Notice of Privacy Caro HIPAA NOTICE OF PRIVACY PRACTICES For LIGHTHOUSE, INC. CARO 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. PLEASE NOTE THAT THIS NOTICE IS SEPARATE FROM THE RECIPIENT RIGHTS PAMPHLET YOU HAVE RECEIVED AS PART OF THE INTAKE/ADMISSION PROCESS. This notice will tell you how we may use and disclose protected health information about you. Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this notice, we call all of that protected health information, a medical information.@ This notice also will tell you about your rights and our duties with respect to medical information about you. In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.

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I. Uses and Disclosure of Protected Health Information The Lighthouse, Inc. may use and disclose medical health information about you for a number of different purposes. Each of these purposes is described below. For Treatment The Lighthouse may use medical information about you to provide, coordinate or manage your health care and related services by both us and other health care providers. We may disclose medical information about you to doctors, nurses, hospitals, and other health facilities who become involved in your care. We may consult with other health care providers concerning you and as part of the consultation share your medical information with them. Similarly, we may refer you to another health care provider and as part of the referral share medical information about you with that provider.

 

• For example, we may conclude you need to receive services from a physician with a particular specialty. When we refer you to that physician, we also will contact that physician=s office and provide medical information about you to them so they have information they need to provide services for you. Another example is we may disclose your medical information to a pharmacy to fulfill a prescription.

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• For Payment The Lighthouse may use and disclose your medical information as needed, to obtain payment for the services we provided to you. This may include billing you, a third party payer, or communications to your health insurer to get approval for the treatment that we recommend. For example, we may need to give your insurance company information about the health care services we provide to you so your insurance company will pay us for those services or reimburse you for amounts you have paid. We also may need to provide your insurance company or a government program, such as Medicare or Community Mental Health facility, with information about your medical condition and the health care you need in order to determine if you are covered by that insurance or program. In order to get payment for services provided, we may also need to disclose your protected health information to your insurance company to demonstrate the medical necessity of the services or to demonstrate that required documentation exists.

 

• We may also disclose patient information to another provider involved in your care for the other providers payment activities.

• For Health Care Operations We may use or disclose medical information, as necessary, for our own health care operations in order to facilitate the function of the Lighthouse, Inc., and to provide/maintain quality health care to all patients. Health care operations include such activities as:

  • Training programs including those in which practitioners, health professionals, students, trainees, volunteers, and other direct care staff in health care learn under our supervision.

  • Performance review/activities of our employees.

  • Quality assessment and improvement activities.

  • Accreditation, certification, licensing or credentialing activities.

  • Review and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs.

  • Business management and general administrative activities.

  • In certain situations, we may also disclose consumer information to another provider or health plan for their health care operations.

 

• Other Uses and Disclosures As part of treatment, payment, and healthcare operations, we may also use or disclose your protected medical information for the following purposes:

  • How we will contact you unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see A Right to Receive Confidential Communications.

  • At appointment reminders in certain situations and circumstances we may use and disclose medical information about you to contact you to remind you of an appointment or meeting you may have with the Lighthouse, Inc. For example, we may contact you to remind you of a team meeting. We may also contact you regarding a cancellation of a meeting or treatment appointment.

  • Treatment Alternatives and Health Related Benefits, we may use and disclose medical information about you to contact you about treatment alternatives, health-related benefits or services that may be of interest to you.

  • Marketing Communications, we may use and disclose medical information about you to communicate with you about a product or service to encourage you to purchase the product or service. This may be: to describe a health related product or service that is provided by us and may be of benefit to you; For your treatment; For case management or care coordination for you; To direct or recommend alternative treatments, therapies, health care providers, or settings of care.

  • We may communicate to you about products and services in a face-to-face communication by us to you. All other use and disclosure of medical information about you by us to make a communication about a product or service to encourage the purchase or use of a product or service will be done only with your written authorization.

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II. Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted Without Authorization or Opportunity to Object The HIPAA Privacy Rule also allows us to use or disclose your protected medical information without your permission or authorization for a number of reasons including the following:

• Lighthouse, Inc. directory, we may include your name, your location in our facility, your condition described in general terms, and your religious affiliation in our directory while you are a patient in our facility. This information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, such as a minister, priest, or rabbi. If you want to restrict the information we include in the directory, you must notify Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723 of your objection.

• Individuals involved in your care, we may disclose to a family member, other relative, a close personal friend, or any other person identified by you, medical information about you that is directly relevant to that person=s involvement with your care or payment related to your care.

• We also may use or disclose medical information about you to notify, or assist in notifying, those persons of your location, general condition, or death. If there is a family member, other relative, or close personal friend that you do not want us to disclose medical information about you to, please notify Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723 or tell our staff member who is providing care to you.

• Disaster Relief, we may use or disclose medical information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a family member, other relative, close personal friend, or other person identified by you of your location, general condition, or death.

