Mercy Family Care
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GRAYLING
1250 East Michigan Avenue
Monday - Friday, 8 am - 5 pm
(989) 348-0550

PRUDENVILLE
Mercy Community Health Center
2585 West Houghton Lake Drive
Monday - Friday, 8 am - 5 pm
Saturday & Sunday, 9 am - 5 pm
(989) 366-2900

ROSCOMMON
234 Lake Street
Monday - Friday, 8 am - 5 pm
(989) 275-1200

 

MERCY FAMILY CARE
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.

Your physician's practice is part of Mercy Family Care and is referred to herein as "MFC". MFC is a member of Mercy Hospital Grayling and an affiliate of Munson Healthcare. We are 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.
MFC 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 MFC will use and disclose your PHI.

This Notice applies to the delivery of health care by Mercy Family Care (MFC). This Notice also applies to the utilization review and quality assessment activities of Mercy Hospital Grayling, Munson Healthcare and MFC as a member of Mercy Hospital Grayling and an affiliate of Munson Healthcare.

I. Permitted Use or Disclosure

A. Treatment: MFC will use and disclose your PHI in the provision and coordination of health care to carry out treatment functions.
MFC 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.

MFC also will disclose your medical information to people or entities outside MFC who will be involved in your medical care after you leave MFC, such as other care providers who will provide services that are part of your care.

MFC 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.

MFC will use and disclose your PHI to inform you of, or recommend possible treatment options or alternatives that will be of interest to you.

MFC will use and disclose PHI to contact you as a reminder that you have an appointment for medical care at MFC.

If you are an inmate of a correctional institution or under the custody of a law enforcement officer, MFC will disclose your PHI to the correctional institution or law enforcement official.

B. Payment: MFC 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.

MFC will disclose PHI to collection agencies and other subcontractors engaged in obtaining payment for care.

C. Health Care Operations: MFC 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 MFC, and for educational purposes.

For instance, MFC 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.

MFC may also use and disclose your PHI to support the sale, transfer, or other corporate restructuring of Mercy Hospital Grayling'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: MFC 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: MFC 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. MFC will also send you information based on your own health concerns. MFC 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. The MFC 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, MFC will disclose PHI about you to a friend or family member who is involved in your medical care. MFC will also give information to someone who helps you pay for your care. In addition, MFC 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: MFC 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. The MFC does maintain a database of individuals for promotional communications, disease management, and health promotion purposes. MFC sends information to the individuals in this database about the programs and services of MFC. If you wish to be deleted from this database, you may notify the Privacy Official.

III. Use or Disclosure Requiring Your Authorization

A. Marketing: MFC is not permitted to provide your PHI to any other person or company for marketing to you of any products or services other than the MFC products or services without a signed authorization from you.

B. Research: MFC 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, the MFC 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 MFC has taken action in reliance on the authorization.

IV. Use or Disclosure Permitted by Public Policy or Law without your Authorization

A. Law Enforcement Purposes: MFC 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: MFC will disclose PHI about you when required by federal, state or local law to make reports or other disclosures. MFC also will make disclosures for judicial and administrative proceedings such as lawsuits or other disputes in response to a court order or subpoena. MFC will disclose your medical information to government agencies concerning victims of abuse, neglect or domestic violence. MFC 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. MFC 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, MFC will use and disclose PHI to avert a serious threat to health and safety of a person or the public. MFC will use and disclose PHI to Public Health Agencies for immunizations, communicable diseases, etc. MFC 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 MFC must maintain all records concerning your treatment by the MFC, 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.

MFC 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 MFC 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;
  • MFC 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, MFC will allow the review of its decision by a health care professional that MFC 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 MFC. MFC will respond to your request within 30 days of its receipt. If MFC cannot, MFC will notify you in writing to explain the delay and the date by which we will act on your request. In any event, MFC 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 MFC maintains it. However, MFC will deny your request for amendment if:

  • MFC 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 MFC denies your request for changes in your PHI, MFC will notify you in writing with the reason for the denial. MFC will also inform you of your right to submit a written statement disagreeing with the denial. You may ask that MFC include your request for amendment and the denial any time that MFC discloses the information that you wanted changed. MFC 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 MFC, including your reason to support the requested amendment. MFC will respond to your request within 60 days of its receipt. If MFC cannot, MFC will notify you in writing to explain the delay and the date by which MFC will act on your request. In any event, MFC 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 MFC 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 MFC. You must include the time period of the accounting, which may not be longer than 6 years. MFC will respond to your request within 60 days from its receipt. If MFC cannot, MFC will notify you in writing to explain the delay and the date by which MFC will act on your request. In any event, MFC will act on your request within 90 days of its receipt.

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. MFC 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 MFC only contact you at work or by mail.

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 MFC or with the Secretary of the Department of Health and Human Services. To file a complaint with MFC, please contact MFC's Privacy Official, at:

Mercy Family Care — Grayling
1250 E. Michigan Ave.
Grayling, MI 49738
(989) 348-0550

Mercy Family Care — Roscommon
234 Lake St.
Roscommon, MI 48653
(989) 275-1200

Mercy Family Care — Prudenville
2585 W. Houghton Lake Dr.
Prudenville, MI 48651
(989) 366-2900

All complaints must be submitted in writing directly to MFC's Privacy Official. MFC 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 our mission to improve the health of the community, MFC will share your PHI with other organizations as described below who have agreed to abide by the terms described below:

A. Business Associates: MFC will use and disclose your PHI to business associates contracted to perform business functions on its behalf including Mercy Hospital Grayling (its parent) and Munson Healthcare (its affiliate), who perform certain business functions for MFC. Whenever an arrangement between MFC 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 Mercy Hospital Grayling and Munson Healthcare: MFC and other members of Mercy Hospital Grayling 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 Mercy Hospital Grayling, Munson Healthcare and their members. Members of Mercy Hospital Grayling and 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 Mercy Hospital Grayling/Munson Healthcare, MFC and the various hospitals, nursing homes, and health care providers in Mercy Hospital Grayling and Munson Healthcare share your PHI for utilization review and quality assessment activities of Mercy Hospital Grayling and Munson Healthcare. Members of Mercy Hospital Grayling and Munson Healthcare may also use your PHI for your treatment, payment to MFC and/or for the health care operations permitted by HIPAA with respect to our mutual patients.

VIII. Additional Information

For further information regarding the issues covered by this Notice of Privacy Practice, please contact MFC's Privacy Official, at GRAYLING: (989) 348-0550; ROSCOMMON: (989) 275-1200; PRUDENVILLE: (989) 366-2900.

IX. Changes to this Notice

MFC will abide by the terms of the Notice currently in effect. MFC reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all PHI that it maintains. Any revised Notice will contain the new effective date. Upon your request, we will provide you with the revised Notice of Privacy Practices by calling the offices and requesting a revised copy be sent by mail or by asking for one at your next visit.