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.
We at Doctors’ Hospital of Michigan are required by law to maintain the privacy of individually identifiable patient health information (this information is “protected health information” and is referred to in this document as “PHI”). We are also required to provide patients with a Notice of Privacy Practices regarding PHI. We are required to post this Notice in a prominent place within our facility. We will only use or disclose your PHI as permitted or required by applicable state or federal law. This Notice applies to your PHI in our possession including the medical records generated by us.
Doctors’ Hospital of Michigan understands that health information about you is personal and we are committed to protecting your privacy.
This notice applies to all records of your care generated by Doctors’ Hospital of Michigan and it’s workforce, at the main hospital, outpatient departments, outpatient facilities, clinics, Physician Services, Inc., Waterford Ambulatory Care Center, Waterford Ambulatory Surgi-Center, Euro Peds, RT Services Corporation, and all related services. This Notice also applies to the utilization review and quality management activities of the above named entities. Your personal doctor or consulting doctor(s) may have different policies or notices regarding use and disclosure of your health information related to their services outside of Doctor’s Hospital of Michigan. Doctors’ Hospital of Michigan will be referred to in this document as DHM.
I. Permitted Use or Disclosure
A. Treatment: DHM will use and disclose your PHI in the provision and coordination of health care to carry out treatment functions.
- DHM may disclose all or any portion of your patient medical record information to your attending physician, consulting physician(s), nurses, technicians, medical students and other health care providers who have a legitimate need for such information in your care and continued treatment.
- Different departments may share medical information about you in order to coordinate specific services, such as lab work, x-rays and prescriptions.
- DHM may disclose your medical information to people or entities outside DHM who will be involved in your medical care after you leave DHM such as family members, clergy, home health care services and others who will provide services that are part of your care.
- DHM may share certain information such as your name, address, employment, insurance carrier, emergency contact information and appointment scheduling information in an effort to coordinate your treatment with us and other health care providers.
- DHM may use and disclose your PHI to inform you of, or recommend, possible treatment options or alternatives that may be of interest to you.
- DHM may use and disclose PHI to contact you as a reminder that you have an appointment for treatment or medical care at DHM.
- If you are an inmate of a correctional institution or under the custody of a law enforcement officer, DHM will disclose your PHI to the correctional institution or law enforcement official.
B. Payment: DHM may disclose PHI about you for the purposes of determining coverage, eligibility, funding, billing, claims management, medical data processing, stop loss/reinsurance and reimbursement.
- The medical information may be disclosed to an insurance company, third party payer, third party administrator, health plan or other health care provider (or their duly authorized representatives) involved in the payment of your medical bill and may include copies or excerpts of your medical records which are necessary for payment of your account. It may also include sharing the necessary information to obtain pre-approval for payment for treatment from your health plan.
- DHM may disclose PHI to collection agencies and other subcontractors to obtain payment for care.
C. Health Care Operations: DHM will use and disclose your PHI during routine health care operations including quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing or credentialing activities of DHM, and for educational purposes.
- For example, DHM may need to share your demographic information, diagnosis, treatment plan and health status for population based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, and contacting health care providers and patients with information about treatment alternatives, in order for us to operate our business in an efficient, safe and legal manner.
I. Permitted Use or Disclosure (Con’t.)
D. Other Uses and Disclosures: As part of treatment, payment and health care operations, we may also use your PHI for the following purposes:
- Fundraising Activities: DHM may use certain demographic information (name, address, phone, e-mail, gender, age, type of insurance, date of service) to contact you in the future to raise money for charitable activities of DHM. The money raised will be used only for charitable activities to expand and improve the services and programs provided to our community. In addition, DHM may choose to include information about fundraising practices in newsletters and may post the information in the North Oakland Foundation office. DHM may disclose limited PHI to the North Oakland Foundation or to a company contracted to conduct fundraising for the Foundation. These entities will use your PHI only for charitable activities of DHM. If you do not wish to be contacted, you may notify the North Oakland Foundation at: (248) 857-7096.
- Medical Research: DHM may disclose your PHI to medical researchers who request it for approved medical research projects; however, with very limited exceptions such disclosures must be cleared through a special approval process before any PHI is disclosed to the researchers. Researchers will be required to safeguard the PHI they receive.
