Notice of Privacy Practices
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.
OUR PLEDGE REGARDING MEDICAL INFORMATION: The privacy of your medical information is important to us. We understand that your medical information is personal, and we are committed to protecting it. We create a record of the care and services you receive at our organization, and we need this record to provide you with quality care and to comply with certain legal requirements. This notice will describe the ways we may use and share this information. It also describes your rights and our obligations with respect to such information.
This notice applies to all use and disclosure of information about you that is made by health care professionals, staff, employees, students, trainees, volunteers and certain associates of ChoiceOne at each facility in the ChoiceOne system. It also applies to any sharing of information among ChoiceOne facilities and locations. Your personal doctor may have different policies regarding use and disclosure of protected health information about you. You should be sure to check with each of your personal doctors and obtain a copy of the notice of privacy practices applicable to their respective use and disclosure of protected health information.
OUR USE AND DISCLOSURE OF YOUR HEALTH INFORMATION:
Treatment. Your health information may be used by staff members or disclosed to other health care professionals for evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by our staff members.
Reminders/Notifications. Our staff will use your health information to send you follow-up care, referral or appointment reminders. We may also send you information describing changes occurring at ChoiceOne Urgent Care such as, address changes, new locations or changes in business hours.
Health Management. Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that may be of interest to you.
Payment. We may use and disclose your medical information for payment purposes. We may need to give your health insurance plan information so that your health plan will pay us or repay you for services.
Individuals Involved in Your Care or Payment for Your Care. We may use or disclose to a family member, other relative, close friend, or any other person you identify, protected health information relevant to that person’s involvement in your care or payment related to your care. We may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person’s involvement with your health care. If you would like to restrict disclosures made to a family member, other relatives, close personal friends or any other person you identify, please contact your ChoiceOne caretaker or the Privacy Officer listed below.
Healthcare Operations. Your health information may be used as necessary to support the day-to-day activities and management of ChoiceOne. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs and getting accreditation, certificates, licenses and credentials we need to serve you. We may combine protected health information about you with that about other patients to help us evaluate our performance and to determine necessary medical services in the community served. For example, we may use protected health information about you to review, assess, compare and improve the skills of individual ChoiceOne staff members, the overall level of care provided at a ChoiceOne facility, or the various levels of success achieved by a particular treatment among various ChoiceOne facilities and the possible causes for such differences.
OTHER USES AND DISCLOSURES:
Disaster Relief Efforts. In certain cases, as permitted by law, we may release information to an entity assisting in a disaster relief effort so that they may notify your family members of your location and general condition.
Research. Under certain circumstances, we may use and disclose protected health information about you for research purposes. Before they begin, all research projects that are conducted at ChoiceOne are carefully reviewed regarding the purpose and scope of the project itself and regarding their use and disclosure of protected health information. Except in very limited circumstances as permitted by applicable law, we will ask for your specific written permission if protected health information that identifies you will be used or disclosed in connection with a research project.
As Required by Law. ChoiceOne will use and disclose protected health information about you when we are required to do so by federal, state or local law.
Serious Threats to Health or Safety. We may use and disclose protected health information about you when necessary to prevent a serious threat to your health or safety, or the health and safety of other individuals or the public in general. For example, as further described below, we may be required to report cases of certain contagious or infectious diseases to public health authorities, or to report possible cases of child abuse or neglect to the proper authorities.
Health Oversight Activities. We may use and disclose protected health information about you to health oversight agencies for certain activities authorized by law for the appropriate oversight of the health care system, governmental benefit programs and regulatory or statutory compliance. For example, we may disclose information to facilitate and enable certain audits, investigations, inspections, licensing determinations and disciplinary actions.
Public Health. We may disclose protected health information for various public health activities and programs, authorized by law, to a number of different public entities or organizations, generally including the following:
- To prevent or control disease, injury or disability;
- To report vital statistics, such as births and deaths;
- To report child abuse and neglect to the appropriate authorities;
- To notify the appropriate authorities, if required by law to do so, of suspected cases of abuse, neglect or domestic violence;
- To report adverse reactions or events related to food or dietary supplements, product defects or problems, or biological product deviations;
- To notify persons of recalls of products that they may be using; and
- To notify persons who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Law Enforcement. We may disclose protected health information about you to law enforcement officials as permitted by law. Some of the circumstances in which we may do so include:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness or missing person; and
- To report criminal conduct on the premises of a ChoiceOne facility.
