Effective Date: February 1, 2013
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
WHO WILL FOLLOW THIS NOTICE?
This notice describes the information sharing practices of Children’s Eye Care (also known as CEC), and our medical staff when they are providing services to you as a patient of our health system. That system includes locations in Clinton Township, Dearborn, Detroit and West Bloomfield. Most of the information sharing within our system is done to treat you, to obtain payment for that treatment, for administrative purposes and to evaluate the quality of care that you’ve received while you were our patient. There are times, as described in this notice, when we may share information about you for other reasons. We keep this information in what is generally referred to as a “medical record”. The medical record is the physical property of CEC.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
Each of the following categories describes how medical information about you may be used and disclosed.
- For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other healthcare personnel who are involved in taking care of you. For example, a doctor treating you for asthma may need to know if you are taking certain eye medications because they may exasperate breathing issues.
- For Payment. We may use and disclose medical information about you so that the treatment and services you receive at CEC may be billed to and payment may be collected from an insurance company or a third party. For example, we may need to give your insurance provider information about care you received at the CEC so your insurer will pay us or reimburse you for the surgery.
- For Health Care Operations. We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run our health system 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 disclose information to doctors, nurses, technicians, medical students and other healthcare personnel for review and learning purposes.
- Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care with us.
- Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.
- Research. Under certain circumstances, we may use and 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. All projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use and its use of medical information trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital.
- As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
- To Avert a Serious Threat to Health or Safety. We may use and 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 help prevent the threat.
- Organ and Tissue Donation. If you are an organ donor, we may release medical 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.
- Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Workers’ Compensation. We may release medical information about you for the workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following: Reporting births and deaths; prevention or control of disease; to report child and/or senior/vulnerable persons abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition and as required by law.
- Health Oversight Activities. We may disclose medical information to a health oversight agency activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure.
- Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a dispute. As deemed appropriate and allowable, DMC will obtain an order protecting the information requested.
- Law Enforcement. We may release medical information to law enforcement officials. We might do this in order to help identify or locate a suspect, fugitive or material witness. Or we may release medical information when it is the subject of a subpoena or other court order.
- Coroners, Medical Examiners and Funeral Directors. We may release medical information 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 release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy. You have the right to inspect and be provided copies of medical information that may be used to make decisions about your care.
- 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. We will 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 will deny your request if you ask us to amend information that was not created by us. We will deny your request if you ask us to amend information that is not part of the medical information kept by CEC. We will deny your request when our information is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”. An accounting of disclosures is a list of those people and/or organizations we’ve given your medical information to with a number of notable exceptions. Those exceptions include, but are not limited to: disclosures of your medical information for purposes of treatment, payment or healthcare operations, or disclosures we’ve made pursuant to a valid authorization.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree with your request.
- Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.
OTHER USES OF THIS MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
GENERAL INFORMATION & COMPLAINTS
Please tell us about any problems or concerns you have with your privacy rights or to find out how the office uses or discloses your medical information, please contact:
Children’s Eye Care’s corporate offices: 248-254-8140
Email at firstname.lastname@example.org