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Practical Medical Insights
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.

Practical Medical Insights is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our clients with notice of our legal duties and privacy practices with respect to your protected health information.

Disclosure of Your Health Care Information

Medical Guidance

We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations.

E.g.: On occasion, it may be necessary to seek consultation regarding your condition from other health care providers.

Payment

We do not accept insurance for our services and do not bill insurance companies.

If payment is not made as arranged, our office may utilize an outside collection agency, credit reporting agency or other means of collecting outstanding debt. Your file, containing protected health care information, may be reviewed by the designated collection agency or authority.

Workers’ Compensation

If applicable, we may disclose your health information as necessary to comply with state Workers’ Compensation Laws.

Emergencies

We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care, about your medical condition or in the event of an emergency or of your death.

Public Health

As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

Judicial and Administrative Proceedings

We may disclose your health information in the course of any administrative or judicial proceeding.

Law Enforcement

We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.

Deceased Persons

We may disclose your health information to coroners or medical examiners.

Public Safety

It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

Specialized Government Agencies

We may disclose your health information for military, national security, prisoner and government benefits purposes.

Marketing and Other Communications

We may contact you for marketing purposes or other communication purposes, as described below:

E.g.: As a courtesy to our clients, we may call your home on the evening prior to your scheduled appointment to remind you of your appointment time. If you are not at home, we may leave a reminder message on your answering machine or with the person answering the phone. No protected health information will be disclosed during this call other than the date and time of your scheduled appointment and a request to call our office if you need to cancel or reschedule your appointment.

E.g.: We may at times send you a letter, post card, or e-mail, or call you to let you know about new services offered by Practical Medical Insights, to follow up on your satisfaction with our services, to invite you to participate in a charitable activity with Practical Medical Insights, or for other similar purposes. No protected health information will be disclosed in these communications.

Change of Ownership

In the event that Practical Medical Insights is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

  • You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Practical Medical Insights is not required to agree to the restriction that you requested.
  • You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
  • You have the right to inspect and copy your health information.
  • You have a right to request that Practical Medical Insights amend your protected health information. Please be advised, however, that Practical Medical Insights is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s)and information about how you can disagree with the denial.
  • You have a right to receive an accounting of disclosures of your protected health information made by Practical Medical Insights.
  • You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices

Practical Medical Insights reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Practical Medical Insights is required by law to comply with this Notice. Updated notices of our privacy practices will be available on our website, www.practicalmedicalinsights.com. Practical Medical Insights is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: Dr. Abigail Schildcrout by calling this office at 248-439-9123. If Dr. Abigail Schildcrout is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

Complaints

Complaints about your privacy rights, or how Practical Medical Insights has handled your health information should be directed to Dr. Abigail Schildcrout by calling this office at 248-439-9123. If Dr. Abigail Schildcrout is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to: DHHS, Office of Civil Rights 200 Independence Avenue, S.W. Room 509F HHH Building Washington, DC 20201 This notice is effective as of ___12___/___19___/___2012____

I have read the Privacy Notice and understand my rights contained in the notice.

By way of my signature, I provide Practical Medical Insights with my authorization and consent to use and disclose my protected health care information for the purposes of treatment, payment and health care operations as described in the Privacy Notice. Client’s Name (print) ________________________________________________
Client’s Signature ________________________________________________ Date ______________
Authorized Practical Medical Insights Signature ________________________________________________ Date _____________