Effective Date: September 23, 2013
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 Angie O'Dowd, LifeWays Community Mental Health, Corporate Compliance Officer at 517.789.1278, 1200 N. West Ave., Jackson, MI 49202.
This notice applies to the information and records we have about you, your health, health status, and the health care and services you receive from LifeWays Community Mental Health. 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. LifeWays’ employees are responsible for upholding the privacy practices describes below.
Your health information may include information created and received by LifeWays, may be in the form of written or electronic records or spoken words, and may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity and similar types of health-related information.
We may use and disclose health information for the following purposes:
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, case managers, staff or other personnel who are involved in taking care of you and your health.
Different personnel in our organization may share information about you and disclose information to people who do not work for LifeWays Community Mental Health in order to coordinate your care, such as phoning in prescriptions to your pharmacy or scheduling lab work. 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 will request your permission before sharing health information with your family or friends unless you are unable to give permission to such disclosures due to your health condition.
We may use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party.
We may use and disclose health information about you in order to run LifeWays 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 use or disclose health information about you for the following purposes, subject to all applicable legal requirements and limitations:
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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. Examples of disclosures requiring your authorization include disclosures to your partner, your spouse, your children and your legal counsel. We also will not use or disclose your health information for the following purposes 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.
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.
You have the following rights regarding health information we maintain about you:
If we deny or partially deny your request for amendment, you have the right to submit a rebuttal and request the rebuttal be made a part of your medical record. You also have the right to request that all documents associated with the amendment request (including rebuttal) be transmitted to any other party any time that portion of the medical record is disclosed.
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. {If a direct care provider - We will post the current notice at our location(s) with its effective date in the top right hand corner. You are entitled to a copy of the notice currently in effect.
We will inform you of any significant changes to this Notice. This may be through our newsletter, a sign prominently posted at our location(s), a notice posted on our web site or other means of communication.
We are legally required to notify you if there is a breach of your unsecured protected health information. Unsecured protected health information is health information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the protected health information unusable, unreadable, and undecipherable to unauthorized users. Our notice to you will describe what happened, let you know about any additional steps you should take to protect yourself from potential harm resulting from the breach, and let you know how to contact us to ask questions or obtain more information about the breach. In addition to notifying you, we will also report the breach to the Secretary of the U.S. Department of Health and Human Services and, where required by law, to media outlets.
If you believe your privacy rights have been violated, you may file a complaint with our office. You may also file a complaint with the Secretary of the Department of Health and Human Services at:
Angie O'Dowd Corporate Compliance Officer 1200 N. West Ave. Jackson, MI 49202 Phone: 517.789.1278 Anonymous Hotline: 517.789.2485 Fax: 517.789.1271
U.S. Department of Health & Human Services Celeste Davis, Regional Manager 233 N. Michigan Ave., Suite 240 Chicago, IL 60601 Phone: 800.368.1019 Fax: 202.619.3818