DAVID MARTIN, MD; WILLIAM MUTH, MD; KAREN SPEIRS, DO, & LORRAINE BEERS, NP (INFECTIOUS
DISEASE)
NOTICE OF PRIVACY PRACTICES
Effective Date: 4/14/2003
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.
The Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP 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.
We understand 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 the Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP. This Notice also applies to
the utilization review and quality assessment activities of Munson
Healthcare and the Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP as a member of Munson
Healthcare.
I. Permitted Use or Disclosure
A. Treatment: We will use and disclose
your PHI in the provision and coordination of health care to carry
out treatment functions.
We 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.
We also will disclose your medical information
to people or entities outside the Office who will be involved
in your medical care after you leave the Office, 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.
We will use and disclose your PHI to inform
you of, or recommend possible treatment options or alternatives
that will be of interest to you.
We will use and disclose PHI to contact you as a reminder that
you have an appointment for medical care at the Office.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, we will disclose
your PHI to the correctional institution or law enforcement official.
B. Payment: The Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP
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: We 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 the Office, and for educational purposes.
For instance, we 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:
We 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. We may send
you this information if we have 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.
We 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,
we 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: We do
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. We do 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 the Office.
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 our products or services without a signed authorization from
you.
B. Research: We 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, we 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: The Office
of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP 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: We will disclose PHI
about you when required by federal, state or local law to make
reports or other disclosures. We 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. We 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. We 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, we 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.
We 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 must maintain all records concerning
your treatment by us, 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 we 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;
We 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, we will allow the review of its decision
by a health care professional that we have 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 David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP. 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:
We 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 we deny 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 we disclose
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 David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP, including your reason to support
the requested amendment. We 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 we 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 David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP. 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. We 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 the Office or with the
Secretary of the Department of Health and Human Services. To file
a complaint with the Office, please contact the Operations Manager
of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP at:
127 South Madison
Traverse City, MI 49684 (231) 935-5904
All complaints must be submitted in writing
directly to the Operations Manager. We assure 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, the Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP will share
your PHI with other organizations as described below who have
agreed to abide by the terms described below:
A. Business Associates: We will use
and disclose your PHI to business associates contracted to perform
business functions on our behalf including Munson Healthcare,
its parent who performs certain business functions for the Office
of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP. Whenever an arrangement between the Office
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:
The Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP, 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, the Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP 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 the Office 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
The Office of David Martin, MD; William Muth, MD; Karen Speirs, DO; & Lorraine Beers, NP will abide by the terms
of the Notice currently in effect. We reserve the right to change
the terms of this Notice and to make the new Notice provisions
effective for all PHI that we maintain. We 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.
