Notice of Privacy Practices
Notice of Privacy Practices
This noticed describes how medical information about you may be used and how you can get access to this information. Please read it carefully.
Our Legal Duty
We are required by law to protect the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We will follow the privacy practices described in the notice. We reserve the right to change our policies and the terms of this notice at any time. Any changes we make will be effective for all of the information we maintain, including the information we created or received before we made the changes. If this notice is changed, the new notice will be made available for patients to read. You can request a copy of our notice at any time. For more information about our privacy practices or for additional copies of this notice, contact us using the information listed at the end of this notice.
Uses and Disclosures of Your Health Information
We use and disclose health information about you for treatment, payment, and healthcare operations. This means that we may use or disclose your health information:
- To a physician or healthcare provider who is providing treatment to you.
- To obtain payment for services that we provide for you.
- To assess the care that was provided and monitor the quality and effectiveness.
Additional Reasons to use and Disclose Your Health Information:
- When you specifically request and authorize us to do so in writing.
- We may release your health information to authorized friends or family members you have listed.
- To provide appointment reminders via phone, mail, email.
- To provide test results. We will leave a message to have you call us back.
- To meet legal requirements- we may disclose information as requested by law for certain judicial or administrative court proceedings.
- For certain public health activities, we are required by law to report certain information for disease control and public health investigations.
- To prevent serious harm to you or others- we are obligated to report abuse, neglect, and domestic violence.
- For research purposes, it must be approved by the Institutional Review Board with reviewed proposals and established protocols to ensure that your privacy is protected.
- When required by the Food and Drug Administration.
- To a coroner or funeral director to complete their legal duties.
- To comply with workers’ compensation laws.
- We will disclose information to facilitate organ, eye, or tissue donation.
- You have the right to obtain copies of your health information by completing an Authorization Form.
- You have the right to request that we place additional restrictions on the usage of your medical information. These restrictions cannot hinder treatment, payment, or requirements of the law.
- You have the right to request any information in your record that you feel is incorrect. We may deny the request in certain circumstances.
Questions and Complaints
We support your right to the privacy of your health information. If you would like more information about our privacy practices or have questions, please contact us:
Contact: Privacy Officer
Address: 1155 East Paris Avenue SE, Suite 100, Grand Rapids, MI 49546
Phone: 616.459.8088 Fax: 616.459.831
West Michigan Rheumatology, PLLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. West Michigan Rheumatology, PLLC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. West Michigan Rheumatology, PLLC provides free aids and services to people with disabilities to communicate effectively with us, such as: Written information in other formats (large print and accessible electronic formats). If you need these services, contact the Compliance Officer for West Michigan Rheumatology, PLLC at: (616) 459-8088. If you believe that West Michigan Rheumatology, PLLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Compliance West Michigan Rheumatology, PLLC 1155 East Paris Ave SE Suite 100 Grand Rapids, MI 49546 Phone (616) 459-8088 Fax (616) 459-8312. Email: firstname.lastname@example.org You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Compliance Officer is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html