Privacy Policy
NOTICE OF PRIVACY PRACTICES
BIRMINGHAM COSMETIC SURGERY, LLC
Effective Date:
April 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.
OUR PLEDGE REGARDING MEDICAL INFORMATION
Birmingham Cosmetic Surgery’s employees and staff understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at this office. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by Birmingham Cosmetic Surgery. If you have any questions about this notice, please contact Ashley Hillier, our Office Manager.
This office is required by law to:
1. make sure that medical information that identifies
you is kept private.
2. give you this Notice of our legal duties and privacy
practices with respect to medical information about you; and
3. follow the
terms of the Notice that is currently in effect.
HOW THIS
OFFICE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following describes the different ways that your
medical information may be used or disclosed by this office. For clarification, we have included some
examples. Not every possible use or
disclosure is specifically mentioned.
However, all of the ways we are permitted to use and disclose your
medical information will fit within one of these general categories:
CATEGORY 1 -
FOR TREATMENT. We will use medical information about you to
provide you with medical treatment and service.
We may disclose medical information about you to doctors, nurses,
technicians and other office personnel who are taking care of you. Some examples are:
* Your physician or a staff member may need to
talk to another physician who will provide you care when he/she is away.
* Your physician or a staff member may need to
discuss your medical information with members of the hospital staff.
* Your physician or a staff member may refer you
to a specialist and will discuss your condition with that specialist.
* Your physician or a staff member may want to talk with a friend or
family member who will assist you with care you need outside the office. We may tell your friend or family member your
condition and that you are receiving care.
We may give information to someone who helps pay for your care.
CATEGORY 2 – FOR PAYMENT. We may use and disclose medical information
about you so that the treatment and services you receive from Birmingham
Cosmetic Surgery may be billed to and collected from you, an insurance company,
or a third party. Some examples are:
* We may need to give your health plan information
about treatment you received here so your health plan will pay us or reimburse
you for the treatment.
* We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
CATEGORY 3 – FOR HEALTH CARE OPERATIONS. We may use and disclose medical information
about you for office operations. The use
and disclosure is necessary to run our office and make sure that all of our
patients receive quality care. Some
examples are:
* We may use medical information to review our
treatment and services and to evaluate the performance of our staff in caring
for you.
* We may combine medical information about many
of our patients to decide what additional services the office should offer,
what services are not needed, and whether certain new treatments are
effective.
* We may disclose information to doctors,
nurses, technicians, and other office personnel for review and learning
purposes.
* We may remove information that identifies you
from a set of medical information so others may use it to study health care and
health care delivery without learning the identity of the specific patients.
CATEGORY 4 -
APPOINTMENT REMINDERS. We may use and disclose medical information to
contact you as a reminder that you have an appointment for treatment or
services.
CATEGORY 5 – TREATMENT ALTERNATIVES. We may use and disclose medical information
to tell you about or recommend possible treatment options or alternatives that
may be of interest to you.
CATEGORY 6 – HEALTH-RELATED BENEFITS AND SERVICES. We may use and disclose medical information
to tell you about health-related benefits or services that may be of interest
to you.
CATEGORY 7 – RESEARCH. Under certain circumstances, we may use and
disclose medical information about you for research purposes. Some examples are:
* We may disclose medical information to
researchers involved in the Silicone Breast Implant Study conducted by the Food
and Drug Administration (FDA).
* We may disclose medical information if your
physician decides to participate in a research project testing the effects of a
new medication.
CATEGORY 8 – AS REQUIRED BYLAW. We will disclose medical information about
you when required to do so by federal, state, or local law. An example is:
* We are required
to report suspected child or elder abuse, sexually transmitted diseases, HIV,
or tuberculosis, etc.
CATEGORY 9 – TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY. We may use and disclose medical
information about you when necessary to prevent a serious threat to your health
and safety or the health and safety of the public or another person. Any disclosure, however, would only be to
someone able to help prevent the threat.
Special Situations:
* Military or Veterans – If you are a member of the armed forces, we may disclose medical information about you as required by military command authorities. We may disclose medical information about foreign military personnel to the appropriate foreign military authority.
* Workers Compensation – We may disclose medical information about you for workers’ compensation or similar programs.
* Public Health Risks – We may disclose medical information about you for public health activities. These activities generally include the following:
** To prevent or control disease, injury, or
disability
** To report births and deaths
** To report child abuse or neglect
** To report reactions to medications or
problems with medical products
** To notify people of recalls of products they
may be using.
** To notify a
person who may have been exposed to a disease or may be at risk for contacting
spreading a disease or condition.
CATEGORY 10 – HEALTH OVERSIGHT ACTIVITIES. We may disclose medical information to a
health oversight agency for activities authorized by law. These oversight activities are necessary for
the government to monitor the health care system, government programs, and
compliance with civil rights laws. For
example:
* Disclosure of
your medical information may be made in connection with audits, investigation,
inspections, and licensure renewals, etc.
