Notice of Privacy Practices
Katranji Reconstructive Surgery Institute, PLLC "KRSI".
And its Affiliated Corporations Katranji Hand Center, Michigan Therapy Center, and Work Wellness of Michigan
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
2111 Merritt Road
East Lansing, MI 48823
EATON RAPIDS MEDICAL CENTER
1500 South Main
Eaton Rapids, Michigan 48827
901 South Oakland Street
Saint Johns, Michigan 48879
Katranji Reconstructive Surgery Institute, PLLC. "KRSI" is required under the federal health care privacy rules to protect the privacy of your health information, which includes information about your health history, symptoms, test results, diagnoses, treatment, and claims and payment history (collectively, "Health Information"). KRSI is also required to provide you with this Privacy Notice regarding our legal duties, policies and procedures to protect and maintain the privacy of your Health Information. KRSI is required to follow the terms of this Privacy Notice unless (and until) it is revised. KRSI reserves the right to change the terms of this Privacy Notice and to make the new notice provisions effective for the Health Information that KRSI maintains and uses, as well as for any Health Information that KRSI may receive in the future. Should the terms of this Privacy Notice change, KRSI will make a revised copy of the notice available to you. Revised Privacy Notices will be available at our office for individuals to take with them and KRSI will post a copy of revised Privacy Notices in a prominent location in our office. Privacy Notices will also be posted and available electronically on KRSI’s web site.
PERMITTED USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
These are general descriptions only and do not cover every example of disclosure within a category
1. General Uses and Disclosures
Under the Privacy Rules, KRSI is permitted to use and disclose your Health Information for the following purposes, without obtaining your permission or authorization:
Treatment. We are permitted to use and disclose your health information for treatment and coordination of your health care. For example, we may disclose health information about you to other KRSI physicians and/or other health care personnel involved in your care that have a need to know your health information. We may also disclose your health information to your primary care provider and/or consulting providers.
Payment. We are permitted to use and disclose your health information for determining benefit coverage, billing and reimbursement purposes. This information may be released to an insurance company, third party payor or other authorized entities or person(s) involved in the payment of your medical bills. We will use your health information to prepare your bill and we may include copies or portions of your medical record which may be necessary for payment of your bill. For example, a bill sent to your insurance company may include information that directly identifies you, your diagnosis and the services and/or supplies you received. We may also disclose health information about you to other health care providers, insurance plans and health care clearing houses for payment purposes.
Health Care Operations. We are permitted to use and disclose your health information during health care operations, including, but not limited to: quality assurance, auditing, education purposes, consulting services, etc. For example, members of our medical staff may review your health information to evaluate the treatment and services provided, and the performance of our staff in caring for you. If ambulance service is required the medical team may require information on your condition in order to properly treat and transport you.
Business Associates. We are permitted to disclose your health information to our business associates who provide services to us. Our business associates are required to protect the confidentiality of your health information. For example, we may disclose your health information to an outside billing company who assists us in billing insurance companies or to a company utilized to determine customer satisfaction.
Required by Law. We may use and disclose your health information when required to do so by Federal, State or Local Law, disclosure may include but is not limited to: reporting abuse, neglect and/or domestic violence; in response to judicial and administrative proceedings; in response to a law enforcement request for information.
Law Enforcement. We may release certain health information if asked to do so by law enforcement officials:
As required by law, reporting wounds and physical injuries;
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness or missing person;
About the victim of a crime;
To alert authorities of a death we believe may be the result of criminal conduct;
Any evidence of criminal conduct occurring on our premises;
In emergency circumstances to report a crime; the location of the crime or victims; or the identity description or location of the person who committed the crime.
Or any other situation when required to do so by law.
KRSI may use or disclose your health information if we have reason to believe, in good faith, that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.
Public Health Activities. We may disclose health information about you for public health activities. These activities may include, but are not limited to:
A public heath authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury or disability;
Appropriate authorities authorized to receive reports of child abuse and neglect;
FDA-regulated entities for purposes of monitoring or reporting the quality, safety or effectiveness of FDA-regulated products; or
Notify a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.
Abuse, Neglect or Domestic Violence. We may disclose your health information to the appropriate government authority if we have reason to believe a patient has been the victim of abuse, neglect or domestic violence.
Regulatory Agencies/Health Care Oversight. We may disclose your health information to a health care oversight agency for activities authorized by law, including, but not limited to, licensure, investigations and inspections. These activities are necessary for the government and certain private health oversight agencies to monitor the health care system, government programs, and compliance with civil rights.
Judicial and Administrative Proceedings. We may disclose your health information if you are involved in a lawsuit or a dispute. We may disclose health information about you in response to an order of a court, administrative tribunal or in response to a subpoena, summons, warrant, discovery request or other similar legal requests.
Appointment Reminders. We may use and disclose your health information in order to contact you as a reminder that you have an appointment for treatment or medical services.
Treatment Alternatives. We may use and disclose your health information in order to contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Deceased Individuals. We may use and disclose the health information of deceased individuals to a coroner, medical examiner or funeral director as necessary for them to carry out their duties.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, KRSI may release your Health Information to the correctional institution or law enforcement official, where such information is necessary for the institution to provide you with health care; to protect your health or safety, or the health or safety of others; or for the safety and security of the correctional institution.
