We are required by law to maintain the privacy of Protected Health Information (PHI), to provide individuals with notice of our legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI. We much follow the privacy practices that are described in this notice while it is in effect. The notice takes effect Nov. 18, 2013, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law, and to make new notice provisions effective for all PHI that we maintain. When we make significant change in our privacy practices, we will change this notice and post the new notice clearly and prominently at our practice location, and we will provide copies of the new notice upon request.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We may use and disclose your health information for different purposes, including treatment, payment and health care operations. For each of these categories we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.
Treatment – We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to
Payment – We may use and disclose your health information to obtain reimbursement for treatment and services your receive from us or another entity involved with your care. Payment activities including billing, collections, claims management and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your dental health plan containing certain health information.
Healthcare Operations – We may use and disclose your health information in connection with your healthcare operations. For example, healthcare operations include quality, assessment and improvement activities, conducting training programs, and licensing activities.
Individuals Involved in Your Care or Payment for Your Care – We may disclose your health information to your family or friends or any other individual identified by you when they are involved in your care or in the payment for your care. Additionally, we may disclose information about your to a patient representative. If a person has the authority to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.
Disaster Relief – We may use or disclose your health information to assist in disaster relief efforts.
Required by Law – We may use or disclose your health information when we are required to do so by law.
Public Health Activities – We may disclose your health information for public health activities, including disclosures to: prevent or control disease, injury or disability; report child abuse or neglect; report reactions to medications or problems with products or devices; notify a person of a recall, repair, or replacement of products or devices; notify a person who may have been exposed to a disease or condition; or notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
National Security – We may disclose to military authorities the health information or Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials, health information required for lawful intelligence, counterintelligence, and other nation security activities. We may disclose to correctional institution or law enforcement official having lawful custody the PHI of an inmate or patient.
Secretary of HHS – We will disclose your health information to the Secretary of the U.S Department of Health and Human Services when required to investigate or determine compliance with HIPPA.
Worker’s Compensation – We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Law Enforcement – We my disclose your PHI for law enforcement purposes as permitted by HIPPA, as required by law, or in response to a subpoena or court order.
Health Oversight Activities – We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil right laws.
Judicial and Administrative Proceedings – If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.
Research – We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that have reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners, and Funeral Directors – We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to carry out their duties.
Fundraising – We may contact you to provide you the information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving communications.
Other Uses and Disclosures of PHI
Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. We will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for this notice (or as otherwise permitted or required by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance of the authorization.
Your Health Information Rights
Access – You have the right to look at or get copies of your health information, with limited exceptions. You mush make the request in writing. You may obtain a form of request access by using the contact information listed at the end of this notice. You may request information that we maintain on paper, we may provide photocopies. If you request information that we maintain electronically, you have the right to electronic copy. We will use the form and format you request if readily producible. We will charge you a reasonable cost based fee for the cost of supplies and labor of copying and for postage if you want copies mailed to you. Contact us using the information listed at the end of this notice for an explanation of our fee structure.
If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.
Disclosure Accounting – With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit your request in writing to the Privacy Official. If you request this accounting more than once in a 12 month period, we may charge you a reasonable, cost-based fee for responding to the additional requests.
Right to Request a Restriction – You have the right to request additional restrictions on our use of disclosure of your PHI by submitting a written request to the Privacy Official. Your written request must include (1) what information you want to limit, (2) whether you want to limit our use, disclosure or both, (3) to whom you want the limits to apply. We are required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for you or a person on your behalf (other than the health plan), has paid our practice for.
Alternative Communication – You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location request.
Amendment – You have the right to request that we amend your health information. Your request musts be in writing and it must explain why the information should be amended. You may deny your request under certain circumstances. If we agree to your request, we will amend your record(s) and notify you of such. If we deny your request for amendment, we will provide you with a written explanation of why we denied it and explain your rights.
Right of Notification of a Breach – You will receive notification of breaches of your unsecured PHI as required by law.
Electronic Notice – You may receive a paper copy of this notice upon request, even if you have agreed to receive this notice electronically on our web site or by electron mail (e-mail).
Questions and Complaints
If you have more information about our privacy practices or have questions or concerns, please contact us.
Michael P. Girskis DDS,MS & Associates
37667 Pembroke Ave.
Livonia, MI 48152