|| 27177 Lahser Road
Southfield, MI 48034
Phone: 248. 352. 8970
Fax: 248. 352. 8933
Notice of Privacy Practices
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:
Tracey Gardner, Privacy Officer
Lahser Medical Campus
27177 Lahser, Suite 100
Southfield, Michigan 48048
Telephone (248) 352-8970
Fax (248) 352-8933
Your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at this office. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records generated by this office whether made by your personal physician or one of the office's employees.
This Notice will tell you about the ways in which we may use and disclose your medical information. This Notice will also describe your rights as well as the obligations we have regarding the use and disclosure of your medical information.
This office is required by law to:
How this Office May Use and Disclose Your Medical Information
- Make sure that medical information that identifies you is kept private;
- Give you this Notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the Notice that are currently in effect.
The following describes the various ways that your medical information may be used or disclosed by this office. For clarification we have included some examples. Not every possible use or disclosure is specifically mentioned, however, all of the ways we are permitted to use or disclose your medical information will fit into one of these general categories:
- Treatment. Medical information about you will be used to provide you with medical treatment and services. We may disclose your medical information to doctors, nurses, technicians and other personnel who are involved in providing you medical treatment.
- Payment. We may use or disclose medical 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 third party. For example, we may need to give your insurance provider (carrier) information about treatment you have received: they may then pay us or reimburse you for the treatment. We may also tell your insurance provider (carrier) about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- Health Care Operations. We may use or disclose medical information about you for office operations. These uses and disclosures are necessary to run our office and make sure that all of our patients receive quality care. For Example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many of our patients to determine what additional services the office should offer, what services are not needed, and whether new treatments are effective. We may also disclose information to doctors, nurses, technicians, and other personnel for training purposes. We will remove information that identifies you from this set of medical information so that others may use it to study health care and health care delivery without learning the identity of our patients.
- Appointment Reminders. We may use or disclose medical information to contact you as a reminder that you have an appointment at this office.
- Treatment Alternatives. We may use or disclose medical information to inform you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. We may use or disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Research. Under certain circumstances, we may use or disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition.
- As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, disclosure may be required by Worker's Compensation statutes and various public health statutes in connection with required reporting or certain diseases, child abuse and neglect, domestic violence, adverse drug reactions, etc.
- To Avert a Serious Threat to Health or Safety. We may use or disclose medical 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. Any disclosure, however, would only be to someone able to prevent the threat.
- Health Oversight Activities. We may disclose medical information to a governmental or other oversight agency for activities authorized by law. For example, disclosures of your medical information may be made in connection with audits, investigations, inspections, and licensure renewals, etc.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may use your medical information to defend the office or to respond to a court order.
- Law Enforcement. We may release medical information about you if required by law when asked to do so by a law enforcement official.
- Coroners and Medical Examiners. We may release medical information to a medical examiner to identify a deceased person or determine athe cause of death.
Your Rights Regarding Your Medical Information
You have the following rights regarding the medical information this office maintains about you:
- Right to Copy and Inspect. You have the right to copy and inspect your medical information.
To inspect and copy your medical information, you must submit your request in writing to Tracey Gardner, Lahser Medical Campus, 27177 Lahser, Suite 100, Southfield, Michigan 48048. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circimstances.
If you are denied access to your medical information, you may request that the denial be reviewed. For information regarding such a review contact Tracey Gardner.
- Right to Amend. If you feel that medical 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 for as long as the information is kept by this office.
To request an amendment, your request must be made in writing and submitted to Tracey Gardner. In addition, you must provide a reason that supports your request.
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:
- Was not created by us;
- Is not part of the medical information kept by this office;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to Accounting of Disclosures. You have the right to request a list of disclosures this office has made of your medical information.
To request an accounting of disclosures, you must submit your request in writing to Tracey Gardner. Your request must state a time period which may not be longer than six years and may not include dates prior to
February 26, 2003.
- Right to Request Restrictions. You have the right to request a restriction or limiation on the use or disclosures we make of your medical information.
We are not required to agree to your request for a restiction. If we do agree, we will comply with your request unless the information is required to provide emergency treatment for you.
To request restrictions, you must make your request in writing to Tracey Gardner.
- Right to Request Confidential Communications. You have the right to request that we communicate with only you in a certain matter. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to Tracey Gardner. We will accommodate all reasonable requests.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy.
You may obtain a copy of this Notice at our website: www.bwestmdpc.com
To obtain a paper copy of this notice, contact Tracey Gardner. TGardner@BWestMDPC.com
Revisions to This Notice
We reserve the right to revise this Notice. Any revised Notice will be effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of any revised Notice in this office. A revised Notice will have the effective date printed on the first page in the top right-hand corner. In addition, each time you visit the office we will offer you a copy of the current Notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the Department of Health and Human Services. To file a complaint with this office, contact Tracey Gardner, Lahser Medical Campus, 27177 Lahser, Suite 100, Southfield, Michigan, 48048. Telephone (248) 352-8970. Fax (248) 352-8933. TGardner@BWestMDPC.com
All complaints must be submitted in writing.
THIS OFFICE WILL NOT PENALIZE YOU IN ANY WAY FOR FILING A COMPLAINT.
Other uses of Medical Information
Other uses and disclosuers of your medical information not covered by this Notice or Privacy Practices will be made only with your written authorization. If you provide us with such authorization in writing to use or disclose medical 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 your medical information for the reasons covered by your written authorization.