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.
If you have any questions about this Notice or would like further information, please contact our Privacy Officer at (248) 552-0620.
Your Health Care Information – Protecting Your Privacy
We are required by law to protect the privacy of health information that may reveal your identity, and to provide you with a copy of this Notice which describes the health information privacy practices of Newland Medical Associates. A copy of our current notice will always be posted in our reception area. You will also be able to obtain your own copies by accessing our website at www.NewlandMedical.com, calling our office at (248) 552-0620, or asking for one at the time of your next visit.
Newland Medical Associates’s Responsibilities
It is your right as a patient to be informed of Newland Medical Associates’s legal duties with respect to protection of the privacy of your personal health information.
Newland Medical Associates is required to:
- Maintain the privacy of your health information
- Provide you with a notice of the legal duties and privacy practices regarding protected health information collected and maintained about you
- Abide by the terms of this notice
Newland Medical Associates reserves the right to change the terms of the Notice of Privacy Practices and make the new notice provisions effective for all protected health information that it maintains. Newland Medical Associates also reserves the right to change the terms of its notice with respect to any applicable more limited uses and disclosures.
Newland Medical Associates will promptly revise and distribute its notice whenever Newland Medical Associates makes a substantial change to any of its privacy practices.
Newland Medical Associates will not use or disclose your health information without your authorization, except as described in this notice.
Requirement for Acknowledgement of Notice of Privacy Practices
We will ask you to sign a form that will serve as an acknowledgement that you have received this Notice of Privacy Practices.
Your Health Information Rights
If you wish to use any of the following rights with respect to your health information, please contact your physician or nurse. You will be asked to make your request in writing.
You have the right to:
- Inspect and get a copy of your health record.
- With exceptions, you have the right to look at and obtain a copy of your health care record. You may need to pay a fee if you want a copy of your medical record.
- We will usually respond to your request within 30 days. If we need extra time to respond, we will notify you in writing to explain the reason for the delay and when you can expect to have a final answer to your request.
- Request to challenge or correct your health information. If you believe your health information is not correct, you may ask us to change/correct the information. You will be asked to make this request in writing and give a reason as to why your health record should be changed. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended.
For example, if you believe that information in your medical history is incorrect, such as your birth date, you may request that this information be amended.
- Request additional privacy protections. You may limit how your health information is used. You may ask us to limit the information given to family and friends or those who help in emergencies. Newland Medical Associates is not required to agree to these restrictions, but if we do agree, we will abide by our agreement (except in an emergency). All requests for restriction must be in writing.
- Receive confidential communications. You have the right to request that Newland Medical Associates communicate your health information to you in different ways or places. For example, you may ask that we contact you at home instead of at work. Or, you may ask to learn about your health status in a private area or by a letter to a private address. Newland Medical Associates shall accommodate reasonable requests. To request more confidential communications, please write to your physician. Please specify in your request how or where you wish to be contacted, and how payment for your healthcare will be handled if we communicate with you through this alternative method or location.
- Receive a record of disclosures of your health information. In some cases, you may ask for a list of those who received information from your medical records. The list must include the dates of each disclosure, a short description of what information was given and why it was given. We must give you this list within 60 days unless we give you notice that we need an extra 30 days. We will not charge you for the first list, but can charge you if you ask for a list more than once a year. The list will not include disclosures before April 14, 2003 or disclosure (a) for treatment, payment, health care operations, (b) as authorized by you, and (c) for certain other activities, including disclosures to you.
For example, you may request an accounting of disclosures made from your health record in the last year to the State for disease reporting.
- Obtain a paper copy of the notice upon request. A paper copy of this Notice will be given to you even if you have received this Notice on our web site or by electronic mail (e-mail). Even if you received a copy of the Notice before, you may still be asked to sign that you have received the Notice.
Uses and Disclosures for Treatment, Payment and Health Care Operations
Without your written permission, Newland Medical Associates can use and release your health information or share it with others in order to treat your condition, obtain payment for that treatment, and run our normal business operations.
