Patient Privacy

SHORELINE PEDIATRICS, P.L.C.

NOTICE OF PRIVACY PRACTICES

Effective Date of this Notice: April 14, 2003

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU, AS A PATIENT OF SHORELINE PEDIATRICS, P.L.C., MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.


PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact Julie Jennings, our Privacy Officer, by phone at (231) 773-7837 or by mail at 684 Harvey Street, Suite 201, Muskegon, MI 49442.

WHO WILL FOLLOW THIS NOTICE

This notice describes information about privacy practices followed by our providers, employees and office personnel. The practices described in this notice will be also be followed by healthcare providers you consult with by telephone (when your regular healthcare provider from our office is not available) who provide “call coverage” for your healthcare provider.

YOUR HEALTH INFORMATION

This notice applies to the information and records we have about your health, health status, and the healthcare and services you receive at this office.

We realize that these laws are complicated, but we must provide you with the following important information:

· How we may use and disclose your health information.

· Your privacy rights regarding your health information.

· Our obligations concerning the use and disclosure of your health information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe the different ways in which we may use and disclose your health information.

For Treatment. Our practice may use your health information to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your health information in order to write a prescription for you, or we might disclose your health information to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, our providers and nurses – may use or disclose your health information in order to treat you or to assist others in your treatment. Additionally, we may disclose your health information to others who may assist in your care, such as your parents or legal guardians who are acting as your personal representative.

For Payment. Our practice may use and disclose your health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your health information to bill you directly for services and items.

For Health Care Operations. Our practice may use and disclose your health information to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.

Test Results/Appointment Reminders. Our practice may use and disclose your health information to contact you and remind you of an appointment. If we need to contact you about test results or to remind you of an appointment with our office, we may contact you by phone or mail. If there is no answer at your home we may leave a message on your answering machine or voice mail. If we do not have a current working phone number, we may contact you at work or leave a message at an alternate number asking you to contact our office.

Treatment Options. Our practice may use and disclose your health information to inform you of potential treatment options or alternatives.

Health-Related Benefits and Services. Our practice may use and disclose your health information to inform you of health-related benefits or services that may be of interest to you.

Release of Information to Family/Legal Guardian/Persons Authorized to Seek Medical Care. Our practice may release your health information to a family member or legal guardian that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter or stepparent take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter or stepparent may have access to the child’s medical information.

Disclosures Required By Law. Our practice will use and disclose your health information when we are required to do so by federal, state or local law.

DISCLOSURES IN SPECIAL SITUATIONS

The following categories describe unique scenarios in which we may use or disclose your health information:

Immunization Records. Our practice may use and disclose your immunization records. As examples of the ways in which we may use and disclose your immunization records, our practice may share the information with schools as required by them for your child’s attendance. This information may be mailed or faxed to the schools. Our practice may also use and disclose the information into the state computer registry (MICR) as required.

Public Health Risks. Our practice may disclose your health information to public health authorities that are authorized by law to collect information for the purpose of:

· Maintaining vital records, such as birth and deaths.

· Reporting child abuse or neglect.

· Preventing or controlling disease, injury or disability.

· Notifying a person regarding potential exposure to a communicable disease.

· Notifying a person regarding a potential risk for spreading or contracting a disease or condition.

· Reporting reactions to drugs or problems with products or devices.

· Notifying individuals if a product or device they may be using has been recalled.

· Notifying your employer, or your child's day care or school under limited circumstances related to your child's inability to attend daycare or school.

· Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

Health Oversight Activities. Our practice may disclose your health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings. Our practice may use and disclose your health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement. We may release health information if asked to do so by law enforcement officials:

· Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.

· Concerning a death we believe has resulted from criminal conduct.

· Regarding criminal conduct at our offices.

· In response to a warrant, summons, court order, subpoena or similar legal process.

· To identify/locate a suspect, material witness, fugitive or missing person.

· In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

Deceased Patients. Our practice may release health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

Organ and Tissue Donation. Our practice may release your health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

Serious Threats to Health or Safety. Our practice may use and disclose your health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military. Our practice may disclose your health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

National Security. Our practice may disclose your health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Inmates. Our practice may disclose your health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

Workers’ Compensation. Our practice may release your IIHI for workers’ compensation and similar programs.

DISCLOSURES REQUIRING AUTHORIZATION

Certain disclosures require authorization from the patient, or parent in the case of minor children. The following are disclosures requiring specific authorization:

Mental Health (Psychotherapy) Notes. See also MICHIGAN LAW AND HIPAA as to how this applies for minor children 14 years of age and older.

