
providers.
MFPC will use and disclose your PHI to inform
you of, or recommend possible treatment options or alternatives
that will be of interest to you.
MFPC will use and disclose PHI to contact
you as a reminder that you have an appointment for medical care
at MFPC.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, MFPC will disclose
your PHI to the correctional institution or law enforcement official.
B. Payment: MFPC 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: MFPC 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 of MFPC, and for educational purposes.
For instance, MFPC 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 Munson
Healthcare's 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:
Medical Research: We 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:
MFPC 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. We
will also send you information based on your own health concerns.
MFPC 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.
MFPC 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: With your permission,
MFPC 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: MFPC
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. MFPC 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 MFPC. If you wish to be deleted from this database, you may
notify the Privacy Official of Munson Healthcare.
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 MFPC's products
or services without a signed authorization from you.
B. Research: MFPC 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, MFPC 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
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: MFPC 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: MFPC will disclose
PHI about you when required by federal, state or local law to
make reports or other disclosures. MFPC 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. MFPC 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. MFPC 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, MFPC 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.
MFPC 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 MFPC, 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.
We 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 MFPC 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;
MFPC 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, MFPC will allow the review of its decision
by a health care professional that MFPC 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 MFPC. 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:
MFPC 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 MFPC 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 MFPC 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 MFPC, including your reason to support
the requested amendment. MFPC 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 MFPC 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 MFPC. 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. MFPC 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 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.
VI. Complaints
If you believe your privacy rights have been
violated, you may file a complaint with Munson Healthcare or with
the Secretary of the Department of Health and Human Services.
To file a complaint with Munson Healthcare, please contact Munson
Healthcare's Patient Liaison at:
1105 6th Street
Traverse City, MI 49684 (231) 935-5051
All complaints must be submitted in writing
directly to Munson Healthcare's Patient Liaison. Munson Healthcare
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, MFPC will share your PHI with other organizations
as described below who have agreed to abide by the terms described
below:
A. Business Associates: MFPC 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 MFPC. Whenever
an arrangement between MFPC 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:
MFPC, 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, MFPC
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 MFPC 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
MFPC will abide by the terms of the Notice currently
in effect. MFPC reserves the right to change the terms of its
Notice and to make the new Notice provisions effective for all
PHI that it maintains. MFPC 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.
