We know that keeping your personal information private is important to you. That's why Forest Hills Pediatric Associates wants you to know how we protect the information that you share with us.
We have built our practice on a foundation of integrity, honesty, and trust. These values are reflected in our commitment to protect your privacy.
This Notice of Privacy Practices is NOT an authorization. It describes how we, our Business Associates, and their subcontractors, may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected Health Information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental condition and related health care services.
Your Rights Under The Privacy Rule
Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices—We are required to follow the terms of this notice. We reserve the right to change the terms of our notice at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment.
You have the right to authorize other use and disclosure—This means without your authorization, we are expressly prohibited to use or disclose your PHI for marketing purposes. We may not sell your PHI without your authorization. We may not use or disclose most psychotherapy notes contained in your protected health information. We will not use or disclose any of your PHI that contains genetic information that will be used for underwriting purposes.
You may revoke the authorization, at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential information—This means you have the right to ask us to contact you about medical matters using an alternative method (i.e. email, text, telephone), and to a destination (i.e. cell phone number, alternate address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. You may also go to our website to change your preferred method of contact. We will allow all reasonable requests.
You have the right to inspect and copy your PHI—This means you may inspect and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper of electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI—This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except for in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out of pocket. We are not permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information—This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.
You have the right to receive a privacy breach notice—You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.
How We May Use or Disclose Protected Health Information
Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment—We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose your PHI to other healthcare providers who may be involved in your care and treatment including training of medical students and residents.
Special Notices—We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services provided by our office or suggested by a health insurance plan. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.
Payment—Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.
Healthcare Operations—We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions, and patient safety activities.
Health Information Organization—The practice may elect to use a health information organization, physician's organization or other such organization to facilitate the electronic exchange of information for the purpose of treatment, payment or healthcare operations.
To Others Involved in Your Healthcare—Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person, that you identify, your PHI that directly relates to that person's involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures—We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; Michigan Childhood Immunization Registry; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker's compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
You have the right to complain to us or to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us.
You may file a complaint with us by notifying our Compliance Officer at (616) 957-5165 extension 318 or firstname.lastname@example.org. We will not retaliate against you for filing a complaint.