Workers' Compensation. We may use and disclose health information about you as authorized by law under the State of Michigan for workers' compensation or similar programs that provide benefits for work-related injuries or illness.
Other Uses and Disclosures. In addition to the reasons outlined above, KRSI may use and disclose your health information for other purposes permitted by the Privacy Rules.
Specialized Government Functions. If you are a member of the U.S. Armed Forces, KRSI may disclose your Health Information as required by military command authorities. KRSI may also disclose your Health Information to authorized federal officials for national security reasons and the Department of State for medical suitability determinations.
2. Uses and Disclosures that Require Patient Opportunity to Verbally Agree or Object Under the Privacy Rules, KRSI is permitted to use and disclose your health information:
To disaster relief agencies
To family members, close personal friends or any other person identified by you, if the information is directly related to that person’s involvement in your care or treatment. For example, we may allow a family member to pick up your prescriptions, medical supplies or X-rays.
Except in emergency situations, you will be notified in advance and have the opportunity to verbally agree or object to this use and disclosure of your health information.
3. Uses and Disclosures which Require Written Authorization
As required by the Privacy Rules, all other uses and disclosures of your Health Information (not described above) will be made only with your written Authorization. For example, in order to disclose your Health Information to a company for marketing purposes, KRSI must obtain your Authorization. Under the Privacy Rules, you may revoke your Authorization at any time. The revocation of your Authorization will be effective immediately, except to the extent that: KRSI has relied upon it previously for the use and disclosure of your health information; the Authorization was obtained as a condition of obtaining insurance coverage where other laws provide the insurer with the right to contest a claim under the policy or the policy itself.
INDIVIDUAL PATIENT RIGHTS
You have the following rights concerning your health information:
1. Request for Voluntary Restrictions. You have the right to request a restriction on the use and disclosure of your health information for treatment, payment and health care operations, as well as disclosures to persons involved in your care or payment of your care, such as family members or friends We will consider your requests, but we are not required to agree to your request and will notify you if we are unable to accommodate the request.
2. Access to Health information. Upon written request, you have the right to inspect and copy much of the health information we maintain about you, with some exceptions. The records that maintain include medial and billing records and any other records that KRSI uses for making decisions about you. KRSI is not required to provide you access to all the health information that that KRSI maintains. For example, the right of access does not extend to psychotherapy notes or information compiled in reasonable anticipation of, or the use in a civil, criminal or administrative proceeding. Where permitted by the Privacy Rules, you may request that certain denials to inspect and copy your health information be reviewed. If you request a copy or summary of explanation of your health information, KRSI will charge you a reasonable fee for copying costs, including cost of supplies, postage, labor and any other associated costs in preparing the summary of explanation.
Amendment. You have the right to request that we amend certain health information that we keep in your records. We are not required to make all requested amendments, but will give each request careful consideration. If we deny your request, we will provide you a written explanation of the reasons and your rights. Some information contained in your health information may include health information not created by KRSI or is not health information maintained by us or for us.
3. Accounting. You have the right to receive an accounting of disclosures of your health information KRSI made within six (6) years to the date of your request. The accounting will not include: disclosures related to treatment, payment or health care operations; disclosures to you; disclosures based on your Authorization; disclosures that are part of a Limited Data Set; incidental disclosures; disclosures to persons involved in your care or payment of your care; disclosures to correctional institutions or law enforcement officials; disclosures for facility directories or disclosures that occurred prior to October 1, 2005.
4. Confidential Communications. You have the right to receive confidential communications. You have the right to request that we communicate with you about your health information by a different means or at a different location than previously provided. For example, you may request that KRSI contact you only at home or by personal cell phone.
5. Rights to Receive a Paper Copy of This Privacy Notice: You have the right to receive a paper copy of this Privacy Notice upon request, even if you have agreed to receive this Privacy Notice electronically.
6. How to Exercise These Rights. All requests to exercise any of these rights must be in writing. Please contact our Privacy Officer at the address or phone number below to obtain the designated form(s) that KRSI will provide to you.
HOW TO REPORT A PRIVACY VIOLATION. If you believe that your privacy rights have been violated or that we have violated our own privacy practices, you may file a complaint with Katranji Reconstructive Surgery Institute, PLLC. directly using the contact information below. Or you may chose to file a confidential complaint by calling the Compliance Hotline at 1-800-826-6762. The Compliance Hotline is operated by an independent, third party that will take your concerns and forward those to our Compliance Officer for investigation. You may also file a complaint with the Secretary of DHHS at Region V, Office for Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave. Suite 240, Chicago, IL 60601, voice phone (312) 886-2359, fax (312) 886-1807, TDD (312) 353-5693. Complaints filed directly with the Secretary of the Department of Health and Human Services must be made in writing, name us, describe the act(s) or omissions in the violation of the Privacy Rules or our privacy practices and must be filed within 180 days of the time you knew or should have known of the violation. There will be no retaliation for filing a complaint.
PRIVACY OFFICER CONTACT INFORMATION
If you have questions and/or would like additional information regarding the use and disclosure of your health information, please contact our Privacy Officer:
Katranji Reconstructive Surgery Institute, PLLC.
Attention: Hipaa Privacy Officer
2111 Merritt Road
East Lansing, MI 48823
Telephone: (517) 332-4263
Fax: (517) 332-1132