• Required by Law, we may use or disclose medical information about you when we are required to do so by law.

• When there are risks to Public Health, we may disclose medical information about you for the following public activities and purposes:

  • To prevent, control, or report disease, injury or disability as permitted by law.

  • To report vital events such as birth or death as permitted or required by law.

  • To conduct public health surveillance, investigations, and interventions as permitted or required by law.

  • To collect or report adverse events and product defects, track FDA regulated products, enable product recalls, repairs or replacements to the FDA, and to conduct post marketing surveillance.

  • To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.

  • To report to an employer information about an individual who is a member of the workforce as legally permitted by law. Victims of Abuse, Neglect or Domestic Violence We may disclose medical information about you to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence, if we believe you are a victim of abuse, neglect, or domestic violence.

• This will occur to the extent the disclosure is: (a) required by law; (b) agreed to by you; or, (c) authorized by law and we believe the disclosure is necessary to prevent serious harm to you or to other potential victims, or, if you are incapacitated and certain other conditions are met, a law enforcement or other public official representing that immediate enforcement activity depends on the disclosure.

• Health Oversight Activities, we may disclose your medical information to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.

• Judicial and Administrative Proceedings, we may disclose medical information about you in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal as expressly authorized by such order or in response to a signed authorization (in a format approved by the Michigan Court Administrator). Disclosures for Law Enforcement Purposes

  • a. As required by law.

  • b. Pursuant to court order, court-ordered warrant, subpoena, summons or similar process

  • c. For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.

  • d. About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain that person=s agreement, in limited circumstances, the information may still be disclosed.

  • e. To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.

  • f. About crimes that occur at our facility.

  • g. To report a crime in emergency circumstances.

• To Coroners, Funeral Directors, and for Organ Donation, we may disclose protected medical information to a coroner or medical examiner for identification purposes, to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected medical information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. Protected medical information may be used to facilitate organ, eye or tissue donation and transplantation, we may disclose medical information about you to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes, or tissue. For Research Purposes Under certain circumstances, we may use or disclose medical information about you for research. Before we disclose medical information for research, the research will have been approved through an approval process that evaluates the needs of the research project with your needs for privacy of your medical information. We may, however, disclose medical information about you to a person who is preparing to conduct research to permit them to prepare for the project, but no medical information will leave the Lighthouse, Inc. during that person=s review of the information. We will not release genetic information without your written consent.

• To Avert Serious Threat to Health or Safety, we may consistent with applicable law and ethical standards of conduct, use or disclose protected health information about you if we believe, in good faith, the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.

• We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.

• Military, if you are a member of the Armed forces, we may use and disclose medical information about you for activities deemed necessary by the appropriate military command authorities to assure the proper execution of the military mission. We may also release information about foreign military personnel to the appropriate foreign military authority for the same purposes. For Specified Government Functions In certain circumstances, the Federal regulations authorize the Lighthouse, Inc. to use or disclose your medical information to authorized federal officials to facilitate specified government functions relating to national security activities, intelligence, counter-intelligence, and other national security activities authorized by law, protective services for the President, other federal officials, or foreign heads of state, and medical suitability determinations including disclosing the results to officials in the United States Department of State for purposes of a required security clearance or service abroad.

• Inmates; Persons in Custody, we may disclose medical information about you to a correctional institution or law enforcement official having custody of you. The disclosure will be made if the disclosure is necessary:

  • (a) to provide health care to you;

  • (b) for the health and safety of others; or,

  • (c) the safety, security and good order of the correctional institution.

• Workers Compensation, we may disclose medical information about you to the extent necessary to comply with workers= compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault. ​

 

III. Uses and Disclosures Permitted Without Authorization But With Opportunity to Object, we may disclose your protected medical information to your family member or a close personal friend if it is directly relevant to the person=s involvement in your care or payment related to your care. We can also disclose your information in connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death. You may object to these disclosures; however, if you do not object to these disclosures or we can infer from the circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is in your best interests for us to make disclosure of information that is directly relevant to the person=s involvement with your care, we may disclose your protected medical information as described.

 

IV. Other Uses and Disclosures Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying Privacy Officer at P.O. Box 289, 1655 East Caro, Road, Caro, MI 48723 in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect on actions taken by us in reliance on it. V. Your Rights With Respect to Medical Information About You In addition to other rights you may have under State law, you have the following rights under HIPAA regarding your medical information.

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Right to Request Restrictions, you have the right to request that we restrict the uses or disclosures of medical information about you to carry out treatment, payment, or health care operations. You have the right to restrict the use or disclosure of medical information if you have paid in full out of pocket for the services. You also have the right to request that we restrict the uses or disclosures we make to;

• (a) a family member, other relative, a close personal friend or any other person identified by you; or,

• (b) for public or private entities for disaster relief efforts. For example, you could ask that we not disclose medical information about you to your brother or sister. To request a restriction, you may do so at any time. If you request a restriction, you should do so to, Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723 or call at (989) 673-2500. We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction.

