THIS NOTICE DESCRIBES HOW
MEDICAL AND
DRUG AND ALCOHOL RELATED
INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, West Michigan Addiction Consultants, PC (WeMAC) may not say to a person outside WeMAC that you attend the program, nor may WeMAC disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
WeMAC must obtain your written consent before it can disclose information about you for payment purposes. For example, WeMAC must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before WeMAC can share information for treatment purposes or for health care operations. However, federal law permits WeMAC to disclose information without your written permission:
For example, WeMAC can disclose information without your consent to obtain legal
or financial services, or to another medical facility to provide health care to you, as long as there is a qualified service organization/business associate agreement in place.
Before WeMAC can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. WeMAC is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.
You have the right to request that we communicate with you by alternative means or at an alternative location. WeMAC will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by WeMAC, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances.
Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in WeMAC’s records, and to request and receive an accounting of disclosures of your health related information made by WeMAC during the six years prior to your request (and not prior to April 14, 2003). This does not include disclosures with a proper authorization; to carry out treatment, payment, or health care operations; to individuals themselves; for the facility’s directory; to persons involved in the patient’s care; for national security or intelligence purposes; or to correctional institutions or to law enforcement officials. You also have the right to receive a paper copy of this notice.
You are advised that e-mail communication may be used between you and WeMAC staff. Please be aware that such communication may not be secure. Likewise, WeMAC staff uses cell phones for communication and will take reasonable precautions against improper disclosures, but cannot guarantee that these communications are secure.
WeMAC 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. WeMAC is
required by law to abide by the terms of this notice. WeMAC reserves the right to change the terms
of this notice and to make new notice provisions effective for all protected
health information it maintains. This
information will be made available to patients upon admission or at the time of
receiving services.
You may complain to WeMAC and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. You are requested to make a written description of your complaint and submit it to the WeMAC Privacy Officer. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
For further information, contact:
Gail E. Haynes, MA, CSW Privacy Officer (616)365-8800
Beth Kandow, BA Privacy Officer (616)365-8800