Newland Medical Associates may use or disclose your health information for treatment.
Newland Medical Associates may use or release your health information in order to provide treatment to you or to coordinate or manage your health care.
Example: Your information may be disclosed from one physician to another if they are consulting each other in relation to your care and treatment.
Example: A doctor may use the information in your medical record to decide what treatment, such as a type of drug, best meets your medical needs. The treatment chosen will be written in your medical record, so that other health care professionals can make the best decisions for your care.
Example: Newland Medical Associates may contact you, either orally or in writing with regard to your treatment. We may also use your health information to provide you with an appointment reminder, schedule a lab or x-ray test, call a prescription to your pharmacy or to continue your care.
Example: Newland Medical Associates may send you information about treatment alternatives or other health related services (including newsletters) that may be of interest to you.
Newland Medical Associates may use or disclose your health information for payment.
Newland Medical Associates may use or disclose your health information to obtain payment for services we provide to you.
Example: Newland Medical Associates must send a bill that gives your name, your diagnosis, and the care you received to your insurance company. We will give this information to help get payment for your medical bills. We may also share information about you with your health insurance company to determine whether it will cover your treatment or to obtain necessary pre-approval before providing you with treatment.
We may disclose your health information to another health care provider or entity subject to the federal privacy rules so they can obtain payment.
Newland Medical Associates may use or disclose your health information for routine health care operations.
Newland Medical Associates may use or disclose your health information in connection with our health care operation. Your diagnosis, treatment, and results may help improve the quality or cost of care we give our patients. These quality and cost improvement activities may include:
- Reviewing the performance of health care providers
- Looking at the success of your treatment and comparing the success to other patients
- Calling a patient and leaving a reminder message for a scheduled appointment
- Healthcare review or accreditation reviewers
- Making hospice or home health care arrangements
- Conducting training programs, certification, licensing or credentialing activities
- Medical review, auditing, and legal services
- Business management, planning and development
Example: Newland Medical Associates may look at your health information and decide that another treatment or a new service we offer may interest you. For example, we may contact a cancer patient to notify them that we have a new cancer research facility that offers new treatments.
Example: Newland Medical Associates may use information found in your medical record, such as your name, address and phone number to contact you for our fund-raising purposes. For example, we may want to raise money to improve the health of our community and contact you for a donation.
Example: We may also share your health information with another company that performs business services for us. If so, we will have a written contract to ensure that this company also protects the privacy of your health information.
Uses or Disclosures of Your Protected Health Information Permitted Without Your Authorization.
Newland Medical Associates may use or disclose your health information, and share it with others, in order to treat you in an emergency or to meet important public needs. We will not be required to obtain your written authorization, consent, or any other type of permission before using or disclosing your information for the following reasons:
As Required by Law:
Newland Medical Associates may use or disclose protected health information if we are required by law to do so. We will comply with and limit the information to only what is necessary by law. Uses or disclosures required by federal privacy rule and limited by the more protective requirements of state law include the following:
- Disclosures about victims of elderly or child abuse
- Disclosures for judicial and administrative proceedings
- Disclosures for law enforcement purposes
As required by law, Newland Medical Associates may need to report your health information to help prevent or control disease, injury or disability. This may include information for:
- Disease, injury and vital statistic reporting
- Child abuse reporting
- Food and Drug Administration
- Poison control
We may need your written permission to disclose health information or information taken from your mental health records or HIV test results.
Example: We may disclose your protected health information (excluding mental health, alcohol or drug abuse or developmental disabled or HIV test result) without your authorization to the Food and Drug Administration (FDA) to: (1) report or track product defects or problems; (2) repair, replace, or recall defective or dangerous products; or (3) monitor the performance of a product after it has been approved for use by the general public.
Newland Medical Associates may disclose your HIV test result without your authorization to a person that may have sustained a contact that carries a potential for transmission of HIV.
