Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. We must follow the terms of the notice of privacy practices that we have in effect at the time. We reserve the right to revise or amend this Notice of Privacy Practices at any time. Any revision or amendment to this notice will be effective for all of your PHI about you that we maintain at the time of the change and that we maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

1. Treatment.
Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice, such as our doctors, nurses, medical assistants, technicians or clerical staff - may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, unless you object, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents.
2. Payment.
Our practice may use and disclose your PHI in order to bill and collect payment for the services and items that you receive from us. For example, we may contact your health insurer to make sure that you are eligible for benefits (and for what kinds of benefits), and we may give your insurer details about your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items.
3. Health Care Operations.
Our practice may use and disclose your PHI to operate our business. For example, our practice may use PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
4. Appointment Reminders.
Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options.
Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services.
Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
7. Messages.
We may leave messages containing your PHI on your answering machine or with individuals who answer your phone. In such cases, we will limit the amount of PHI disclosed to that which we determine is in your best interests.
8. Release of Information to Family/Friends.
Unless you object, our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a guardian may ask that a caretaker take a patient to our office for treatment. In this example, the caretaker may have access to this patient's PHI.
9. Disclosures Required By Law.
Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

We also may use or disclose your PHI under the following circumstances:

1. Public Health Purposes.
Our practice may disclose your PHI to public health authorities who are authorized by law to collect information for such purposes as:


• Maintaining vital records, such as births and deaths;
• Reporting child abuse or neglect;
• Preventing or controlling disease, injury or disability;
• Notifying a person regarding potential exposure to a communicable disease;
• Notifying a person regarding a potential risk for spreading or contracting a disease or condition; Investigations and surveillance;
• Activities related to the quality, safety or effectiveness of FDA regulated products or activities, such as reporting reactions to drugs or problems with products or devices;
• Notifying appropriate government agency(ies) and authority(ies) regarding the abuse or neglect of an adult patient (including domestic violence). However, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information; and
• Notifying your employer under limited circumstances related primarily to workplace injury or illness or illness or medical surveillance.
2. Health Oversight Activities.
Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings.
Our practice may use and disclose your PHI in response to a court or administrative order. We also may disclose your PHI in response to a discovery request, subpoena or other lawful process without a court order, but only under certain circumstances permitted by law.
4. Law Enforcement.
We may release PHI to a law enforcement official:
• Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement;
• Concerning a death we believe has resulted from criminal conduct;
• Regarding criminal conduct at our offices;
• In response to a warrant, summons, court order, subpoena or similar legal process;
• To identify/locate a suspect, material witness, fugitive or missing person; As required by law; and
• In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
.
5. Deceased Patients.
We may release your PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation.
We may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation.
7. Research.
Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when: a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; or b) we obtain certain representations from the researcher. Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
8. Government Functions.
Our practice may disclose your PHI for various military and veterans activities. Our practice also may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations, medical suitability determinations, and for eligibility or enrollment in government programs.
9. Inmates.
Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: a) for the institution to provide health care services to you; b) for the safety and security of the institution; c) for law enforcement at the correctional institution; and/or d) to protect your health and safety or the health and safety of other individuals.
10. Workers Compensation.
Our practice may release your PHI for workers' compensation and similar programs. When Michigan law requires your prior consent or authorization for a use or disclosure of PHI, or gives you greater rights regarding your PHI, we will comply with Michigan law. For example, third parties will not be given a copy of your medical record without your prior authorization except as otherwise permitted by Michigan law.

1. Confidential Communications.
You have the right to ask that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. To request a type of confidential communication, you must make a written request specifying the requested method of contact or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions.
You have the right to request a restriction on our use or disclosure of your PHI for treatment, payment or health care operations. You also have the right to request that we restrict our disclosure of your PHI to only certain individuals. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing that clearly describes the PHI you wish restricted; whether you are requesting to limit our practice's use, disclosure or both; and how you want the restrictions to apply.
3. Inspection and Copies.
You have the right to inspect and obtain a copy of the PHI that we keep about you, including patient medical records and billing records, [but not including psychotherapy notes,] or PHI gathered for civil, criminal or administrative proceedings. You must submit your request in writing in order to inspect and/or obtain a copy of your PHI. Our practice will charge a fee of $35.00 for the cost of copying, mailing, labor and supplies associated with your request. Our practice may deny your request in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
4. Amendment.
You may ask us to amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and it must provide us with a reason that supports your request for amendment. We may deny your request under certain circumstances permitted by law.
5. Accounting of Disclosures.
You have the right to request an "accounting" of certain of our disclosures of your PHI. To obtain an accounting of disclosures, you must submit your request in writing. All requests must specify a time period for the disclosures, which may not be longer than six years from the date of disclosure and may not include dates before April 14, 2003. The first accounting that you request within a 12-month period is free of charge, but our practice will charge you a fee of $25.00 for additional lists within the same 12-month period. TO EXERCISE YOUR RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS, RESTRICTIONS, INSPECTION AND COPIES, AMENDMENTS OR ACCOUNTING OF DISCLOSURES, PLEASE SUBMIT YOUR REQUEST IN WRITING TO:


Catherine Tennant, Billing Manager
645 Barclay Circle
Rochester Hills, MI 48307

6. Right to a Paper Copy of This Notice.
You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the office manager in this office.
7. Right to File a Complaint.
If you believe your privacy rights have been violated, you may file a written complaint with our practice and/or with the Secretary of the Department of Health and Human Services. To file a written complaint with our practice, write


James Aluia, Executive Director
645 Barclay Circle
Rochester Hills, MI 48307

All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures.
Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice that are not permitted or required by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization but the revocation will not apply to uses and disclosures already made.