Katherine L. Boyd M.D., P.C.
Effective Date: April 14, 2003
Notice of Privacy Practices for Protected Health Information
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!
If you consent, this office is permitted by federal privacy laws to make uses
and disclosures of your health information for purposes of treatment, payment,
and health care operations. Protected health information is the information we
create and obtain in providing our services to you. Such information may include
documenting your symptoms, examination and test results, diagnoses, treatment,
and applying for future care or treatment. It also includes billing documents
for those services.
Examples of uses of your health information for treatment purposes are:
· A nurse or medical assistant obtains treatment information about you
and records it in a health record.
· During the course of your treatment, Dr. Boyd determines she will need
to consult with another specialist in the area. She will share the information
with that specialist and obtain his/her input.
Examples of use of your health information for payment purposes:
· We submit requests for payment to your health insurance company. The
health insurance company (or other business associate helping us obtain payment)
requests information from us regarding medical care given. We will provide information
to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
We obtain services from our insurers or other business associates such as quality
assessment, quality improvement, outcome evaluation, protocol and clinical guidelines
development, training programs, credentialing, medical review, legal services,
and insurance. We will share information about you with such insurers or other
business associates as necessary to obtain these services.
Your Health Information Rights
The health and billing records we maintain are the physical property of this Physician's
office. The information in it, however, belongs to you. You have a right to:
· Request a restriction on certain uses and disclosures of your health
information by delivering the request in writing to our office-we are not required
to grant the request, but we will comply with those requests that we do grant.
· Obtain a paper copy of the Notice of Privacy Practices for Protected
Health Information ("Notice") by making a request at our office.
· Request that you be allowed to inspect and copy your health record and
billing record--you may exercise this right by delivering the request in writing
to our office using the form we provide to you upon request.
· Appeal a denial of access to your protected health information except
in certain circumstances.
· Request that your health care record be amended to correct incomplete
or incorrect information by delivering a written request to our office using the
form we provide to you upon request. Note: this is not required by law.
· File a statement of disagreement if your amendment is denied, and require
that the request for amendment and any denial be attached in all future disclosures
of your protected health information.
· Obtain an accounting of disclosures of your health information as required
to be maintained by law by delivering a written request to our office using the
form we provide to you upon request. An accounting will not include internal uses
of information for treatment, payment, or operations, disclosures made to you
or made at your request, or disclosures made to family members or friends in the
course of providing care.
· Request that communication of your health information be made by alternative
means or at an alternative location by delivering the request in writing to our
office using the form we give you upon request; and,
If you want to exercise any of the above rights, please contact Jennifer Davich
at 28755 Schoenherr, Warren, MI 48088; in writing. She will provide you with assistance
on the steps to take to exercise your rights.
The office is required to:
· Maintain the privacy of your health information as required by law.
· Provide you with a notice as to our duties and privacy practices as to
the information we collect and maintain about you.
· Abide by the terms of this Notice.
· Notify you if we cannot accommodate a requested restriction or request.
Accommodate your reasonable requests regarding methods to communicate health information
We reserve the right to amend, change, or eliminate provisions in our privacy
practices and access practices and to enact new provisions regarding the protected
health information we maintain. If our information practices change, we will amend
our Notice. You are entitled to receive a revised copy of the Notice by calling
and requesting a copy of our "Notice" or by visiting our office and
picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a
problem regarding the handling of your information, you may contact Ms. Jennifer
Davich, compliance officer, at (586) 573-7249.
Additionally, if you believe your privacy rights have been violated, you may file
a written complaint at our office by delivering the written complaint to Mrs.
Donna Shand. You may also file a complaint by mailing it or emailing it to the
Secretary of Health and Human Services whose street and email address is available
through any internet search engine.
· We cannot, and will not, require you to waive the right to file a complaint
with the Secretary of Health and Human Services as a condition of receiving treatment
from this office.
· We cannot, and will not, retaliate against you for filing a complaint
with the Secretary of Health and Human Services.
Other Disclosures and Uses
· We may use and disclose your protected health information to contact
you to remind you that you have an appointment with us.
· Unless you object, we may use or disclose your protected health information
to notify, or assist in notifying, a family member, personal representative, or
other person responsible for your care, about your location, and about your general
condition, or your demise.
Communication with Family
· Using our best judgment, we may disclose to a family member, other relative,
close personal friend, or any other person you identify, health information relevant
to that person's involvement in your care or in payment for such care if you do
not object or in an emergency.
· We may disclose information to researchers when their research has been
approved by an institutional review board that has reviewed the research proposal
and established protocols to ensure the privacy of your protected health information.
· We may use and disclose your protected health information to assist in
disaster relief efforts.
· We may disclose your protected health information to funeral directors
or coroners consistent with applicable law to allow them to carry out their duties.
Organ Procurement Organizations*
· Consistent with applicable law, we may disclose your protected health
information to organ procurement organizations or other entities engaged in the
procurement, banking, or transplantation of organs for the purpose of tissue donation
· We may contact you to provide you with appointment reminders, with information
about treatment alternatives, or with information about other health related benefits
and services that may be of interest to you.
· We may contact you as part of a fund raising effort.
Food and Drug Administration (FDA)
· We may disclose to the FDA your protected health information relation
to adverse events with respect to food, supplements, products and product defects,
or post-marketing surveillance information to enable product recalls, repairs,
· If you are seeking compensation through Worker's Compensation, we may
disclose your protected health information to the extent necessary to comply with
laws relating to Worker's Compensation.
· As required by law, we may disclose your protected health information
to public health or legal authorities charged with preventing or controlling disease,
injury, or disability.
Abuse & Neglect*
· We may disclose your protected health information to public authorities
as allowed by law to report abuse or neglect.
· If you are an inmate of a correctional institution, we may disclose to
the institution or it's agents the protected health information necessary for
your health and the health and safety of other individuals.
· We may disclose your protected health information for law enforcement
purposes as required by law, such as when required by a court order, or in cases
involving felony prosecutions, or to the extent an individual is in the custody
of law enforcement.
· Federal law allows us to release your protected health information to
appropriate health oversight agencies or for health oversight activities.
· We may disclose your protected health information in the course of any
judicial or administrative proceeding as allowed or required by law, with your
consent, or as directed by a proper court order.
· To avert a serious threat to health or safety, we may disclose your protected
health information consistent with applicable law to prevent or lessen a serious,
imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions
· We may disclose your protected health information for specialized government
functions as authorized by law such as to Armed Forces personnel, for national
security purposes, or to public assistance program personnel.
· All other uses and disclosures must be made pursuant to your written
authorization. You may revoke authorizations by delivering a written revocation
notice to your office.
· If we maintain a website that provides information about our entity,
this Notice will be on the website.
* Items with an asterisk denote possible state law conflicts.