Huron Valley Consultation Center, Inc.
2750 South State St.
Ann Arbor, MI 48104(734) 662-6300
www.huronvalleyconsult.org
ALEX MARTINEZ, MSW, PRIVACY OFFICER
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
YOUR RIGHTS
When it comes to your health information, you have certain rights. This sections explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
*You can ask to see or get an electronic or paper 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 a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
*You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
*We may say "no" to your request, but we'll tell you why in writing within 60 days.
Request confidential communications
*You can ask us to contact you in a specific way(for example, home or office phone) or to send mail to a different address.
*We will say "yes" to all reasonable requests.
Ask us to limit what we use or share
*You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say no if it would affect your care.
*If you pay for a service or health care item out of pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
Get a copy of this privacy notice
*You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
*If you have given someone medical power of attorney or if someone is your 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 feel your rights are violated
*You can complain if you feel we have violated your rights by contacting us directly.
*You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/compaints/.
* We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
*Share information with your family, close friends, or others involved in your care
* Share information in a disaster relief situation
*Include your information in a hospital directory
*Contact you for fundraising efforts
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
* Marketing purposes
*Sale of your information
*Most sharing of psychotherapy notes
In the case of fundraising:
*We may contact you for fundraising efforts, but you can tell us not to contact you again.
OUR USES AND DISCLOSURES
We typically use or share your health information in the following ways:
* Treat you: We can use your health information and share it with other professionals who are treating you. Example: A clinic treating you asks another treating professional about your condition.
*Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.
*Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
Other ways we can use or share your health information:
Help with public health and safety issues.
*We can share health information about you for certain situations such as:
Preventing disease
Helping product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect or domestic violence
Preventing or reducing a serious threat to anyone's health or safety
*Do research
We can use or share your information for health research
*Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
*Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
*Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner or funeral director when an individual dies.
*Address workers' compensation, law enforcement and other government requests
We can use or share health information about you:
*For workers' compensation claims
*For law enforcement purposes or with a law enforcement official
*With health oversight agencies for activities authorized by law
* For special government functions such as military, national security, and presidential protective services
* Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Whenever a conflict between state and federal law exists, we adhere to the most restrictive guidelines to help ensure the highest level of protection for your health information.
OUR RESPONSIBILITIES
*We are required by law to maintain the privacy and security of your protected health information.
*We will let you know promptly 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 give you a copy of it.
*We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
* For more information see: www.hhs/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
* 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 upon request, in our office and on our website.
This notice of Privacy Practices applies to the following organization:
Huron Valley Consultation Center
Effective Date: 5.15.2017
FOR MORE INFORMATION ABOUT THE JOINT COMMISSION, OUR ACCREDITATING ORGANIZATION, OR TO FILE A COMPLAINT:
THE JOINT COMMISSION OFFICE OF QUALITY MONITORING
ONE RENAISSANCE BOULEVARD
OAKBROOK TERRACE, IL 60181
(800) 994-6610