Effective Date: September 1, 2013
Mott Children’s Health Center
THIS 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.
Mott Children’s Health Center (“MCHC”) takes the privacy of the health information entrusted to us seriously. We are required by law to:
- Maintain the privacy of health information
- Provide you with this Notice of Privacy Practices (“Notice”), which tells you about our duties and practices with respect to protecting health information.
- Abide by the terms of the Notice that is currently in effect.
- Notify you following a breach of unsecured health information that affects you or your child.
HOW WE MAY USE AND DISCLOSE YOUR OR YOUR CHILD’S HEALTH INFORMATION.
The following categories describe different ways MCHC may use and disclose health information without your written authorization. Health information is most often used and disclosed to provide treatment, to obtain payment, or for health care operations. For each of these categories, we will provide some examples. Not every use or disclosure in a category will be listed, but all the ways we use or disclose information are described in this Notice. References to “you” and “your” information include your child’s information, when appropriate.
- For Treatment. MCHC may use and disclose health information to provide treatment, health care or other related services. Health information may be used by or disclosed to doctors, nurses, aides, or other healthcare providers who are involved in taking care of you/your child. Additionally, MCHC may use or disclose health information to manage or coordinate treatment, health care or other related services. [For example, we might use or disclose health information when you or your child is referred to a specialist, when prescribing medicine, or when you request that we transfer care to another clinician.]
- For Payment. MCHC may use and disclose health information to bill and collect for the treatment and services we provide. We may send health information to an insurance company or other third party for payment purposes. We may tell your health plan about proposed treatment to obtain prior approval, or to determine whether the health plan will pay for the treatment. [For example, we will use and disclose health information for payment purposes when we send information to your insurance company so they will pay for your care.]
- For Health Care Operations. MCHC may use and disclose health information for health care operations. These uses and disclosures are necessary to run MCHC, to make sure you/your child receive competent, quality health care, and to maintain and improve the quality of health care we provide. [For example, we may disclose medical records for to obtain accreditation, for quality improvement activities, or for teaching purposes.]
- As Required by Law. MCHC will disclose your/your child’s health information when required to do so by federal, state or local law.
- For Public Health Purposes. MCHC may disclose your/your child’s health information for public health activities. While there may be others, public health activities generally include the following:
- Preventing or controlling disease, injury or disability;
- Reporting births and deaths;
- Reporting defective medical devices or problems with medications;
- Notifying people of recalls of products they may be using; and
- Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- About Victims of Abuse. MCHC may disclose your/your child’s health information to notify the appropriate government authority if we believe you/your child have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
- Health Oversight Activities. MCHC may disclose your/your child’s health information to a health oversight agency for activities authorized by law. These activities include audits, investigations, licensure and disciplinary actions needed to monitor the health care system, governmental benefit programs and certain civil rights laws which require healthcare information for enforcement.
- Judicial Purposes. MCHC may disclose your/your child’s health information in response to a court or administrative order, if certain requirements are met.
- Law Enforcement. MCHC may release health information if asked to do so by a law enforcement official if the disclosure is:
- Required by law;
- Required by a court order, subpoena, warrant, summons or similar process;
- To identify or locate certain people who are missing or possibly involved in a crime;
- About a crime committed at MCHC, or about victim of a crime in some situations;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at MCHC or
- In certain emergency circumstances to report details about a crime.
Research. Under certain circumstances, MCHC may use and disclose health information about you/your child for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who receive one medication to those who receive another. All research projects, however, are subject to a special approval process. This process includes evaluating a proposed research project and its use of health information, trying to balance the research needs with your need for privacy of your/your child’s health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. When it is necessary for research purposes and the health information will not leave MCHC, we may disclose your/your child’s health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. We may ask for your specific permission if the researchers will need more access to your health information. If certain criteria are met, MCHC may disclose your/your child’s health information to researchers after your/your child’s death for research purposes.
- To Avert a Serious Threat to Health or Safety. MCHC may use and disclose health information when MCHC believes it is necessary to prevent a serious threat to health and safety of an individual or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in some circumstances.
- Decedent. MCHC may disclose health information about an individual that has died to law enforcement officials for the purpose of alerting law enforcement about the death of the individual if it is suspected the death may have resulted from criminal conduct.
- Coroner, Medical Examiners, and Funeral Directors. MCHC may disclose health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties authorized by law. MCHC may disclose health information to a funeral director, consistent with law, to permit the funeral director to carry out his/her duties.
- Organ Donation Purposes. MCHC may disclose health information to organ procurement organizations and others engaged in procurement, banking or transplantation of cadaveric organs, eyes, or tissue for the purposes of facilitating organ donation and transplantation.
- Military and Veterans. If you/your child are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
- National Security and Intelligence Activities. MCHC may release health information to authorized federal officials for intelligence, counterintelligence and other national security activities as authorized by law.
- Protective Services for the President and Others. MCHC may disclose health information to authorized federal officials so they may provide protection to the President, other authorized persons, or for the conduct of special investigations.
- Custodial Situations. If you are an inmate or in the custody of law enforcement, MCHC may disclose health information to the correctional institution or law enforcement official for treatment or safety purposes.
- Worker’s Compensation. MCHC may disclose your health information as authorized by and to the extent necessary to comply with worker’s compensation laws or laws relating to similar programs.
