“THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU CAN BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY”… OCR/HIPAA
Privacy Regulation Text
January 2017
We value you as a consumer of our agency and we take the privacy of your personal health information (PHI) seriously. A number of laws and regulations, including HIPAA, the Health Insurance Portability and Accountability Act of 1996 and Public Act 258 of the Michigan Mental Health Code, protect your health.
- This document gives you a summary of important information about your personal health information and privacy.
- More detailed information about how health information about you may be used and disclosed and how you can get access to this information is available from the program from which you receive services. Or, you may contact our Privacy Officer at 248-475-6400 for this information.
- If you are receiving services funded by the Oakland County Community Mental Health Authority, you may also contact the Authority’s Privacy Officer at 248-858-1210.
- During the time that you are using services at our agency, we will collect and keep different kinds of information about you. This information is called Protected Health Information (PHI). We want you to understand how we might use the information we collect.
The following is some information that gives you a summary of your privacy rights:
“Protected Health Information” means:
- Information about you that may identify you and
- Relates to your past, present or future physical or mental health or condition, and
- Health care services related to your health or condition.
Examples of this may include:
- Your name, address, telephone number and date of birth
- Your diagnosis (the condition for which you are receiving treatment)
- Your treatment plan and goals
- Your progress toward those goals.
Your information will be used to help us to provide you health care services.
- We will use your information when we are giving you services. We may disclose your information when we are helping you get other services you need.
- We will disclose parts of your information to get payment for your health care services.
- We may use your information to do the business of this agency.
- We may use parts of your information to send you newsletters and other information.
- We may use or disclose your health information to obtain help for you in an emergency.
We may sometimes use or disclose your information without your permission when the law requires it.
- We may disclose parts of your information for public health uses.
- We may disclose your information to make sure our services meet quality standards.
- We may disclose your information if the Food and Drug Administration requires it.
- We may disclose your information to follow rules for workers’ compensation and other programs like it.
- We may disclose your information for court or law enforcement uses.
- In certain situations, we will disclose your information to the police.
- If you are in jail, we may use or disclose your information that we created or received while we provided services to you.
- We will disclose your information if we think a child or an adult who is disabled is being abused or neglected.
YOUR RIGHTS:
- You have the right to look at and make copies of your protected health care information.
- You have the right to ask us to not disclose parts of your protected health care information.
- You have the right to be told when we disclose your protected health care information and to whom.
- You have a right to tell us how we may contact you. We will record your request on the Consumer Information Form.
YOU HAVE THE RIGHT TO CHANGE PARTS OF YOUR PROTECTED HEALTH CARE INFORMATION IF YOU THINK THEY ARE WRONG.
BUSINESS ASSOCIATES:
This “Notice of Privacy Practices” applies to all services provided to you by Easterseals Michigan, Inc. In accordance to HIPAA requirements, our agency also has “Business Associate” agreements with each organization with which we do business that may relate to your personal health care information. Each Business Associate must also comply with the requirements of HIPAA, and where applicable, the Michigan Mental Health Code or other federal or state laws and regulations.
ADDITIONAL RIGHTS:
Depending on your services received from Easterseals, you may have additional privacy protection under existing or future state laws. We are committed to complying with all applicable laws when we use or disclose your health information.
PRIVACY COMPLAINTS:
If you have any concerns about our privacy practices, or if you feel your rights have been compromised, you have a right to file a complaint with Easterseals MORC Healthcare, Inc. (DBA Easterseals MORC) at:
Corporate Compliance Officer
Easterseals MORC.
2399 E. Walton Blvd.
Auburn Hills, MI 48326
Phone: 248-475-6400
Fax: 248-475-6402
TDD: 312-353-5693
Or, you may file a complaint with:
Region V, Office for Civil Rights,
U.S. Department of Health and Human Resources
233 N. Michigan Avenue
Suite 240
Chicago, IL 60601
Phone: 312-886-2359
Fax: 312-886-1807
Please be assured that if you file a privacy complaint, your complaint will be handled in a professional manner, and you will not be subject to any type of penalty for filing the complaint.
QUESTIONS:
We want to make it easy for you to make informed health care decisions. Your Easterseals MORC staff are more than happy to assist you with any questions that you may have about your services. If you have any questions about this Notice, please contact our Privacy Officer at the number provided in the Notice.