Newland Medical Associates may disclose your protected health information that is reasonably related to a work related illness or injury if an application for workers’ compensation has been filed.
Health oversight activities:
Newland Medical Associates will not disclose HIV test results to health care oversight agencies without an authorization. Newland Medical Associates may disclose your mental health, alcohol or drug abuse or developmental disability related health information to the Department of Health and Family Services, to the county for coordination of human services and to a representative of the board on aging and long-term care. We may give your health information to health oversight agencies, including agencies who monitor or regulate hospitals, clinics, or other health care providers to be certain you are given the correct and proper care.
Judicial and Administrative Proceedings:
Newland Medical Associates may disclose your protected health information if we are ordered to do so by a court that is handling a lawsuit or other dispute. We may also disclose your information in response to a subpoena, discovery request, or other lawful request.
Newland Medical Associates may disclose your protected health information to law enforcement officials in response to subpoenas under a court order, and signed by a judge, or other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person. We may disclose your health information to correctional institutions or law enforcement personnel for certain purposes if you are an inmate or are in lawful custody.
Coroner or Medical Examiner:
In the unfortunate event of your death, we may disclose your protected health information that is not an HIV test result or related to mental health, alcohol or drug abuse and developmental disabilities to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death.
Newland Medical Associates may use or disclose your HIV test result to a funeral director.
For organ, eye or tissue donation purposes:
Newland Medical Associates may give your health information to people who obtain, store, or transplant organs, eyes, or tissue of people who have died.
Newland Medical Associates may use or disclose your protected health information for research purposes if the researcher has obtained your permission or fulfilled the stringent privacy requirements of state and federal law. Such research might help us to improve care or develop new treatments. Depending on the research, you may be able to refuse the use of your health information.
To avoid a serious threat to health or safety:
We may release some of your medical record to people in authority if we think that it will prevent or lessen a serious or imminent danger to yourself or the safety and health of other people.
Disclosures for specialized government functions:
Newland Medical Associates may disclose protected health information excluding mental health, alcohol or drug abuse or developmental disabled or HIV test result for national security, for protection of the President, and for medical suitability determination of Armed Forces personnel to a state or federal agency.
Newland Medical Associates may disclose protected health information reasonably related to a workers’ compensation injury.
To those involved with your care or payment of your care:
If family members or close friends are helping care for you or helping you pay your medical bills, we may give health information about you to those people to the extent necessary for them to help with your care or payment for your care. The information may include your name and location within our facility. We must give you enough information so you can decide if you want other people involved with your care to have information from your medical records. If you are unable to agree or object to such disclosure we may give information as necessary to determine that it is in your best interest based on professional judgment.
HIV test results:
Your HIV test results, if any, may be disclosed as set forth in Wisconsin Statutes 252.15 (5)(a).
State Regulatory Bodies:
We may disclose to state agencies who require us to submit information such as births, deaths, and to cancer registries.
Newland Medical Associates has attempted to explain with this notice the circumstances where state law may be more protective than the federal privacy rule and provides greater privacy protection.
Except for the situations listed above and treatment, payment or health care operation purposes, the use or disclosure of your health information requires Newland Medical Associates to obtain your written authorization.
You may withdraw your authorization in writing at any time by submitting your written withdrawal to Newland Medical Associates’s Privacy Officer. Your revocation will not affect any use or disclosures while your permission was in effect.
Patient Complaint Process
If you believe your privacy rights have been violated, you may file a complaint with Newland Medical Associates or with the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint.
To file a complaint with Newland Medical Associates please contact the Newland Medical Associates Privacy Officer who will provide you with the necessary assistance.
Privacy Officer – Newland Medical Associates
22301 Foster Winter Drive
Southfield, MI 48075
Phone: (248) 552-0620
Fax: (248) 552-8602
This Notice of Privacy Practice is effective as of April 14, 2003.