CATEGORY 11 – LAWSUITS AND DISPUTES. If you are involved in a lawsuit or a
dispute, we may disclose medical information about you in response to a court
or administrative order or to defend the office. We may also disclose medical information
about you in response to a subpoena, discovery request, or other lawful process
by someone else involved in the dispute, but only if efforts have been made to
tell you about the request or to obtain an order protecting the information
requested.
CATEGORY 12 – LAW ENFORCEMENT. We may release medical information if asked
to do so by a law enforcement official:
* In response to
a court order, subpoena, warrant, summons, or similar process
* To identify or
locate a suspect, fugitive, material witness, or missing person
* About the victim of a crime if, under certain circumstances, we are unable to obtain the victim/patient’s agreement.
* About criminal conduct in the practice’s office.
* In emergency
circumstances to report a crime, the location of the crime or victims, or the
identity, description or location of the person who committed the crime.
CATEGORY 13 – CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS. We may release
medical information to a coroner, medical examiner, or funeral director. This may be necessary, for example, to
identify a deceased person or determine the causes of death. We may also release medical information about
patients to funeral directors as necessary to carry out their duties.
YOUR RIGHTS
REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding the medical
information this office maintains about you:
Right to
Inspect and Copy. You have the right to inspect and copy your
medical information that may be used to make decisions about your care. Usually, this includes medical and billing
records, but does not include psychotherapy notes.
To inspect and copy your medical information, you must
submit your request in writing to
Birmingham Cosmetic Surgery. If you
request a copy of the information we may charge a fee for the costs of copying,
mailing, or other supplies associated with your request.
Your physician may deny your request to inspect and
copy in certain very limited circumstances.
If you are denied access to your medical information you may request
that the denial be reviewed. For
information regarding such a review, contact the Office Manager.
Right to
Amend.
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the right to request an amendment
for as long as the information is kept by this office.
To request an amendment, your request must be made in writing and submitted to Birmingham
Cosmetic Surgery. Your request
should include the reason that supports your request.
We may deny your request for an amendment if it is not
in writing or does not include a reason to support the request. In addition, we may deny your request if you ask
us to amend information that:
* Was not created
by Birmingham Cosmetic Surgery, unless the person or entity that created the
information is no longer available to make the amendment.
* Is not part of
the medical information kept by or for Birmingham Cosmetic Surgery
* Is not part of
the information which you would be permitted to inspect and copy
* Is correct and
complete.
Right to
Accounting of Disclosures. You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you.
To request this list of accounting of disclosures, you
must submit your request in writing to
Birmingham Cosmetic Surgery. Your
request must state a time period which may not be longer than six years and may
not include dates before April 14, 2003.
Right to
Request Restrictions. You have the right to request a restriction
or limitation on the medical information we use or disclose about you for
treatment, payment, or health care operations.
You also have the right to request a limit on the medical information we
disclose about you to someone who is involved in your care or the payment of
your care, like a family member or friend.
For example, you could ask that we not use or disclose information about
a surgery you had.
We are not required to agree to your request. If we do
agree, we will comply with your request unless the information is needed to
provide you emergency treatment.
To request restrictions, you must make your request in writing to Birmingham Cosmetic Surgery. In your request, you must tell us what
information you want to limit, whether you want to limit our use, disclosure,
or both, and to whom you want the limits to apply, for example, disclosures to
your spouse.
Right to
Request Confidential Communications. You have the right to request that we
communicate with you about medical matters in a certain way or at a certain
location. For example, you can ask that
we only contact you at work or only by mail.
To request confidential communication, you must make
your request in writing to Birmingham
Cosmetic Surgery. We will not ask
you the reason for your request. We will
accommodate all reasonable requests.
Your request must specify how and where you wish to be contacted.
Right to a
Paper Copy of This Notice. You have the right to a paper copy of this
notice. You may ask us to give you a
copy of this notice at any time.
CHANGES TO
THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or
changed notice effective for medical information we already have about you as
well as any information we receive in the future. We will post a copy of the current notice in
the waiting room. The notice will
contain the effective date in the upper right corner of the first page.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the practice, contact Ashley Hillier, Office Manager at 248-723-9370. All complaints should be submitted in writing.
You will not be penalized, discriminated against,
retaliated against, or intimidated for filing a complaint.
OTHER USES OF
MEDICAL INFORMATION
Other uses and disclosure of medical information not
covered by this notice or the laws that apply to us will be made only with your
written permission. If you provide us
permission to use or disclose medical information about you, you may revoke
that permission, in writing, at any time.
If you revoke your permission, we will no longer use or disclose medical
information about you for the reasons covered by your written
authorization. You understand that we
are unable to take back any disclosure we have already made with your permission,
and that we are required to retain our records of the care that we provided
you.