- Individuals Involved in Your/Your Child’s Care or Payment for Your/Your Child’s Care. MCHC may release health information about you/your child to a family member, other relative or any other person identified by you who is involved in your/your child’s health care. MCHC may also give information to someone who helps pay for your/your child’s care. MCHC may also tell your family, friends, personal representative or other person responsible for your/your child’s health care your/your child’s health condition and that you/your child are a patient at MCHC. MCHC may also disclose to a family member, other relative, close personal friend or any other person previously identified by you or your child personal health information that is directly relevant to that person’s involvement with your child’s or payment of the care unless MCHC is aware of your/your child’s desire not to have this information shared.
OTHER USES OF HEALTH INFORMATION
- For School Admission. MCHC may disclosure your child’s immunization record to a school where your child is or will be a student if the school is required by law to have proof of immunizations prior to admitting your child. MCHC must obtain your agreement, written or oral, to disclose this information and document this agreement.
- Health Information Exchange. MCHC may participate in a health information exchange (“HIE”) that permits computer-based transfer of health information directly between healthcare providers at different facilities to facilitate your care and treatment. If you do not want your information to be shared in this way, you can opt out by notifying the HIE.
- Other Laws. MCHC will also comply with other, more strict state and federal laws. For example, state laws are more strict regarding release of HIV and AIDS information, and federal laws limit release of certain drug and alcohol abuse treatment information. MCHC complies with these more strict laws.
- Any 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 provide us authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your health information for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made under the authorization, and that we are required to retain our records of the care that we provided.
*Health information is no longer subject to this Notice after the individual has been dead for more than 50 years.
Tours: MCHC, as a teaching facility and member of the healthcare community, periodically conducts tours of the facility to educate people about the programs that MCHC offers. You may on occasion see groups of individuals being escorted through areas of the facility. In the course of providing these tours, MCHC staff will be respectful of you/your child’s privacy.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding health information we maintain about you:
- Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you/your child for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you/your child to someone who is involved in your/your child’s care or the payment of that care. In most cases, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to our Privacy Officer, Mott Children’s Health Center, 806 Tuuri Place, Flint, MI 48503. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. We must agree to your request if you have paid for the care out-of-pocket, and the restriction requested is that information regarding that care not be provided to your health plan, as long as the disclosure is not needed for your treatment. We will not forward the request for restriction to other providers. If you want your other providers to not tell your health plan about care you paid for out-of-pocket, you must request the restriction separately from each provider.
- Right to Request Confidential Communications. Typically, we communicate with you regarding your/your child’s health care either through your home phone or through the mail at your home address. You have the right to request that we communicate with you or your responsible party about your/your child’s health care in an alternative way or at a certain location. To request confidential communications, you must make your request in writing to our Privacy Officer, Mott Children’s Health Center, 806 Tuuri Place, Flint, MI 48503. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your/your child’s care. You have a right to request to receive your/your child’s protected electronic health information in the electronic form or format of your choice (i.e. flash drive, cd) if it is readily producible in the requested form or format. If the information is not maintained in the requested format, MCHC must provide you/your child with the health information in a readable electronic form and format agreed to by you and MCHC within 30 days of the receipt of the request. MCHC will transmit a copy of your/your child’s health information to another person you/your child designates. The designation must be:
- In writing
- Signed by you
- Clearly identify the designated person and where to send the copy.
To inspect and copy health information that may be used to make decisions about you/your child, you can submit your request in writing or orally to our Privacy Officer at Mott Children’s Health Center, 806 Tuuri Place, Flint, MI 48503.
- Right to Amend. You have the right to ask us to amend your/your child’s health and/or billing information for as long as the information is kept by MCHC. To request an amendment, your request must be made in writing and submitted to Privacy Officer, Mott Children’s Health Center, 806 Tuuri Place, Flint, MI 48503. In addition, you must provide a reason that supports your request. We may 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 may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the health information kept by or for MCHC;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your/your child’s health information. To request this list of disclosures, you must submit your request in writing to the Privacy Officer, Mott Children’s Health Center, 806 Tuuri Place, Flint, MI 48503. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in which format you want to receive the list of disclosures (for example, on paper, electronically). The first list you request within a twelve-month period will be free. For additional lists during such twelve-month period, MCHC may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to notification of a breach of your unsecured health information. MCHC must notify you if MCHC reasonably believes that your/your child’s unsecured protected health information has been accessed, acquired, used or disclosed in an unauthorized manner. [Examples include: hacking of MCHC’s network, theft or loss of files containing unsecured protected health information, loss of a laptop containing unencrypted protected health information]
- 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. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at our web site at www.mottchc.org. To obtain a paper copy of this Notice, contact Privacy Officer, Mott Children’s Health Center, 806 Tuuri Place, Flint, MI 48503.
WHO THIS NOTICE APPLIES TO:
This Notice describes MCHC’s practices and those of:
- Any health care professional authorized to enter information into or consult your/your child’s medical record at MCHC.
- All departments and units of MCHC.
- Any member of a volunteer group we allow to help you/your child.
- All employees, staff and other MCHC personnel.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you/your child, as well as any information we receive in the future. We will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice is also available to you upon request. The Notice will contain, on the first page in the top right-hand corner, the effective date. In addition, if we revise the Notice and you are still with MCHC and request it, we will provide you a copy of the current Notice in effect.
If you believe your/your child’s privacy rights have been violated, you may file a complaint with MCHC or with the Secretary of the Department of Health and Human Services. To file a complaint with MCHC, contact our Privacy Officer at (810) 767-5750, ext. 5183. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you have any questions about this Notice:
Mott Children’s Health Center
Attn: Privacy Officer
806 Tuuri Place
Flint, MI 48503
Mott Children’s Health Center does not discriminate on the basis of race, color, national origin, sex, gender, age or disability in its health programs and activities.
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