HIPAA Notice of Privacy Practices
Public Health Delta and Menominee Counties
As required by the federal Health Insurance Portability & Accountability
Act of 1996 (HIPAA), we are providing you with this notice which describes how medical information about you may be
used and disclosed, and how you can get access to this information. Please review it carefully.
Our Legal Duty
We are required by law to maintain the
privacy of your health information. We are also required to give you this notice about our privacy practices, our legal
duties, and your rights concerning your health information. We reserve the right to make changes to this notice
as allowed by law. Current Notice of Privacy Practices can be obtained at any Public Health, Delta & Menominee
Counties (PHDM), office or from our website (www.phdm.localhealth.net).
Uses & Disclosures of Health Information
We may use your health information and
disclose it to appropriate persons, authorities, and agencies as allowed by federal and state law. We may do
this without your written permission for the following purposes:
Treatment
We may use and disclose your health information to a physician or
other healthcare provider providing treatment to you. For example, if we refer you to a physician for a service
we cannot provide, your health information will be disclosed to that office.
Payment
We may use and disclose your health information to obtain payment for
services we provide to you. For example, if an insurance company pays for your service, it may be necessary
to disclose your health information to that company in order for us to receive payment.
Healthcare Operations
We may use and disclose your health information in connection with
our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing
the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance,
conducting training programs, accreditation, certification, licensing or credentialing activities.
For example, chart audits evaluate the performance levels of nursing staff.
Appointment Reminders
We may disclose limited health information to provide you with
appointment reminders such as telephone voice messages, postcards, or letters.
Other Uses & Disclosures Not Requiring
Written Permission
Family & Friends for Care & Payment
Unless you request otherwise and in emergency situations, we may
disclose information to your family members, relatives, close friends, or others who are helping care for you or
helping pay your medical bills. For example, we may tell these persons of your location, general condition,
or death. If you are present, we will provide you with an opportunity to object to such uses or disclosures before
they are made.
Death
We may disclose your health information to coroners, medical examiners
(for example, to determine the cause of death) and funeral directors so they can carry out their duties.
Public Health Activities
We may use and disclose your health information with authorities to help
prevent or control disease, injury, or disability. For example, we are required to report certain diseases,
injuries, birth or death information to the Michigan Department of Community Health. Appropriate authorities will be
notified if we reasonably believe you are a possible victim of abuse, neglect, domestic violence, or other crimes.
We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or
that of others.
Required By Law
We may disclose your health information when we are required to do so by
federal, state, or local law.
Law Enforcement
We may disclose your health information to law enforcement officials
for specific purposes. For example, we may disclose your health information when required by law to report
certain injuries.
Legal Proceedings
We may disclose your health information in the course of certain legal
proceedings. For example, we may disclose your information in response to a court order.
Workers' Compensation
We may disclose your health information in order to comply with the laws
related to workers' compensation or similar programs.
Military, National Security, Law Enforcement Custody
We may disclose your health information with the proper authorities so
they may carry out their duties under the law. This applies if you are or were involved in the military, national security
or intelligence activities. It also applies if you are in the custody of law enforcement officials or an inmate in a
correctional institution.
Health Oversight Activities
We may disclose your health information to authorities and agencies for
oversight activities allowed by law, including audits, investigations, inspections, licensing, disciplinary actions, or
legal proceedings. These activities are necessary for oversight of the public health system, government programs, and
civil rights laws.
Organ & Tissue Donation
If you are an organ donor, we may disclose your health information to
organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank as
necessary to facilitate organ or tissue donation and transplantation.
Research
We may disclose your health information to research institutions. Should
we receive a request for research, every effort will be made to disclose information that does not contain individually
identifiable information, except as allowed by law.
With Your Authorization
Other uses and disclosures of health information not
covered by this notice or the laws that apply to us will be made only with your written authorization. If you give us
an authorization, you may revoke it in writing at any time. Your revocation will not affect any use of disclosures
permitted by your authorization.
Your Rights
Access
With a few exceptions, you have the right to read and obtain a copy
of your health information. You must make your request to access to your health information in writing. If copies
are requested, we will charge $0.25 for each page plus any postage if applicable.
If we deny your request to review or obtain a copy of
your health information, you may submit a written request for a review of that decision.
Correction
If you believe there is an error in your health information or something
has been left out, you have the right to ask us to correct the information. You must make the request in writing and give
the reason why your health information should be changed. If we did not create the information you believe is incorrect,
of if we disagree with you and believe your health information is correct, your request will be denied. You may appeal the
denial by writing to the address at the end of this form.
Request Restriction(s)
You have the right to ask that we restrict how we use or disclose your
health information for treatment, payment, or healthcare operations or the disclosures we make to someone who is involved
in your care or the payment for your care, such as a family member or friend. Under
the law, we are not required to agree to your request.
Record of Disclosure
You have the right to ask in writing for a list of disclosures we made of
your health information for purposes other than treatment, payment, healthcare operations, and certain other activities
for a period up to six years but not prior to April 14, 2003. If you request this record more than once per year, we may
charge you a reasonable, cost-based fee for providing the list.
Confidential Communications
You have the right to ask that we send information to you in different
ways or at different places. For example, you may wish to receive a test result at an address other than you home
address. We will grant reasonable requests.
Other Restrictions
Some state and federal laws have more strict privacy
requirements than HIPAA as to how we use and disclose your health information. PHDM will abide by whichever privacy
laws the are most strict. For example, we will not disclose your HIV test results without obtaining your written
permission, except as permitted by state law. We may also be required by law to obtain your written permission to use
and disclose your information related to treatment for a mental illness, developmental disability, or alcohol or drug
abuse.
Questions, Complaints & Requests
Any questions, complaints, appeals, or requests for information may be
addressed to:
Privacy Officer Public
Health, Delta & Menominee Counties
2920 College Avenue Escanaba, MI 49829
(906) 786-4111
You may also submit a written compliant to the U.S.
Department of Health & Human Services. You will not be penalized for filing a complaint.
This notice is effective on and after April 14, 2003.
This notice is in effect for all PHDM employed staff and business associates with whom we share health information
and who agree to be bound by this notice.
phdm:3/03:HIPAA-2
