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.
Our Responsibilities
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 to you.
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
Directory
· We may use and disclose your protected health information to contact you to remind you that you have an appointment with us.
Notification
· 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.
Research*
· 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.
Disaster Relief*
· 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 and transplant.
Marketing*
· 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.
Fund Raising*
· 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, or replacements.
Workers Compensation*
· 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.
Public Health*
· 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.
Correctional Institutions*
· 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.
Law Enforcement*
· 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.
Health Oversight*
· Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings*
· 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.
Other Uses
· 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.
Website
· 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