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THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY. Millman-Derr and Affiliates Health Information Practices Each time you visit a healthcare provider, a record is made of your visit. Typically, this record contains your health history, current symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment. This information, often referred to as your medical record, serves as a:
Your Health Information Rights Although your health record is the physical property of Millman-Derr or its affiliates, the information contained in the record belongs to you. Right to Inspect and Copy. You have the right to inspect and obtain a copy of your health record. This right is not absolute and does not include access to data generated by outside organizations or providers. In circumstances where access to the requested information would cause harm to others, we may deny access. To inspect and copy medical information, you must submit your request in writing to our Medical Records Department. We will charge a fee for the cost of copying, mailing or other services associated with your request. Right to Amend. If you consider the medical information we have about you to be incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to our Medical Records Department. We may deny your request for amendment if it is not in writing or does not provide a reason to support the request. In addition, we may deny your request if the information to be amended:
Right to an Accounting of Disclosures. You have the right to request an accounting of uses and disclosures of your medical record not associated with treatment, payment, and healthcare operations. This request must be in writing and pertain to a specific time frame of less than six (6) months. The request must relate to dates after implementation of these rules. (Tentatively set for April 14, 2003). Right to Request Restrictions on Uses and Disclosures. You have the right to request a limit or restriction on the medical information we use or disclose about you for treatment, payment or healthcare operations. Millman-Derr or its affiliates 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 with emergency treatment. Right to Request Confidential Communications. You have the right to request communication of your health information by alternative means or at alternative locations. For example, you can ask that we contact you only at work or by mail. We will accommodate reasonable requests that are in writing and specify how and where we should communicate with you. Right to Revoke Your Authorization. You have the right to revoke your authorization to Millman-Derr or its affiliates to use or disclose health information about you. Your revocation must be in writing and will be honored to the extent that action has not already been taken related to use or disclosure. Right to a Pager Copy of this Notice. The most current Notice of Our Health Information Practices will be posted in visible areas of Millman-Derr and its affiliates. You are entitled to receive a paper copy of the notice. Medical Information Policy We recognize that medical information about you and your health is personal. We are committed to protecting the record of services that you receive at Millman-Derr or its affiliates. This record is needed to provide you with quality care and to comply with certain legal requirements. Your health information will not be used or disclosed without your consent and authorization except as provided by law or otherwise described in this notice. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will make the new version available to you upon request. We are required by law to:
If you have questions, would like more information or would like to report concerns, please contact our Office Manager at 248.852.3636. If you believe your privacy rights have been violated, please request a "Patient Grievance Form." The completed form should be sent to the attention of the Privacy Office, 375 Barclay Circle, Rochester Hills, MI 48307. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. How We May Use and Disclose Medical Information. The following categories describe different ways that we use and disclose medical information about you. Examples are provided to help clarify each; however, not every use or disclosure within a category will be listed. For Treatment. We may use medical information about you to provide you with medical treatment. We may disclose medical information about you to staff personnel who will care for you, your personal physician, or any physician or other health care provider rendering health care services to you at Millman-Derr or its affiliates. For example: Members of your healthcare team will record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We may also provide various reports to your primary physician to assist him or her in subsequent treatment. For Payment. We may use and disclose medical information about you so that the medical care and services you receive may be billed to and payment collected from you, an insurance company or a third party. For example: A bill may be sent to your third-party payer, which identifies you, your diagnosis, treatment and supplies used. In the event payment is not made, we may provide limited information to collection agencies, attorneys, credit reporting agencies and other organizations as is necessary to collect for services rendered. We may also provide medical information to assist you in obtaining benefits to which you may be entitled. For Health Operations. We may use and disclose medical information for healthcare operations. These activities may include operational efficiencies and quality assurance. For example: Members of the medical staff or the risk management and quality assurance committee may use information in your health record to assess the quality of care and health outcomes. Business Associates. Some services are provided at Millman-Derr or its affiliates through contracts with business associates. An example of such a service is anesthesia provided as part of surgery. We disclose health information to our business associates so that they can do their job and bill you or your third party payer for services rendered. To protect your health information, however, we require the business associates to appropriately safeguard your information. Appointment Reminders and Treatment Alternatives. We may use and disclose medical information to contact your home, office or other location that you designate to provide a reminder of your appointments or to recommend possible treatment alternatives or services that may be of interest to you. As Required by Law. We will disclose medical information about you when required by federal, state or local law. Examples of these disclosures are to the Department of Public Health, to law enforcement agencies as required by law or in response to a valid subpoena. We will also release medical information about you to the extent necessary to comply with laws related to workers compensation. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure.
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Millman-Derr Center for Eye Care, P.C.
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