NOTICE OF PRIVACY PRACTICES FOR
THE BEHAVIORAL CENTER OF MICHIGAN
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.
If you have any questions about this notice, please contact the
Privacy Officer at The Behavioral Center of Michigan at
WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed
by our employees, staff and other office personnel. The practices
described in this notice will also be followed by health care
providers you consult with by telephone (when your regular health
care provider from our office is not available) who provide "call
coverage" for your health care provider.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about
your health, health status, and the health care and services you
receive at this office.
We are required by law to give you this notice. It will tell you
about the ways in which we may use and disclose health information
about you and describes your rights and our obligations regarding
the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH
INFORMATION ABOUT YOU
We may use health information about you to provide you with
medical treatment or services. We may disclose health information
about you to doctors, nurses, technicians, office staff or other
personnel who are involved in taking care of you and your health.
For example, your doctor may be treating you for a heart condition
and may need to know if you have other health problems that could
complicate your treatment. The doctor may use your medical history
to decide what treatment is best for you. The doctor may also tell
another doctor about your condition so that doctor can help
determine the most appropriate care for you.
Different personnel in our office may share information about you
and disclose information to people who do not work in our office
in order to coordinate your care, such as phoning in prescriptions
to your pharmacy, scheduling lab work and ordering x rays. Family
members and other health care providers may be part of your
medical care outside this office and may require information about
you that we have.
We may use and disclose health information about you so that the
treatment and services you receive at this office may be billed to
and payment may be collected from you, an insurance company or a
third party. For example, we may need to give your health plan
information about a service you received here so your health plan
will pay us or reimburse you for the service. We may also tell
your health plan about a treatment you are going to receive to
obtain prior approval, or to determine whether your plan will
cover the treatment.
For Health Care Operations
We may use and disclose health information about you in order to
run the office and make sure that you and our other patients
receive quality care. for example, we may use your health
information to evaluate the performance of our staff in caring for
you. We may also use health information about all or many of our
patients to help us decide what additional services we should
offer, how we can become more efficient, or whether certain new
treatments are effective.
We may contact you as a reminder that you have an appointment for
treatment or medical care at the office.
We may tell you about or recommend possible treatment options or
alternatives that may be of interest to you.
Health Related Products and Services
We may tell you about health related products or services that may
be of interest to you.
Please notify us if you do not wish to be contacted for
appointment reminders, or if you do not wish to receive
communications about treatment alternatives or health related
products and services. If you advise us in writing (at the address
listed at the top of this Notice) that you do not wish to receive
such communications, we will not use or disclose your information
for these purposes.
We may use or disclose health information about you without your
permission for the following purposes, subject to all applicable
legal requirements and limitations:
To Avert a Serious Threat to Health or
We may use and disclose health information about you when
necessary to prevent a serious threat to your health and safety or
the health and safety of the public or another person.
Required By Law
We will disclose health information about you when required to do
so by federal, state or local law.
We may use and disclose health information about you for research
projects that are subject to a special approval process. We will
ask you for your permission if the researcher will have access to
your name, address or other information that reveals who you are,
or will be involved in your care at the office.
Organ and Tissue Donation
If you are an organ donor, we may release health information to
organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary
to facilitate such donation and transplantation.
Military, Veterans, National Security and
If you are or were a member of the armed forces, or part of the
national security or intelligence communities, we may be required
by military command or other government authorities to release
health information about you. We may also release information
about foreign military personnel to the appropriate foreign
We may release health information about you for workers'
compensation or similar programs. These programs provide benefits
for work related injuries or illness.
Public Health Risks
We may disclose health information about you for public health
reasons in order to prevent or control disease, injury or
disability; or report births, deaths, suspected abuse or neglect,
non accidental physical injuries, reactions to medications or
problems with products.
Health Oversight Activities
We may disclose health information to a health oversight agency
for audits, investigations, inspections, or licensing purposes.
These disclosures may be necessary for certain state and federal
agencies to monitor the health care system, government programs,
and compliance with civil rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose
health information about you in response to a court or
administrative order. Subject to all applicable legal
requirements, we may also disclose health information about you in
response to a subpoena.