- Information and Health Promotion Activities: DHM may use and disclose some of your PHI for certain health promotion activities. For example; your name and address may be used to send you newsletters or general communications. DHM may also send you information based on your own health concerns. DHM may send you this information if it has determined that a product or service may help you. The communication will explain how the product or service relates to your well being and can improve your health.
- Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
E. More Stringent State and Federal Laws: The State of Michigan is more stringent than HIPAA in several areas. Michigan law is more stringent when the individual is entitled to greater access to records than under HIPAA and when under state law the records are MORE protected from disclosure than under HIPAA. Certain federal laws are also more stringent than HIPAA. DHM will continue to abide by these more stringent state and federal laws. The federal laws include applicable internet privacy laws, such as the Children’s Online Privacy Protection Act and the federal laws and regulations governing the confidentiality of health information regarding substance abuse treatment.
In Michigan, patients have MORE rights of access to behavioral health information under Michigan law than under HIPAA and State law defines a minimum necessary standard for release of mental health information. Disclosure is permitted with consent and for treatment without consent, but only in an emergency. Minors in Michigan have MORE rights to confidentiality and protection of certain information (reproductive health, behavioral health and substance abuse) than under HIPAA. State law genetic and HIV testing and disclosure consents remain in place.
II. Permitted Use or Disclosure with an Opportunity for You to Agree or Object
A. Family/Friends: DHM may disclose PHI about you to a friend or family member who is involved in your medical care. DHM may also give information to someone who helps you pay for your care. In addition, DHM may disclose PHI about you to an agency assisting in a disaster relief effort so that your family can be notified about your condition, status and location. You have a right to request that your PHI not be shared with some or all of your family or friends.
B. Doctors’ Hospital of Michigan Patient Information Listing: DHM will include certain limited information about you in the DHM patient information listing while you are a hospital patient at DHM. This information will include your name, location in DHM, your general condition (e.g., fair, stable, critical, etc.) and your religious affiliation. This is so your family and friends can visit you in DHM and know how you are doing. The Patient Information Listing, except for your religious affiliation, will also be disclosed to people who ask for you by name. You have the right to request that your name not be included in the DHM Patient Information Listing. If you request to opt out of the DHM Patient Information Listing, we cannot inform visitors of your presence, location, or general condition.
C. Spiritual Care: Patient information listing information including your religious affiliation may be given to a member of the clergy, such as a minister, priest, rabbi or other clergy even if they don’t ask for you by name. Your name, location and general condition may be disclosed to members of the religious community. You have a right to request that your name not be given to any member of the clergy.
II. Permitted Use or Disclosure with an Opportunity for You to Agree or Object (Con’t.)
D. Promotional Communications: DHM does not share or sell your PHI to companies that market health care products or services directly to consumers for use by those companies to contact you, such as drug companies. DHM does maintain a database of individuals for promotional communications, disease management, health promotion, and fundraising purposes. This database includes individuals to whom DHM may have sent health improvement materials and news about DHM previously and also individuals who have donated to the North Oakland Foundation or who have expressed an interest in donating to the charitable activities of DHM. You may be included in this database. The North Oakland Foundation sends information to the individuals in this database about the charitable activities of DHM. If you wish to be deleted for this database, you may notify the North Oakland Foundation at: (248) 857-7096.
E. Media Conditions Reports: DHM may release information for an update to the media if the media requests information about you using your full name and you have not requested that your name and information be excluded from the DHM Patient Information Listing. The following information may then be disclosed: your condition described in general terms that do not communicate specific medical information, such as “good”, “fair”, “serious”, or “critical”.
III. Use or Disclosure Requiring Your Authorization
A. Marketing: DHM is not permitted to provide your PHI to any other person or company for marketing to you of any products or services other than DHM’s products or services unless you have signed an authorization.
B. Research: DHM may use or disclose your PHI as part of research that includes providing you with treatment. For example, if you are part of a research study that includes treatment, DHM may require that you sign an authorization to allow the researchers to use or disclose your PHI for this research.
