The Michigan Center for Cosmetic Surgery Notice of Privacy Information Practices
This notice describes how medical information about you may be used and/or disclosed and how you can get access to this information.
1. Your Protected Health Information (PHI) may be used or disclosed by those within our office who have a necessary reason to access the information, or we may use or disclose your PHI to those outside our office who have a need to know your information in order to provide you with health care services related to your treatment, payment or health care operations. We will make reasonable efforts to limit the use and disclosure of your PHI to the minimum necessary.
What is Treatment Related? We may use and disclose your PHI for use by staff, physicians, or other health care professionals involved in your care that may provide you with treatment, evaluation, diagnostic, and other health care services. Examples are, but not limited to: other physicians who are treating you, pharmacies, or laboratories.
What is Payment Related? We will use your PHI as necessary to assist you in paying for your health care services. Examples are, but not limited to: providing insurance companies with information about the dates of service, services provided, and your medical condition, in order for them to make a decision regarding coverage, or payment.
What is Health Care Operations Related? We may use/disclose your PHI in order to conduct ordinary and reasonable business operations for our office on a day-to-day basis. Examples include, but are not limited to: budgeting, accounting, and managing our staff in performing their duties, and training residents, or medical students.
2. We reserve the right to take photos prior to surgery to assist preoperatively and to review the results post operatively with the patient. We reserve the right to use photographs for assisting with insurance prior-authorization, and for educational purposes.
3. We are permitted or required to use or disclose PHI without the individual’s written consent or authorization in certain circumstances. Two examples are, but not limited to, Public Health requirements, Food and Drug Administration, Federal or State Law requirements, such as court orders, and Victims of Abuse, Neglect or Domestic Violence (45 CFR 164.512).
4. We will not make any other use or disclosure of a PHI without the individual’s written authorization. Such authorization may be revoked at any time. Revocation must be written. However, you may not revoke your authorization regarding release prior to the date of your revocation.
5. We may contact you at home/work to remind you of an appointment, and leave reminders on your voice mail, connected to your home phone number or cell phone number unless you request otherwise.
6. We will also request that you sign-in upon visiting our office and may call your name in the waiting room unless you request otherwise.
7. You as a patient have the right to:
Inspect and copy your medical information that may be used to make decisions about your care.
Request an amendment to your medical records if you feel they are incorrect or incomplete. We may deny your request and will notify you of the reason for our denial.
Request an accounting of disclosures. This is a list of disclosures for other than treatment, payment or health care operations.
Request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. All requests must be in writing. However, we have the right to deny the restriction or limitation. If we do agree to the restriction or limitation, we will comply with your request unless the information is needed to provide you with emergency care.
8. We will abide by the terms of this notice or the notice currently in effect at the time of the disclosure.
9. We reserve the right to change the terms of its notice and to make new notice provisions effective for all PHI that it maintains.
10. Revisions of our Notice of Privacy Information Practice will be posted in the office. Copies may also be obtained at any time from our office.
11. Any person/patient may file a complaint to the Practice and to the Secretary of Health and Human Services if they believe their privacy rights have been violated. All complaints should be in writing, state the nature of the complaint, and how to contact you. No retaliatory action will be made against any individual who submits or conveys a complaint.
12. We are required by law to maintain the privacy of your PHI and to provide you with this Notice of Privacy Information Practices.
You May Contact:
The Michigan Center for Cosmetic Surgery
2260 South Huron Street
Ann Arbor, Michigan 48104
Secretary of Health and Human Services
US Dept of Health and Human Services
200 Independence Avenue, S.W.
Washington D.C. 20201