NOTICE OF PRIVACY PRACTICES – rev 03.28.2017
We are required by law to maintain the privacy and security of your protected health information. We will promptly let you know if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and if requested, give you a copy of it. We will not use or share your information other than as described below, unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.
For more information go to: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
You have the right to get a copy of your paper or electronic medical record.
- You can ask to see or get a copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or summary of your health information, within 30 days of your request. We may charge a reasonable, cost-based fee as determined by the State of Michigan.
- Correct our paper or electronic medical record.
- You can ask us to correct health information about you that you think is incorrect or incomplete. As us how to do this.
- We can deny your request, but we will tell you why in writing within 60 days.
- Request confidential communication.
- You can ask us to contact you in a specific way (example: home or office phone) or to send mail to a different address and we will comply with all reasonable requests.
- Ask us to limit the information we share.
- You can ask us NOT to use or share certain information for treatment/payment/or our operations.
- We are NOT required to agree to your request, and we can say no if it would affect your care.
- If you pay for a service we provide out-of-pocket in full, you can ask us not to share that information with your health insurer.
- We will comply with this request unless a law requires us to share that information.
- Get a list of those with whom we have shared your information.
- You can ask for a list of times we shared your health information for up to 6 years prior to the date you ask who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment and other disclosures that you might have asked us to make.
- We will provide the first list for free but will apply a cost-based fee if another is request is made within 12 months.
- You can ask for and promptly receive a paper copy of this notice at any time.
- You can assign someone to act for you.
- If you have given someone medical power of attorney or if you have a legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
- File a complaint if you think you privacy rights have been violated.
- You can complain if you feel we violated your rights as outlined above.
- Complaints can be filed in writing with the US Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, SW, Washington DC, 20201.
- You can also file a complaint by calling 877-696-6775, or by internet at hhs.gov/ocr/privacy/hipaa/complaints/
- We will not retaliate against you for filing a complaint.
For certain health information, you can choose how we use and share your information. Based on the following situations, you can tell us what you want us to do and we will follow your instructions. If you are unable to tell us your preference (example: you are unconscious), we may share your information if we believe it is in your best interest. We may also share your information when needed due to a serious and imminent threat to health or safety.
- You can tell us if you want us to provide information to family, close friends, or others involved in your care.
- You can tell us whether you want us to provide information in case of a disaster relief situation.
We will NEVER share your information for marketing purposes or sell your information. We CAN use and share your information:
- To provide your medical care or share your information with other health professionals who are involved in your health care.
- To bill and receive payment from your health plans or other entities, for the services we provide.
- In ways that contribute to the public good, such as public health and safety issues as we are allowed or required by law. Before we can share your information for these purposes, there are conditions we must meet by law. For further information go to: hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
- For health research.
- If state or federal laws require it, including with the Department of Health and Human Services if it wants to confirm we are complying with federal privacy law. We will also share your information in response to a court order or administrative order, or in response to a subpoena.
- With organ and/or tissue procurement organizations.
- With a coroner, medical examiner or funeral director when a patient dies.
- For workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; or for special government functions like the military, national security, and presidential protective services.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available in our office upon request, or on our web site: www.cantonallergy.com. Our Privacy Officer is: Jacquelyn Arzooyan. She can be reached at our Canton office at 734/394-2661.
This Notice of Privacy Practices is effective 1 March 2017, and applies to the following locations:
Canton Asthma & Allergy – CANTON
1600 S Canton Center Road, #360
Canton, MI 48188
Canton Asthma & Allergy – NOVI
39475 Lewis Drive, #140
Novi, MI 48377