C. Other Uses: Any uses or disclosures that are not for treatment, payment or operations and that are not permitted or required for public policy purposes or by law, will be made only with your written authorization or the written authorization of your personal representative after positive identification. Written authorizations will let you know why we are using your PHI. You have to the right to revoke an authorization at any time.
IV. Use or Disclosure Permitted by Public Policy or Law Without Your Authorization
A. Law Enforcement Purposes: DHM will disclose your PHI for law enforcement purposes as required by law, such as responding to a court order or subpoena, identifying a criminal suspect or a missing person, or providing information about a crime victim or criminal conduct.
B. Required by Law: DHM will disclose PHI about you when required by federal, state or local law to make reports or other disclosures. DHM also will make disclosures for judicial and administrative proceedings such as lawsuits or other disputes in response to a court order or subpoena. DHM will disclose your medical information to government agencies concerning victims of abuse, neglect or domestic violence. DHM will report drug diversion and information relating to fraudulent prescription activity to law enforcement and regulatory agencies. Specialized government functions will warrant the use and disclosure of PHI. These government functions will include military and veteran’s activities, national security and intelligence activities, and protective services for the President and others. DHM will make certain disclosures that are required in order to comply with workers’ compensation or similar programs.
C. Coroners, Medical Examiners, Funeral Directors: DHM may disclose your PHI to a coroner or medical examiner. For example, this may be necessary to identify a deceased person or to determine a cause of death. DHM will also disclose your medical information to funeral directors as necessary to carry out their duties.
D. Organ Procurement: DHM may disclose PHI to an organ procurement organization or entity for organ, eye or tissue donation purposes.
E. Health or Safety: DHM may use or disclose PHI to avert a serious threat to health and safety of a person or the public. DHM may use or disclose PHI to Public Health Agencies for immunizations, communicable diseases, etc. DHM may use and disclose PHI for activities related to the quality, safety or effectiveness of FDA-regulated products or activities, including collecting and reporting adverse events, tracking and facilitating product recalls, etc. Any patient receiving a medical device subject to FDA tracking requirement may refuse to disclose, or refuse permission to disclose, their name, address, telephone number and social security number, or other identifying information for the purpose of tracking. If you wish to opt-out, you may do so by contacting the DHM Director of Patient Relations/Customer Services at: (248) 857-7539.
V. Your Health Information Rights
Although we at DHM must maintain all records concerning your hospitalization and treatment by DHM, you have the following rights concerning your PHI:
A. Right to Inspect and Copy: You have the right to access your PHI and to inspect and copy your PHI, as long as, we maintain it except for: information that will be used in a civil, criminal or administrative action or proceeding, and where prohibited or protected by law. DHM may deny your request for access to your PHI without giving you an opportunity to review that decision if:
- You don’t have the right to inspect the information; or it is otherwise prohibited or protected by law;
- You are an inmate at a correctional institution and obtaining a copy of the information would risk the health, safety, security, custody or rehabilitation of yourself or other inmates;
- The disclosure of the information would threaten the safety of any officer, employee or other person at the correctional institution or who is responsible for transporting you;
- DHM obtained the information that you seek access to from someone other than the health care provider under a promise of confidentiality and your access request is likely to reveal the source of the information;
- Under other limited circumstances. In these instances, however, DHM will allow the review of its decision by a health care professional that DHM has chosen. This person will not have been involved in the original decision to deny your request.
You must agree to pay a reasonable copying charge. You must make your requests to access and copy your PHI in writing to DHM and supply an appropriate authorization as required by Michigan Law. DHM will supply you with an authorization form upon request. DHM will respond to your request within 30 days of its receipt. If DHM cannot respond to your request within 30 days of its receipt, it will notify you in writing to explain the delay and the date by which we will act on your request. In any event, DHM will act on your request within 60 days of its receipt.
B. Right to Amend: You have the right to amend your PHI for as long as DHM maintains it. However, DHM may deny your request for amendment if:
- DHM did not create the information;
- The information is not part of the designated record set;
- The information would not be available for your inspection (due to its condition or nature); or
- The information is accurate and complete.
