For the Healthcare Facility of:
| Facial Pain and Sleep Center PLC Dr. Ghabi A. Kaspo 3144 John R, Suite 100 Troy, Michigan 48083 248-519-1100 |
Facial Pain and Sleep Center, PLC Dr. Ghabi A. Kaspo 31000 Telegraph Road, Suite 110 Bingham Farms, Michigan 48025 248-519-1100 |
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices in accordance with the Federal Health Insurance Portability & Accountability Act of 2013, HIPAA Omnibus Rule, (Formally HIPAA 1996 & HITECH of 2004, and will remain in effect until we replace them as specified by Federal and/or State Law. This Notice describes how we protect your health information and what rights you have regarding it. The privacy practices described in this Notice apply to all of our employees, volunteers, and students. These individuals will share your health information amongst themselves for treatment, payment, and health care operations as described below.
The most common reason why we use or disclose your health information is for treatment, payment or health care operations.
Examples of how we use or disclose information for treatment purposes are: performing assessments of your health and functional status; developing treatment plans; treating you; prescribing medications for you; making arrangements for you to see specialists or to go to a hospital, skilled nursing facility or other care setting; or getting copies of your health information from another professional that you may have seen before us.
Examples of how we use or disclose your health information for payment purposes are: asking you about your health care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney).
“Health care operations” mean those administrative and managerial functions that we have to do in order to run our practice. Examples of how we use or disclose your health information for health care operations are: participating in financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.
But because of special Michigan laws, however, we will ask for special written permission to disclose your health information outside of our office for treatment, payment or health care operations if your health information includes HIV or AIDS, mental health treatment, genetic testing, or substance use disorder treatment.
In some limited situations other than treatment, payment or health care operations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office at all. Such uses or disclosures are:
• when a state or federal law mandates that certain health information be reported for a specific purpose;
• for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the Federal Food and Drug Administration regarding drugs or medical devices;
• disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
• uses and disclosures for health oversight activities, such as for the licensing of facilities; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
• disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
• disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our facility; or to report a crime that happened somewhere else;
• disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
• uses or disclosures for health related research that has been approved by an Institutional Review Board or its equivalent;
• uses and disclosures to prevent a serious threat to your or someone else’s health or safety;
• uses or disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;
• disclosures of de-identified information;
• disclosures relating to worker’s compensation programs;
• disclosures of a “limited data set” for research, public health, or health care operations;
• incidental disclosures that are an unavoidable consequence of permitted uses or disclosures;
• disclosures to “business associates” who perform health care functions for us and who commit to respect the privacy of your health information.
Unless you object, we will also share relevant information about your care with your family or friends who are involved in your care.
Most uses and disclosures of psychotherapy notes, and of your health information for marketing purposes and for the sale of your health information require your written authorization. We will not make any other uses or disclosures of your health information that are not mentioned above in this Notice unless you sign a written authorization form. The content of an “authorization form” is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it’s your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours.
If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. We will not withhold treatment from you because you choose not to sign an authorization, unless you are participating in approved research that requires disclosure or unless we are treating you specifically for the purpose of generating information for a third party. If you do sign one, you may revoke it at any time unless we have already made uses or disclosures in reliance upon it. Revocations must be in writing. Send them to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
The law gives you many rights regarding your health information. You can:
• ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. Except as described in the next sentence, we do not have to agree to do this, but if we agree, we must honor the restrictions that you want. We are required by law to agree to a request to restrict disclosure of your health information to a health plan if the disclosure is for payment or health care operations and pertains to a health care item or service for which you have paid out of pocket in full. (The rules about these required restrictions are complicated, so please ask us for assistance if you are interested in restricting disclosure of your health information to a health plan.) To ask for a restriction, send a written request to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
• ask us to communicate with you in a particular confidential way, such as by phoning you only on your cell phone, mailing health information to a different address, or by using e- mail to your personal e-mail address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for this kind of confidential communications, send a written request to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
• ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us. You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30 day extension of the time for us to give you access or photocopies if we send you a written notice of the extension. If we have health information about you in electronic form, we will provide it to you electronically if we can agree with you about the format, such as PDF. If you wish, you can request that electronic health information that we have about you be sent to someone else that you specify. We will send the electronic information where you request so long as your instructions are clear and there is no other reason why we need to deny your request. You may have to pay for the cost of producing an electronic copy of your health information. If you want to review or get copies of your health information, send a written request to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
• ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons who we know got the wrong information, and others that you specify. If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
• get a list of the disclosures that we have made of your health information within the past six years (or a shorter period if you want or if your request relates to disclosures from an electronic health record). By law, the list will not include: disclosures for purposes of treatment, payment or health care operations (unless we have made disclosures from an electronic health record); disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30 day extension of time if we notify you of the extension in writing. If you want a list, send a written request to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
• get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice.
• Be notified in accordance with law if there is ever a data breach that involves your health information.
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site.
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the Privacy Officer at the address, fax or e-mail shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.
If you want more information about our privacy practices, call or visit the Privacy Officer at the address or phone number shown at the beginning of this Notice.