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Privacy PracticesThis notice describes how personal and medical information about you may be used and disclosed, and how you can get access to this information.
You have a right to ask for a copy at any time.
Please review it carefully.
Understanding the type of information we collect
We collect information about you when you visit the Health Department for services. It may include your date of birth, address, identification numbers (like social security numbers), and other personal information. It also may include medical, health, and billing information.
Our Privacy Commitment to you
We at the Health Department take confidentiality and privacy of your health information very seriously. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing, we will only disclose your information for the purposes of treatment, payment, healthcare operations, or when we are required by law to do so.
We may use and disclose your health information to provide, coordinate, or manage your health care and related services. For example, a nurse may obtain medical information from you to determine the proper care and services to provide.
We may use and disclose information so that the care you receive can be properly billed and paid for. For example, if you have Medicaid, we will need to disclose your health information to the Medicaid Program in order to be reimbursed for our services.
We may need to use and disclose information for our healthcare operations. For example, we may use information to review the quality of care you receive.
Certain kinds of sensitive records will require your written permission to be released even for treatment, payment, and healthcare operations.
As Required By Law
We will release information when we are required by law to do so. Examples of such releases would be for law enforcement or national security purposes, subpoenas or other court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety, or in other kinds of emergencies.
With Your Permission
If you give us permission in writing, we may use and disclose your personal information. You have the right to change your mind and revoke this permission at any time, in writing. We cannot take back any uses or disclosures that have already been made with your previous permission.
Your Privacy Rights
You have the following rights regarding the health information that we collect about you. Your requests must be made in writing to the Health Department Privacy Contact listed at the end of this document.
Your Right to Receive a Written Copy of the Notice of Privacy Practices
You may ask for a paper copy of the notice at any time.
Your Right to Inspect and Copy
In most cases, you have the right to look at or get copies of your records. You may be charged a fee for the cost of copying your records.
Your Right to Amend
You may ask us to change your records if you feel that there is a mistake. We can deny your request for certain reasons, but we must give you a written reason for our denial.
Your Right to a List of Disclosures
You have the right to ask for a list of disclosures of your health information made after April 14, 2003. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you, or information that was sent with your written permission.
Your Right to Request Restrictions on our Use or Disclosure of Information
You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to such requests.
Your Right to Request Confidential Communications
You have the right to ask that we share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home address. You do not have to explain the reason for your request.
Changes to this Notice
We reserve the right to revise this notice. A revised notice will be effective for health information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes to our notice will be posted in our main clinic areas and published on our web site, www.grandtraverse.org. We will provide you with a revised copy upon your request.
For More Information
If you would like more information about any part of this Notice of Privacy Practices, there is a longer more detailed version available. You may ask for a copy of this at any time.
If you want to exercise your rights under this notice, or file a complaint, you may call or write to the Privacy Contact at the number or address below. If your request to us must be in writing, we will help you prepare your written request, if you wish.
Kim White R.N., Privacy Contact
Grand Traverse County Health Department
2600 LaFranier Road
Traverse City, MI 49686
Complaints to the Federal Government
If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government at the address below. We will not retaliate against you for filing a complaint with the Health Department or the federal government.
Region V, Office for Civil Rights
U.S. Department of Health & Human Services
233 N. Michigan Ave., Suite 240
Chicago, Ill. 60601
Voice Phone: (312) 886-2359
Fax: (312) 886-1807
TDD: (312) 353-5693
This notice was published and becomes effective on April 14, 2003