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.
Taylor Street Primary Clinic (“Clinic”) is committed to compliance with Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its implementing regulations. This Notice of Privacy Practices (“Notice”) has been drafted in accordance with the HIPAA Privacy Rule, contained in the Code of Federal Regulations at 45 CFR Parts 160 and 164, and the final rule issued by the Office of Civil Rights of the U.S. Department of Health and Human Services on January 25, 2013 implementing changes to the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules. Terms not defined in this Notice have the same meaning as they have in the HIPAA Privacy Rule.
Health care you receive at the Clinic is documented in a medical record, which we use to provide you with quality care and to comply with certain legal requirements. The privacy of your personal medical information is important to us, and we are committed to protecting your privacy and expect our employees, independent contractors, agents and business associates to do the same. This Notice describes how we may use and disclose your protected health information (“PHI”), your rights to access and control your PHI and our obligations regarding the use and disclosure of your PHI.
The law requires the Clinic to:
The Clinic has the right to:
Notice of change to privacy practices:
USE AND DISCLOSURE OF YOUR PHI:
The following section describes different ways that we may use and disclose your PHI. Most uses and disclosures of psychotherapy notes (where appropriate and if the Clinic has any such notes), uses and disclosures of PHI for marketing, and disclosures that constitute a sale of PHI, as well as other uses and disclosure of your PHI that are not described in this Notice will be made only with your written authorization, but we cannot require your authorization as a condition of your treatment. You may revoke any authorization in writing at any time, and this revocation will be effective for future uses and disclosures of PHI. However, such a revocation will not be effective for information that the Clinic has used or disclosed in reliance on the authorization.
Treatment, Payment and Health Care Operations
Once you sign the Clinic’s enrollment form, we may use and disclose your PHI for all activities that are included within the definitions of “treatment”, “payment” and “health care operations” as defined in the HIPAA Privacy Rule.
We may use PHI about you to provide you with medical treatment or services. We may disclose your PHI to doctors, nurses, or other health care professionals who are taking care of you. For example:
We contract with service providers, called business associates, to perform various functions on our behalf. For example, the Clinic may contract with a service provider to perform the administrative functions necessary to pay your medical claims. To perform these functions or to provide the services, business associates will receive, create, maintain, use, or disclose PHI, but only after the Clinic and the business associate agree in writing to contract terms requiring the business associate to appropriately safeguard your information.
Other Covered Entities
We may use or disclose your PHI to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with certain health care operations. For example, we may disclose your PHI to a health care provider when needed by the provider to render treatment to you, and we may disclose PHI to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing, or credentialing. This also means that we may disclose or share your PHI with other health care programs or insurance carriers (such as Blue Cross Blue Shield, etc.) in order to coordinate benefits, if you or your family members have other health insurance or coverage.
Others Involved in Your Health Care
We may disclose your PHI to a friend or family member that is involved in or responsible for your health care, unless you object or request a restriction (in accordance with the process described below under “Your Rights”). We also may disclose your information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. If you are not present or able to agree to these disclosures of your PHI, then, using professional judgment, we may determine whether the disclosure is in your best interest.
Disclosures to You
We are required to disclose to you or your personal representative most of your PHI when you request access to this information. We will disclose your PHI to an individual who has been designated by you as your personal representative and who has qualified for such designation in accordance with relevant law. Prior to such a disclosure, however, we must be given written documentation that supports and establishes the basis for the personal representation. We may elect not to treat the person as your personal representative if we have a reasonable belief that you have been, or may be, subjected to domestic violence, abuse, or neglect by such person; that treating such person as your personal representative could endanger you; or if we determine, in the exercise of our professional judgment, that it is not in your best interest to treat the person as your personal representative.
The Clinic may use or disclose your PHI for other purposes, without your consent or authorization, if we are required to do so by federal, state or local law. For example, we may release your PHI when required by privacy laws, public health laws, health oversight activities, court orders, certain subpoenas and discovery requests, or other laws, regulations, or legal processes, and for national security and intelligence activities. Under certain circumstances, we may make limited disclosures of PHI directly to law enforcement officials or correctional institutions if you are an inmate, lawful detainee, suspect, fugitive, material witness, missing person, or a victim or suspected victim of abuse, neglect, domestic violence or other crimes.
We may disclose your PHI to the extent reasonably necessary to prevent or lessen a serious and imminent threat to your health or safety or the health or safety of others. We may disclose your PHI when necessary to assist law enforcement officials capture someone who has admitted to a crime against you or who has escaped from lawful custody, and to coroners or medical examiners when necessary to identify a deceased person or determining a cause of death, and to funeral directors as necessary to carry out their duties. We may disclose proof of immunization to a school where State or other law requires the school to have such information prior to admitting the student, if we obtain an agreement, which may be oral, from a parent, guardian or other person acting in loco parentis for the individual, or from the individual himself or herself, if the individual is an adult or emancipated minor. We may also disclose your PHI to Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining the Clinic’s compliance with HIPAA. We may contact you to raise funds for the Clinic and you have the right to opt out of receiving such communications.
To exercise any of your rights in items 1 – 5 above, please make a request in writing to at the contact information listed at the end of this Notice.
If you believe that your privacy rights have been violated, you may file a complaint with the Clinic by writing to Privacy Officer, Taylor Street Primary Care Clinic, 1550 Taylor Street, Detroit, MI 48206, Telephone: 313-486-5501 or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you or penalize you for filing a complaint.
CONTACT INFORMATION AND QUESTIONS:
For more information about this Notice and to exercise any of the rights described in this Notice, contact Privacy Officer, Taylor Street Primary Care Clinic, 1550 Taylor Street, Detroit, MI 48206, Telephone: 313-486-5501.
Effective Date: 10/03/2007
Revision Effective Date: 02/24/2020