Protected Health Information Used for Marketing. Should Shoreline Pediatrics ever wish to use protected health information for marketing purposes, a patient authorization would be required.

Any Disclosure that Constitutes the Sale of Protected Information

MICHIGAN LAW AND HIPAA

Michigan law states that a patient is entitled to confidential treatment of personal and medical records, except as required by law. MCL 33320201(1)(c). There are specific statutory exceptions to a minor’s right to maintain the confidential nature of his or her health information:

Minor Infected with Venereal Disease. MCL 333.5127(2) provides that a minor may consent to treatment by a physician if the minor professes to be infected with a venereal disease. With regard to the release of such minor’s health information, the rule is that, for medical reasons, a physician may, but is not obligated to, inform the spouse, parent, guardian, or person in loco parentis as to treatment given or needed. The information may be given without consent of the minor, even if the minor does not consent to the disclosure of the health information.

Provision of Mental Health Services. MCL 330.1701(1) states that a minor 14 years of age or older may request and receive mental health services and a mental health professional may provide mental health services, on an outpatient basis, excluding pregnancy termination and referral services and the use of psychotropic drugs, without the consent or knowledge of the minor’s parent, guardian, or person in loco parentis. The minor’s parent, guardian, or person in loco parentis shall not be informed of the services without the consent of the minor unless the mental health professional treating the minor determines that there is a compelling need for disclosure based on a substantial probability of harm to the minor or to another individual, and if the minor is notified of the mental health professional’s intent to inform the minor’s parent, guardian, or person in loco parentis.

Provision of Prenatal and Pregnancy Health Services. MCL 333.912 provides that if a minor consents to the provision of prenatal and pregnancy related health care, the consent shall be valid and binding as if the minor had achieved the age of majority. For medical reasons, the treating physician, may, but is not obligated to inform the putative father of the child or the spouse, parent, guardian, or person in loco parentis as to the health care given or needed. The information may be given to or withheld from these persons without consent of the minor and notwithstanding the express refusal of the minor to the providing of the information.

Provision of Substance Abuse Related Medical or Surgical Care. Under MCL 333.6121, a minor’s consent to the provision of substance abuse related medical or surgical care, treatment, or services by a hospital, clinic, or health professional authorized by law is as valid and binding as if the minor had achieved the age of majority if the minor is or professes to be a substance abuser. The consent of any other person, including a spouse, parent, guardian, or person in loco parentis, is not necessary to authorize these services to be provided to a minor.

For medical reasons the treating physician, and on the advice and direction of the treating physician, a member of the medical staff of a hospital or clinic or other profession may, but is not obligated, to inform the spouse, parent, guardian, or person in loco parentis as to the treatment given or needed under these circumstances. The information may be given to or withheld from these persons without the consent of the minor.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding the health information that we maintain about you:

Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Julie Jennings, Privacy Officer, 684 Harvey St., Suite 201, Muskegon, MI 49442 specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your health information, you must make your request in writing to Julie Jennings, Privacy Officer, 684 Harvey St., Suite 201, Muskegon, MI 49442. Your request must describe in a clear and concise fashion:

· The information you wish restricted;

· Whether you are requesting to limit our practice’s use, disclosure or both; and

· To whom you want the limits to apply.

You have the right to request that the office not disclose to an insurance company any information about services for which you paid in full and out of pocket. Your request must be in writing and has to specify:

  • The date of service and information you wish restricted; and
  • What insurance company is not to receive the information.

Inspection and Copies. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Julie Jennings, Privacy Officer, 684 Harvey St, Suite 201, Muskegon, MI 49442 in order to inspect and/or obtain a copy of your health information. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to Julie Jennings, Privacy Officer, 684 Harvey St., Suite 201, Muskegon, MI 49442. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the health information kept by or for the practice; (c) not part of the health information which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your health information for non-treatment or operations purposes. Use of your health information as part of the routine patient care in our practice is not required to be documented. For example, the provider shares information with the nurse; or the billing department uses your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to Julie Jennings, Privacy Officer, 684 Harvey Street, Suite 201, Muskegon, MI 49442. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, request a copy from our receptionist or send a written request to Shoreline Pediatrics, 684 Harvey Street, Suite 201, Muskegon, MI 49442.

Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Julie Jennings at (231) 773-7837. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in the authorization. Please note that we are required to retain records of your care.

Breach Notification. Patients will be notified in writing of any breach of protected health information. A breach includes any loss or inappropriate disclosure of protected health information

The terms of this notice apply to all records containing your health information that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

© Gates, Moore & Company Adapted by Shoreline Pediatrics, P.L.C.

Reviewed & Revised May 30, 2013