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.
Munson Urgent Care ("Urgent Care") is
required by law to maintain the privacy of individually identifiable
patient health information (this information is "protected
health information" and is referred to herein 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 law. This
Notice applies to your PHI in our possession including the medical
records generated by us.
Urgent Care understands that your health information
is highly personal, and we are committed to safeguarding your
privacy. Please read this Notice of Privacy Practices thoroughly.
It describes how we will use and disclose your PHI.
This Notice applies to the delivery of health care
by Urgent Care. This Notice also applies to the utilization review
and quality assessment activities of Munson Healthcare and Urgent
Care as a member of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: Urgent Care will use and disclose
your PHI in the provision and coordination of health care to carry
out treatment functions.
Urgent Care will disclose all or any portion of
your patient medical record information to your consulting physician(s),
nurses, pharmacists, technicians, medical students and other health
care providers who have a legitimate need for such information
in your care and continued treatment.
Different departments will share medical information
about you in order to coordinate specific services, such as lab
work, x-rays and prescriptions.
Urgent Care also will disclose your medical information
to people or entities outside Urgent Care who will be involved
in your medical care after you leave Urgent Care, such as other
care providers who will provide services that are part of your
care.
We will 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 with other health care providers.
Urgent Care will use and disclose your PHI to inform
you of, or recommend possible treatment options or alternatives
that will be of interest to you.
Urgent Care will use and disclose PHI to contact
you as a reminder that you have an appointment for medical care
at Urgent Care.
If you are an inmate of a correctional institution or under the
custody of a law enforcement officer, Urgent Care will disclose
your PHI to the correctional institution or law enforcement official.
B. Payment: Urgent Care will 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 will 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 will include copies or excerpts of your medical records which
are necessary for payment of your account. It will also include
sharing the necessary information to obtain pre-approval for payment
for treatment from your health plan.
We will disclose PHI to collection agencies and
other subcontractors engaged in obtaining payment for care.
C. Health Care Operations: Urgent Care will
use and disclose your PHI during routine health care operations
including quality review, utilization review, medical review,
internal auditing, accreditation, certification, licensing or
credentialing activities of Urgent Care, and for educational purposes.
For instance, Urgent Care will 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.
We may also use and disclose your PHI to support
the sale, transfer, or other corporate restructuring of Munson
Healthcare's assets.
D. Other Uses and Disclosures: As part of
treatment, payment and health care operations, we may also use
your PHI for the following purposes:
Medical Research: We may disclose your PHI
without your Authorization 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:
Urgent Care will use and disclose some of your PHI for certain
health promotion activities. For example, your name and address
will be used to send you newsletters or general communications.
We will also send you information based on your own health concerns.
Urgent Care 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.
E. More Stringent State and Federal Laws:
The State law of Michigan is more stringent than HIPAA in several
areas. State 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 also are more stringent than HIPAA.
Urgent Care 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 the 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 requires
facilities to adopt policies regarding release of information
outside the facility. If the facility policy requires consent
for release, then consent will be required. 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: With your permission,
Urgent Care will disclose PHI about you to a friend or family
member who is involved in your medical care. We will also give
information to someone who helps you pay for your care. In addition,
we will 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. Promotional Communications: Urgent Care
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. Urgent Care
does maintain a database of individuals for promotional communications,
disease management, and health promotion purposes. We send information
to the individuals in this database about the programs and services
of Urgent Care. If you wish to be deleted from this database,
you may notify the Privacy Official of Munson Healthcare.
III. Use or Disclosure Requiring Your Authorization
A. Marketing: We are not permitted to provide
your PHI to any other person or company for marketing to you of
any products or services other than Urgent Care's products or
services without a signed authorization from you.
B. Research: Urgent Care will 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, Urgent Care 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. Written authorizations
will let you know why we are using your PHI. You have the right
to revoke an authorization at any time, except to the extent that
we have taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public Policy
or Law without your Authorization
A. Law Enforcement Purposes: Urgent Care
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 possible criminal conduct as part of a
criminal investigation.
Required by Law: Urgent Care will disclose
PHI about you when required by federal, state or local law to
make reports or other disclosures. Urgent Care also will make
disclosures for judicial and administrative proceedings such as
lawsuits or other disputes in response to a court order or subpoena.
We will disclose your medical information to government agencies
concerning victims of abuse, neglect or domestic violence. Urgent
Care will report drug diversion and information related 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. Urgent Care
will make certain disclosures that are required in order to comply
with workers' compensation or similar programs.
B. Health or Safety: Following the requirements
of the Michigan Department of Commerce, Urgent Care will use and
disclose PHI to avert a serious threat to health and safety of
a person or the public. We will use and disclose PHI to Public
Health Agencies for immunizations, communicable diseases, etc.
Urgent Care will 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. and post marketing
surveillance. Any patient receiving a medical device subject to
FDA tracking requirements 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.
V. Your Health Information Rights
Although we at Urgent Care must maintain all records
concerning your treatment by Urgent Care, 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 have a copy made of
your PHI as long as we maintain it except for: psychotherapy notes,
information that may be used in anticipation of, or that will
be used in a civil, criminal or administrative action or proceeding,
and where prohibited or protected by law.