 

Right to Receive Confidential Communications, you have the right to request that we communicate medical information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why you are asking for the confidential communication. If you want to request confidential communication, you must do so in writing to Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723. Your request must state how or where you can be contacted. We will accommodate your request. However, we may, when appropriate, require information from you concerning how payment will be handled. We also may require an alternate address or other method to contact you.

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Right to Inspect and Copy, with a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of medical information about you. To inspect or copy medical information about you, you must submit your request in writing to Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723. Your request should state specifically what medical information you want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing. We will act on your request within thirty (30) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copies. Subject to limitations imposed upon us by MCL 330.1748 (4) of the Michigan Mental Health Code, under Federal law, however, we may deny your request to inspect and copy the following, medical information in your record: psychotherapy notes, information compiled in anticipation of or use in, a civil, criminal or administrative action or proceeding; and medical information that is subject to a law that prohibits access to protected medical information.

If we deny your request, we will inform you of the basis for the denial, how you may have your denial reviewed, and how you may complain. If you request a review of our denial, it will be conducted by a licensed health care professional designated by us who was not directly involved in the denial. We will comply with the outcome of that review.

Right to Amend, you have a right to ask us to amend medical information about you. You have this right for so long as the medical information is maintained by us. To request an amendment, you must submit your request in writing to Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723. Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within sixty (60) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying. If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment with relevant other persons. We also will make the appropriate amendment to the medical information by appending or otherwise providing a link to the amendment. We may deny your request to amend medical information about you. We may deny your request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny your request to amend medical information if we determine that the information:

• Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment; Is not part of the medical information maintained by us;

• Would not be available for you to inspect or copy; or

• Is accurate and complete. If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information.

• We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the medical information involved. You also will have the right to complain about our denial of your request.

• Right to an Accounting of Disclosures, you have the right to receive an accounting of disclosures of medical information about you. The accounting may be for up to six (6) years prior to the date on which you request the accounting, but not before April 14, 2003. Certain types of disclosures are not included in such an accounting:

  • a.Disclosures to carry out treatment, payment and health care operations;

  • b.Disclosures of your medical information made to you;

  • c.Disclosures that are incident to another use or disclosure;

  • d.Disclosures that you have authorized;

  • e.Disclosures for our facility directory or to persons involved in your care;

  • f.Disclosures for disaster relief purposes;

  • g.Disclosures for national security or intelligence purposes;

  • h.Disclosures to correctional institutions or law enforcement officials having custody of you;

  • i.Disclosures that are part of a limited data set for purposes of research, public health, or health care operations (a limited data set is where things that would directly identify you have been removed.)

  • j.Disclosures made prior to April 14, 2003. Under certain circumstances your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended. Should you request an accounting during the period of time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official or to a health oversight agency. To request an accounting of disclosures, you must submit your request in writing to, Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723.​

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Your request must state a time period for the disclosures. It may not be longer than six (6) years from the date we receive your request and may not include dates before April 14, 2003. Usually, we will act on your request within sixty (60) calendar days after we receive your request. Within that time, we will either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting and why the delay is necessary. There is no charge for the first accounting we provide to you in any twelve (12) month period. For additional accountings, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and give you an opportunity to withdraw or modify your request to avoid or reduce the fee. Right to Copy of this Notice You have the right to obtain a paper copy of our Notice of Privacy Practices. You may obtain a paper copy even though you agreed to receive the notice electronically.

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You may request a copy of our Notice of Privacy Practices at any time. You may obtain a copy of our Notice of Privacy Practices over the Internet at our web site, www.lighthouserehab.com. To obtain a paper copy of this notice, contact Privacy Officer at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723. VI. Our Duties Generally We are required by law to maintain the privacy of medical information about you and to provide individuals with notice of our legal duties and privacy practices with respect to medical information. We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.

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Our Right to Change Notice of Privacy Practices, we reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice=s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice.

Availability of Notice of Privacy Practices A copy of our current Notice of Privacy Practices will be posted Lighthouse Outpatient Therapy Center at 1655 East Caro Road, Caro, MI 48723. A copy of the current notice also will be posted on our web site, www.lighthouserehab.com. At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting Privacy Officer at (989)673-2500, or in person at 1655 East Caro Road, Caro, MI 48723. Effective Date of Notice This notice is effective April 14, 2003.

 

Complaints: You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. To file a complaint with us, contact Privacy Officer, at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723 or by phone at (989) 673-2500.

All complaints should be submitted in writing. To file a complaint with the United States Secretary of Health and Human Services, send your complaint to him or her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201. You will not be retaliated against for filing a complaint. Questions and Information If you have any questions or want more information concerning this Notice of Privacy Practices, please contact Privacy Officer at P.O. Box 289, 1655 East Caro Road, Caro, MI 48723 or by phone at (989) 673-2500.