Notice of Privacy Practices

Effective Date: March 1, 2019

This Notice describes how your medical information may be used and disclosed and how you can access this information. Please review it carefully. If you have questions, contact our Privacy Contact at 989-778-1425.

What Is Protected Health Information (PHI)?

PHI is information about you—including demographic data—that may identify you and relates to your past, present, or future physical or mental health or condition and related health care services.

Our Responsibilities

• Maintain the privacy of your PHI.
• Provide you with this Notice of our legal duties and privacy practices.
• Abide by the terms of this Notice currently in effect.
• Notify you if we are unable to agree to a requested restriction.
• Accommodate reasonable requests to communicate by alternative means or locations.

We may change the terms of this Notice at any time. The new Notice will be effective for all PHI we maintain, and a copy will be available upon request at your next appointment.

Your Rights

• Request restrictions on certain uses and disclosures of your information.
• Obtain a paper copy of this Notice on request.
• Inspect and obtain a copy of your health record.
• Request an amendment to your health record.
• Receive an accounting of disclosures of your health information.
• Request confidential communications by alternative means or locations.
• Revoke an authorization to use or disclose information, except where action has already been taken.

How We Use and Disclose PHI

We routinely use and disclose PHI for the following purposes:

• Treatment: To provide, coordinate, or manage your care and related services among providers.
• Payment: To obtain payment for services (e.g., billing, eligibility verification).
• Health care operations: For quality assessment, training, accreditation, and other operational purposes.

Other Permitted or Required Uses/Disclosures

• Business Associates: We may disclose PHI to vendors who perform services for us (e.g., transcription). They are required to safeguard your information.
• Notification & Communication with Family/Friends: Using professional judgment, we may disclose relevant information to a family member, personal representative, or friend involved in your care or payment, or to notify them of your location and condition.
• Marketing/Appointment Information: We may contact you with appointment reminders or information about treatment alternatives or health-related benefits and services.
• Food & Drug Administration (FDA): For reporting adverse events, product defects, or to enable recalls, repairs, or replacements.
• Workers’ Compensation: To comply with workers’ compensation or similar programs established by law.
• Health Oversight/Public Health/Legal Requirements: As required by law to appropriate agencies or authorities.
• Good-Faith Disclosures: Federal law permits disclosures to oversight agencies or authorities if a workforce member or business associate believes in good faith that unlawful conduct or violations of professional standards may endanger patients, workers, or the public.

Other Uses and Disclosures

Uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time, in writing, except to the extent that action has already been taken.

Questions or Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Contact. There will be no retaliation for filing a complaint.

• Practice Privacy Contact: TriCity Lung & Sleep – 989-778-1425

You may also contact the U.S. Department of Health and Human Services:

• The U.S. Department of Health & Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201
• Main: (202) 619-0257  |  Toll-Free: 1-877-696-6775
• More information: www.hhs.gov/hipaa

This Notice applies to the privacy practices of TriCity Lung & Sleep and relates to services we provide as a health care provider under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).