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.
This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). This notice describes information about privacy practices followed by our employees, staff, and other office personnel. It also describes your rights to access and control your protected health information in some cases. This notice applies to the information and records we have about your health, health status, and the healthcare and services you receive at this facility.
Uses and Disclosures of Medical Information
We will use or disclose your medical information for treatment, payment and health care operations. For example:
Treatment: We may use or disclose your medical information to a physician or other health care provider in order to provide the best treatment to you.
Payment: We may use and disclose your medical information in order to receive payment for our services. We may bill and receive payment from you, an insurance company or a third party. We may need to disclose medical information in order to obtain authorization from your insurance for treatment that our doctors recommend or to determine if your insurance will cover the treatment.
Health Care Operations
We may use and disclose your medical information in our health care operations to ensure our patients are receiving the best possible care. For Example:
Health Related Benefits and Services
We may use your medical information to tell you about health related products or services that may be of interest to you. Please notify us if you do not wish to be contacted about treatment alternatives or health related products and services. If you advise us in writing that you do not wish to receive this type of communication, we will not use or disclose your information for this purpose.
On your Authorization
Upon your authorization, we will use your medical information or disclose your medical information for any purpose. If you give us written authorization you may revoke it at any time. If written authorization is not given to us, your medical information will not be disclosed except in the instances listed above.
We may use and disclose medical information to contact you to remind you of an upcoming appointment. When required, a message will be left on a recording or with another person. If you do not wish for a message to be left, please inform us and we will not leave any messages on your voicemail or answering machine.
Family or Friends
Unless we have written notice, we will not disclose information to someone claiming to be a family member or a friend. We will only disclose medical information to specific people on your authorization. In the event of an emergency or your incapacity, we will use our professional judgment of whether the disclosure would be in your best interest. We will assume that if a person escorted you to your appointment and is in the exam room with you, we have informal authorization to disclose information in front of that person.
By Law or Special Authorization
We may disclose or use your medical information as authorized by law for the following purposes as needed for public health or safety.
We must obtain written authorization from the patient for any use or disclosure of protected health information that is not for treatment, payment or health care operations. We may not condition treatment based on an individual granting an authorization. We must obtain your authorization in specific terms for the following situations. The authorization must be in plain language and must contain specific information regarding the information being disclosed or used, the person disclosing and receiving the information, expiration, and the right to revoke in writing.
Your Rights Regarding Your Medical Information
You have the right to look at or get copies of your medical records with limited exceptions. You must make a request in writing to the Privacy Officer. A fee may be charged at our discretion to cover the costs of printing, copying, mailing and accessing your records. If access to your records is denied, you may ask that the denial is reviewed. The person conducting the review will not be the same person who denied the request. We will comply with the outcome of the review.
Changes to This Notice
We reserve the right to change this Notice and to make the revision or changes effective for all medical information we already have about you as well as any information we receive in the future. If this notice is changed, we will post the new Notice in the waiting room. You may request a copy at any time.
Questions and Complaints
If you are concerned that we have violated your privacy rights, disagree with any decisions we made about access to your medical information, wish to appeal a decision made regarding an amendment or restriction or disclosure to your medical records, or to have us communicate with you my alternative means, you may complain to us using the contact information listed at the end of this notice. You may also submit a written complaint to the U.S Department of Health and Human Services. We will provide you with the address to file you complaint with the U.S. Department of Health and Human Services upon your request.
We support your right to privacy of your medical information and will not retaliate in any way if you choose to file a complaint with us or the U.S. Department of Health and Human Services.
Great Lakes Gastroenterology
Great Lakes Endoscopy Center
3903 Hollywood Rd
St. Joseph, MI 49085
Attn: Privacy Officer
December 1, 2016