- Workers’ Compensation. We may release protected health information about you to comply with workers’ compensation laws or other similar programs that provide benefits for work-related injuries or illness.
Organ and Tissue Donations. We may use or disclose protected health information about you to facilitate organ, eye or tissue donation and transplantation, to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ, eye or tissue donation bank.
Legal Proceedings. We may share protected health information about you in response to a court or administrative order, discovery request, subpoena, or other lawful process, as authorized by applicable law.
Coroners, Medical Examiners, and Funeral Directors. We may disclose protected health information to coroners, medical examiners, and funeral directors as necessary for them to carry out their duties.
Military, National Security and Protective Services. Under certain conditions, we may disclose your protected health information for special government functions such as certain military, national security, and presidential protective services.
Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
You have certain rights under the federal privacy standards. These include: the right to request restrictions on the use and disclosure of your protected health information, the right to receive confidential communication regarding your medical condition and treatment, the right to inspect and copy your protected health information, the right to an accounting of how and to whom your protected health information has been disclosed, the right to receive a printed copy of this notice.
Restrictions. We are not required to agree to any request for a restriction of our uses and disclosures of protected health information about you, except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations and the information pertains solely to a health care item or service for which the health care provider has been paid out of pocket in full. To request a restriction on use and disclosure of protected health information about you, you must submit your request in writing to the Privacy Officer listed below.
Confidential Communications. To request confidential communication regarding your medical condition and treatment, you must submit your request in writing to the Privacy Officer listed below. Your request must specify the alternative means or location for communication with you. It also must state whether the disclosure of all or part of the protected health information in a manner inconsistent with your instructions would put you in danger. We will accommodate a request for confidential communications that is reasonable and that states that the disclosure of all or part of your protected health information could endanger you.
Amendment. You have a right to request an amendment to your protected health information that we have about you if you believe that information is incorrect or incomplete. To request an amendment of the protected health information that we maintain and may use to make decisions about you and your care, please submit your request in writing to the Privacy Officer listed below, along with a description of the reason for your request. We may deny your request for amendment. In case of any such denial, we will provide you with a written explanation of why we denied the request and of your rights.
Accounting of Disclosures. You have the right to receive an accounting of certain disclosures we have made of your protected health information. You may submit your request in writing to the Privacy Officer listed below. You must include the past time period that the accounting is to cover. This time period may not be longer than six years prior to the date of your request. You should also indicate the form in which you wish to receive the accounting (for example, on paper or on electronic media). There will be no charge to you for the first accounting that we provide to you in any 12-month period. We may charge you a fee to cover our costs for producing additional accountings of disclosures that you request in a 12-month period.
Notification of a Breach. You will receive notification of breaches of your unsecured protected health information as required by law.
Paper Copy of Notice. You have the right to receive a paper copy of this notice, even if you have agreed to receive this notice electronically. You may request a paper copy of our notice at any time simply by asking for one at any ChoiceOne facility, by contacting our Privacy Officer listed below.
ChoiceOne DUTIES: We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.
RIGHT TO REVISE PRIVACY POLICIES: As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.
REQUESTS TO INSPECT MEDICAL RECORDS: You may generally inspect or copy the health information about you that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the receptionist or Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.
COMMENTS & COMPLAINTS: If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to this office, attention: Privacy Officer. If you believe that your privacy rights have been violated, you should bring the matter to our attention by sending a letter describing the cause of your concern to the address listed above. You will not be penalized or otherwise retaliated against for filing a complaint.
FOR ADDITIONAL INFORMATION: Please inquire at the reception desk for a copy of the ChoiceOne Urgent Care Privacy Standards. If you have any additional questions about this notice or any of our privacy practices, please contact us at:
Fresenius Medical Care North America
Attn: FMCNA Privacy Officer
920 Winter Street
Waltham, MA 02451-1457
1-800-662-1237 ext. 4235
EFFECTIVE DATE: This notice is effective on 7/18/2018 and replaces all earlier versions.