If DHM denies your request for changes in your PHI, DHM will notify you in writing with the reason for the denial. DHM will also inform you of your right to submit a written statement disagreeing with the denial. You may ask that DHM include your request for amendment and the denial any time that DHM discloses the information that you wanted changed. DHM may prepare a rebuttal to your statement of disagreement and will provide you with a copy. You must make your request for amendment of your PHI in writing to DHM. DHM will respond to your request within 60 days of its receipt. If DHM cannot respond to your request within 60 days it will notify you in writing to explain the delay and the date by which DHM will act on your request. In any event, DHM will act on your request within 90 days of its receipt.
C. Right to an Accounting: You have a right to receive an accounting (listing) of the disclosures of your PHI that DHM made, except for the following disclosures:
- To carry out treatment, payment or health cares operations;
- To you;
- To persons involved in your care;
- For national security or intelligence purposes;
- To correctional institutions or law enforcement officials; or
- That occurred prior to November 1, 2008.
For each disclosure you will receive; the date of the disclosure, the name of the receiving organization and address if known, a brief description of the PHI disclosed and a brief statement of the purpose of the disclosure or a copy of the written request for the information, if there was one. You must make your request for an accounting of disclosure of your PHI in writing to DHM. You must include the time period of the accounting, which may not be longer than 6 years before the request. DHM will respond to your request within 60 days from its receipt. If DHM cannot respond to your request within 60 days it will notify you in writing to explain the delay and the date by which DHM will act on your request. In any event, DHM will act on your request within 90 days of its receipt.
In any given 12 month period, DHM will provide you with an accounting of the disclosures of your PHI at no charge. Any additional requests for an accounting within that time period will be subject to a reasonable fee for preparing the accounting.
V. Your Health Information Rights (Con’t.)
D. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
DHM will consider your request but is not required to agree to your request if the request involves treatment, payment, health care operations or disclosures we are required to make by law. In general, due to the cost of additional resources necessary to comply with such requests, DHM is unable to grant requests for restrictions on the health information we use or disclose about you for treatment, payment, health care operations, or to someone who is involved in your care or the payment for your care. We will, however, consider requests for a limit on the health information we disclose about you to someone who is involved in your care, like a family member or friend. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
E. Right to 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. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
F. Right to Receive a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice of Privacy Practices upon request.
If you believe your privacy rights have been violated, you may file a complaint with DHM or with the Secretary of the Department of Health and Human Services. To file a complaint with DHM, you must put it in writing and address it to Director of Patient Relations/Customer Service, Doctor’s Hospital of Michigan, 461 West Huron, Pontiac, Michigan 48341. DHM will not retaliate against you for filing a complaint.
VII. Sharing and Joint Use of Your Health Information
In the course of providing care to you and in furtherance of DHM’s mission to improve the health of the community, DHM will share your PHI with other organizations as described below who have agreed to abide by the terms described below:
A. Medical Staff: The medical staff and DHM participate together in an organized health care arrangement to deliver health care to you in DHM facilities. Both DHM and its medical staff have agreed to abide by the terms of this Notice with respect to PHI created or received as part of delivery of health care services to you in DHM facilities. Physicians and allied health care providers who are members of DHM’s medical staff will have access to and use your PHI for their treatment, payment and health care operations purposes related to your care within DHM. DHM will disclose your PHI to the medical staff for their payment, treatment and health care operations.
B. Business Associates: DHM may use and disclose your PHI to business associates contracted to perform business functions on its behalf. Whenever an arrangement to perform a DHM function between DHM and another company involves the use or disclosure of your PHI, that business associate will be required to keep your information confidential.
VIII. Changes To This Notice
We may change our Notice of Privacy Practices from time to time. The changes will apply to all medical information about you that we have at the time of the change, and to all medical information about you that we keep in the future. Generally, the changes will take effect when they appear in a revised Notice of Privacy Practices. A copy of our current notice will be posted in our facilities and be available to all patients. DHM will provide you with the revised Notice at your first visit following the revision of the Notice.
IF YOU HAVE QUESTIONS ABOUT THIS PRIVACY NOTICE CONTACT
THE DHM DIRECTOR OF MEDICAL RECORDS/PRIVACY OFFICER AT: (248) 857-7149