NOTICE OF HEALTH INFORMATION PRACTICES
JUPITER FAMILY MEDICINE
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
INTRODUCTION
We are committed to treating and using protected health information about you responsibly. This notice describes how and when we use or disclose that information. This notice is effective April 14, 2003 and applies to all protected health information as defined by federal regulations.
UNDERSTANDING YOUR HEALTH INFORMATION
Your health information serves as a:
* Basis for planning your care and treatment,
* Means of communication among health professionals who contribute to your care,
* Legal document describing the care you received,
* A tool in educating health care professionals,
* A source of data for medical research,
* A source of information for public health officials charged with improving the health of this state and the nation,
* A source of data for our planning and marketing,
* A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
YOUR HEALTH INFORMATION RIGHTS
You have the right to:
* Inspect and copy your protected health information,
* Amend your protected health information. But at the same time, the doctor has the right to deny those requests,
* Obtain an accounting of disclosures of your health information,
* Specify the manner in which you receive communication about your records or upcoming appointments,
* Restrict who sees your medical information,
* Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
OUR RESPONSIBILITIES
Jupiter Family Medicine is required to:
* Maintain the privacy of your health information,
* Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
* Abide by the terms of this notice,
* Notify you if we are unable to agree to a requested restriction,
* Accommodate reasonable requests you may have concerning the manner in which you receive communication about your records or upcoming appointments.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. You will be advised should our information practices change. We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS
* Information recorded in your records will be used to determine the course of treatment that should work best for you. We may also provide your physicians with copies of various reports that should assist them in treating you if requested.
* A bill may be sent to you or a third-party payer. The information on or with the bill may include information that identifies you, as well as your balance.
* Members of the medical staff may use information in your health record to assess the care an outcomes in your case and others like it.
* We may contact you by phone to provide appointment reminders.
* We may also call you by name in the waiting room.
* We may contact you by phone or mail to provide you with test results and to provide information that describes or recommends treatment alternatives regarding your care.
* We may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. We require the business associate to appropriately safeguard your information.
* We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
* We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact the practice's Privacy Officer at 616-301-2500.
If you believe your privacy rights have been violated, you can file a complaint with the practice's Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office of Civil Rights.
The address for O.C.R. is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201