We may release health information if asked to do so by a law
enforcement official in response to a court order, subpoena,
warrant, summons or similar process, subject to all applicable
Medical Examiners and Funeral Directors
We may release health information to a coroner or medical
examiner. This may be necessary, for example, to identify a
deceased person or determine the cause of death.
Information Not Personally Identifiable
We may use or disclose health information about you in a way that
does not personally identify you or reveal who you are.
Family and Friends
We may disclose health information about you to your family
members or friends if we obtain your verbal agreement to do so or
if we give you an opportunity to object to such a disclosure and
you do not raise an objection. We may also disclose health
information to your family or friends if we can infer from the
circumstances, based on our professional judgment that you would
not object. For example, we may assume you agree to our disclosure
of your personal health information to your spouse when you bring
your spouse with you into the exam room during treatment or while
treatment is discussed.
OTHER USES AND DISCLOSURES OF HEALTH
We will not use or disclose your health information for any
purpose other than those identified in the previous sections
without your specific, written Authorization. If you give us
Authorization to use or disclose health information about you, you
may revoke that Authorization, in writing, at any time. If you
revoke your Authorization, we will no longer use or disclose
information about you for the reasons covered by your written
Authorization, but we cannot take back any uses or disclosures
already made with your permission.
If we have HIV or substance abuse information about you, we cannot
release that information without a special signed, written
authorization from you that complies with the law governing HIV or
substance abuse records.
YOUR RIGHTS REGARDING HEALTH INFORMATION
You have the following rights regarding health information we
maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy your health information,
such as medical and billing records, that we use to make decisions
about your care. You must submit a written request to [designated
privacy official contact] in order to inspect and/or copy your
health information. If you request a copy of the information, we
may charge a fee for the costs of copying, mailing or other
associated supplies. We may deny your request to inspect and/or
copy in certain limited circumstances. If you are denied access to
your health information, you may ask that the denial be reviewed.
If such a review is required by law, we will select a licensed
health care professional to review your request and our denial.
The person conducting the review will not be the person who denied
your request, and we will comply with the outcome of the review.
Right to Amend
If you believe health information we have about you is incorrect
or incomplete, you may ask us to amend the information. You have
the right to request an amendment as long as the information is
kept by this office.
We may deny your request for an amendment if it is not in writing
or does not include a reason to support the request. In addition,
we may deny your request if you ask us to amend information that:
a) We did not create, unless the person or entity that created the
information is no longer available to make the amendment.
b) Is not part of the health information that we keep.
c) You would not be permitted to inspect and copy.
d) Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This
is a list of the disclosures we made of medical information about
you for purposes other than treatment, payment and health care
operations. To obtain this list, you must submit your request in
writing to the Privacy Officer at The Behavioral Center of
Michigan. It must state a time period, which may not be longer
than six years and may not include dates before April 14, 2003.
Your request should indicate in what form you want the list (for
example, on paper, electronically). We may charge you for the
costs of providing the list. We will notify you of the cost
involved and you may choose to withdraw or modify your request at
that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on the
health information we use or disclose about you for treatment,
payment or health care operations. You also have the right to
request a limit on the health information we disclose about you to
someone who is involved in your care or the payment for it, like a
family member or friend. For example, you could ask that we not
use or disclose information about a surgery you had.
We are Not Required to Agree to Your
If we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you may complete and submit a Request for
Restricting Uses and Disclosures and Confidential Communications
Form Information to The Privacy Officer
Right to Request Confidential
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For
example, you can ask that we only contact you at work or by mail.
To request confidential communications, you may complete and
submit the Requests For Restricting Uses and Disclosures and
Confidential Communications to The Privacy Officer at The
Behavioral Center of Michigan. We will not ask you the reason for
your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us
to give you a copy of this notice at any time. Even if you have
agreed to receive it electronically, you are still entitled to a
paper copy. To obtain such a copy, contact the Privacy Officer.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the
revised or changed notice effective for medical information we
already have about you as well as any information we receive in
the future. We will post a summary of the current notice in the
office with its effective date in the top right hand corner. You
are entitled to a copy of the notice currently in effect.
If you believe your privacy rights have been violated, you may
file a complaint with our office or with the Secretary of the
Department of Health and Human Services. To file a complaint with
our office, contact The Privacy Officer at 586-261-2266. You will
not be penalized for filing a complaint.: