This
summary is not the official 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.
Understanding the Type of Information We Have
We get information about you when you visit us. It includes your
name, date of birth, sex, financial information, insurance information
and other personal information. We also get enrollment information
from your health insurers and medical information from your other
health care providers. When you see us, we also collect information
about your condition, diagnosis and treatment.
Our
Privacy Commitment To You
We care about your privacy. The information we collect about you
is private. We are required to give you a notice of our privacy
practices. Only people who have both the need and the legal right
may see your information. Unless you give us permission in writing,
we will only disclose your information for purposes of treatment,
payment, business operations, when we are required by law to do
so, or for the other reasons listed below.
- Treatment:
We may use or disclose medical information about you to provide
and coordinate your health care. For example, we may notify your
regular doctor about care you get in our emergency room.
- Payment:
We may use and disclose information so the care you get can be
properly billed and paid for. For example, we may send your health
insurer a bill for our services that explains what treatment we
gave you and why.
- Business
Operations: We may need to use and disclose information for
our business operations. For example, we may use information to
educate our medical students or review the quality of care you
and others get at the University of Michigan.
- Exceptions:
For certain kinds of records, your permission may be needed even
for release for treatment, payment and business operations.
- Appointment
Reminders: We may contact you to give you appointment reminders
or information about treatment alternatives or other services
that may be of interest to you.
- As Required
By Law and for Other Government Functions: We will release
information when we are required by law to do so or for other
government functions. Examples of such releases would be for law
enforcement or national security purposes, subpoenas or other
court orders, communicable disease reporting, disaster relief,
review of our activities by government agencies, to avert a serious
threat to health or safety or in other kinds of emergencies.
- Public
Health and Safety: We may use or disclose information about
you as necessary to prevent or reduce a serious threat to the
health or safety of a person or the public. For example, we or
our contractors may disclose information about immunizations and
certain diseases to public health officials.
- For
Research: We may use or disclose medical information about
you to perform research. We will either ask for your permission
or get permission from an Institutional Review Board or Privacy
Board before using or disclosing your information for research.
- Fundraising:
We may contact you to ask you for contributions or help in raising
money.
- Facilities
Directories: We keep the name, location, general condition
(e.g., critical, stable), and religious affiliation of patients
staying in our hospitals or other facilities and disclose this
information to members of the clergy and others who might ask
for you by name. You can ask us to remove your name from the directory
when you are hospitalized.
- Family
and Friends: We may disclose your information to family members,
friends or others you identify to the extent it is relevant to
their involvement with your care or payment for your care, or
to let them know about where you are and your condition.
- After
Death: We may disclose your information to coroners or medical
examiners and funeral homes after you are deceased.
- With
Your Permission: If you give us permission in writing, we
may use and disclose your personal information for purposes you
list. If you give us permission, you have the right to change
your mind and revoke it. This must be in writing, too. We cannot
take back any uses or disclosures already made with your permission.
Our use and
disclosure of your personal health information must comply not only
with federal privacy regulations but also with applicable Michigan
law. Michigan law provides different protections to your personal
health information. For example, Michigan provides extra protection
for sensitive information, like HIV/AIDS information and mental
health information.
Your
Privacy Rights
You have the following rights regarding the health
information that we have about you. Your requests must be made in
writing to us at University of Michigan Health System Privacy Office,
P.O. Box 0625, Ann Arbor, MI 48109.
- Your
Right to Inspect and Copy: In most cases, you have the right
to look at or get copies of your medical records. You may be charged
a fee for the cost of copying your records. (You may need to make
an appointment to look at your record to assure that we will have
it available for you.)
- Your
Right to Amend: You may ask us to change your records if you
feel that there is a mistake. We can deny your request for certain
reasons, but we must give you a written reason for our denial.
- Your
Right to a List of Disclosures: You have the right to ask
for a list of certain disclosures made after April 14, 2003. This
list will not include the times that information was disclosed
for treatment, payment, or health care operations. The list will
not include information provided directly to you or your family,
or information that was sent with your permission. It will not
include information released without your name or other data that
would identify you.
- Your
Right to Request Restrictions on Our Use or Disclosure of Information:
You can ask for limits on how your information is used or disclosed.
We are not required to agree to such requests, but can if we believe
it is reasonable to do so.
- Your
Right to Request Confidential Communications: You have the
right to ask that we share information with you in a certain way
or in a certain place. For example, you may ask us to send information
to your work address instead of your home address. We will do
our best to accommodate such a request.
Changes
to this Notice
We reserve the
right to revise this notice. A revised notice will be effective for
medical information we already have about you as well as any information
we may receive in the future. We are required by law to comply with
whatever notice is currently in effect. Any changes to our notice
will be published on our web site. Go to http://www.med.umich.edu/hippa.
If the changes are material, a new notice will be posted in our facilities
before it takes effect.
How
to Use Your Rights Under This Notice
If you want
to use your rights under this notice, you may call us or write to
us at:
University
of Michigan Health System Privacy Office
P.O. Box 0625
Ann Arbor, MI 48109
Phone: 866-482-1252
If your request
to us must be in writing, we will help you prepare your written
request, if you wish.
Complaints
to the Federal Government:
If you believe
that your privacy rights have been violated, you have the right
to file a complaint with the federal government. You may write to:
Office for Civil Rights
U.S.
Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, Ill. 60601
Voice Phone (312) 886-2359, FAX (312) 886-1807, TDD (312) 353-5693.
E-mail OCRComplaint@hhs.gov
You will not
be penalized for filing a complaint with the federal government.
Complaints
and Communications to Us:
If you want
to exercise your rights under this notice or if you wish to communicate
with us about privacy issues or if you wish to file a complaint,
you can write to us at the University of Michigan Health System
Privacy Office listed above. You will not be penalized for filing
a complaint.
Additional
Information
More detailed
versions of this notice can be found at our website at www.med.umich.edu/hipaa,
at our outpatient clinic reception desks, in our test and treatment
waiting rooms, or by calling 866-482-1252. You have the right to receive
additional copies of the detailed notice at any time by contacting
any of these representatives.
This notice
is available in other languages and alternate formats that meet
the guidelines for the Americans with Disabilities Act (ADA).
Esta notificación
está disponible en otras lenguas y formatos diferentes que satisfacen
las normas del Acta de Americans with Disabilities (ADA).
Click
here for the official Notice of Privacy Practices
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