Notice of Privacy Statement
THE 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.
Michigan Institute of Pain Management, P.C., is required by law to maintain the privacy and confidentially of your Protected Health Information and to provide our patients with notice of our legal duties and privacy practice with respected to your Protected Health Information.
Normally, the privacy of patient personal health information is protected. However, under certain circumstances, government rules and regulation supersede the patient’s right of privacy. For instance, doctors are required by law to report certain communicable diseases to the appropriate government agencies. Child abuse is another area where government regulations supersede the patient’s right of privacy.
Effective April 14, 2003, all physicians are required, by law, to provide their patients with a written notice listing the situations in which the patient’s right of privacy may be superseded by, or secondary to, other government regulations and/or Michigan Institute of Pain Management, P.C., privacy practice. The following is your notice, which we are required to give every patient, and also to have each patient acknowledge the fact that they received the notice.
Disclosure of Your Health Care Information
Under certain circumstances, your Protected Health Information may be disclosed as outlined below:
- Disclosure for Treatment Purposes
We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or health operations.Examples:
- On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Michigan Institute of Pain Management, P.C.
- It is our policy to provide a substitute health care provider, authorized by Michigan Institute of Pain Management, P.C., to provide assessment and/ or treatment to our patients, without advance notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.
- Disclosure for Payment Purposes
We may disclose your health information to your insurance provider for the purpose of payment or health care operations.Example: As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Michigan Institute of Pain Management, P.C. for pain care services rendered. If you pay for your health care services personally, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to you. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received.
- Disclosure for Worker’s Compensation Purposes
We may disclose your health information as necessary to comply with State Workers’ Compensation Laws. - Disclosure for Emergency Purposes
We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care, about medical condition or in the event of an emergency or of your death. - Disclosure for Public Health Purposes
As required by law, we may disclose your health information to public health authorities for purpose relates to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure. - Disclosure for Judicial and Administrative Proceedings
We may disclose your health information in the course of any administrative or judicial proceeding. - Disclosure for Law Enforcement
We may disclose your health information to a law enforcement official for proposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes. - Disclosure for Deceased Persons
We may disclose your health information to coroner or medical examiners. - Disclosure for Public Safety Purpose
It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public. - Disclosure for Specialized Government Agencies
We may disclose your health information for military, national security, prisoner and government benefits purposes. - Disclosure for Appointment Reminders, Marketing & Fundraising Purposes
We may contact you for marketing purposes or fundraising purposes, as described below.Example: Appointment Reminders- Our policy is to remind of scheduled or missed appointment. Typically, we may call your home concerning a scheduled appointment or a missed appointment. If you are not home, we may leave a reminder message on your answering machine. If you are not available, we may leave a reminder on your voice mail or with the person who takes your message. No personal health information will be disclosed during this recorded message other then the date and time of your next scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment.
- Lab and Test Results
We may notify you of the availability of lab or test results by calling your home or office. If you are not available, we will leave a message stating that your results are available and to keep and/or schedule an appointment to review lab results. - Emails, SMS and Texting
We may, from time to time communicate with you by electronic means. We will assume that your email, SMS and texting are private. If your e-mail is not private, or if you do not want to receive communication by email, SMS, and/or Texting, please let us know. - Disclosure in the Event of Change of Ownership
In the event that Huraibi Pain & Rehab Institute, PLLC, is sold or merge with another organization, your health information record will become property of the new owner.
YOUR HEALTH INFORMATION RIGHTS
You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, Huraibi Pain & Rehab Institute, PLLC, is not required to agree to the restrictions that you requested.
Your have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
You have the right to inspect and copy your health information.
You have the right to request that Huraibi Pain & Rehab Institute, PLLC, protected health information. Please be advised, however, Huraibi Pain & Rehab Institute, PLLC, is not required to agree to amend your protected health provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.
You have the right to receive any accounting of the disclosures of your protected health information made by Huraibi Pain & Rehab Institute, PLLC
You have the right to a paper copy of this Notice of Privacy at any time upon request.
CHANGE TO THIS NOTICE OF PRIVACY
Huraibi Pain & Rehab Institute, PLLC, reserves the right to amend the Notice of Privacy at any time in the future, and will make the provisions effective for all information that it maintains. Until such amendment is made, Huraibi Pain & Rehab Institute, PLLC, is required by law to comply with this Notice.
Huraibi Pain & Rehab Institute, PLLC, is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practice with respect to your health information.
COMPLAINTS
Complaints about your Privacy right or how Huraibi Pain & Rehab Institute, PLLC, has handled your health information should be directed to our office at 770-739-1233. You may make an appointment for a personal conference in person or by telephone with 2 working days.
If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Ave, S.W.
Room 504F HHH Building
Washington, DC 20201