We will 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 you 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;
You are involved in a clinical research project
and Urgent Care created or obtained the PHI during that research.
Your access to the information will be temporarily suspended
for as long as the research is in progress;
Urgent Care 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; or
Under other limited circumstances. In these instances,
however, Urgent Care will allow the review of its decision by
a health care professional that Urgent Care has chosen. This
person will not have been involved in the original decision
to deny your request.
You agree to pay a reasonable copying charge. You
must make your requests to access and copy your PHI in writing
to Urgent Care. We will respond to your request within 30 days
of its receipt. If we cannot, we will notify you in writing to
explain the delay and the date by which we will act on your request.
In any event, we 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 we maintain it. However, we will
deny your request for amendment if:
Urgent Care 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 Urgent Care denies your request for changes in
your PHI, we will notify you in writing with the reason for the
denial. We will also inform you of your right to submit a written
statement disagreeing with the denial. You may ask that we include
your request for amendment and the denial any time that Urgent
Care discloses the information that you wanted changed. We may
prepare a rebuttal to your statement of disagreement and will
provide you with a copy of that rebuttal.
You must make your request for amendment of your
PHI in writing to Urgent Care, including your reason to support
the requested amendment. Urgent Care will respond to your request
within 60 days of its receipt. If we cannot, we will notify you
in writing to explain the delay and the date by which we will
act on your request. In any event, we will act on your request
within 90 days of its receipt.
C. Right to an Accounting: You have a right
to receive an accounting of the disclosures of your PHI that Urgent
Care made, except for the following disclosures:
To carry out treatment, payment or health care
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 April 14, 2003.
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
disclosures of your PHI in writing to Urgent Care. You must include
the time period of the accounting, which may not be longer than
6 years. We will respond to your request within 60 days from its
receipt. If we cannot, we will notify you in writing to explain
the delay and the date by which we will act on your request. In
any event we will act on your request within 90 days of its receipt.
In any given 12-month period, we 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.
D. Right to Request Restrictions: You have
the right to request restrictions on certain uses and disclosures
of your PHI:
To carry out treatment, payment or health care
operations functions; or
Restricting specific information to only specified
family members, relatives, close personal friends or other individuals
involved in your care.
For example, you may ask that your name not be used
in the waiting room or that information about your condition not
be shared with your family. Urgent Care will consider your request
but is not required to agree to the requested restrictions.
E. Right to Confidential Communications:
You have the right to receive confidential communications of your
PHI by alternative means or at alternative locations. For example,
you may request that we only contact you at work or by mail. We
will make every attempt to honor your request, but we reserve
the right to deny unreasonable requests.
F. Right to Receive a Copy of this Notice:
You have the right to receive a paper copy of this Notice of Privacy
Practices, upon request.
VI. Complaints
If you believe your privacy rights have been violated,
you may file a complaint with Urgent Care or with the Secretary
of the Department of Health and Human Services. To file a complaint
with Urgent Care, please contact Urgent Care's Operations Manager
at:
Munson Healthcare
1105 6th Street
Traverse City, MI 49684 (231) 935-8700
All complaints must be submitted in writing directly
to Urgent Care's Operations Manager. Urgent Care assures you that
there will be no retaliation 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 the Munson Healthcare's mission to improve the health of the
community, Urgent Care will share your PHI with other organizations
as described below who have agreed to abide by the terms described
below:
A. Business Associates: Urgent Care will
use and disclose your PHI to business associates contracted to
perform business functions on its behalf including Munson Healthcare,
its parent who performs certain business functions for Urgent
Care. Whenever an arrangement between Urgent Care and another
company involves the use or disclosure of your PHI, that business
associate will be required to keep your information confidential.
B. Membership in Munson Healthcare: Urgent
Care, other members of Munson Healthcare and Munson Healthcare
participate together in an organized health care arrangement for
utilization review and quality assessment activities. We have
agreed to abide by the terms of this Notice with respect to PHI
created or received as part of utilization review and quality
assessment activities of Munson Healthcare and its members. Members
of Munson Healthcare will abide by the terms of their own Notice
of Privacy Practices in using your PHI for treatment, payment
or healthcare operations. As a part of Munson Healthcare, Urgent
Care and the various hospitals, nursing homes, and health care
providers in Munson Healthcare share your PHI for utilization
review and quality assessment activities of Munson Healthcare,
the parent company, and its members. Members of Munson Healthcare
also use your PHI for your treatment, payment to Urgent Care and/or
for the health care operations permitted by HIPAA with respect
to our mutual patients.
VIII. Additional Information
For further information regarding the subjects covered
in this Notice of Privacy Practice, please contact Munson Healthcare's
Privacy Official at (231) 935-2335.
IX. Changes to this Notice
Urgent Care will abide by the terms of the Notice
currently in effect. Urgent Care reserves the right to change
the terms of its Notice and to make the new Notice provisions
effective for all PHI that it maintains. Urgent Care will provide
you with the revised Notice at your first visit following the
revision of the Notice.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
