ROBERT
LEFEBVRE, MD AND STANLEY SZWALEK, MD (NEPHROLOGY) NOTICE OF PRIVACY
PRACTICES
Effective Date: 4/14/2003
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.
The Nephrology practice of Robert Lefebvre, MD and
Stanley Szwalek, MD is required by law to maintain the privacy
of individually identifiable patient health information (this
information is "protected health information" and is
referred to herein as "PHI"). We are also required to
provide patients with a Notice of Privacy Practices regarding
PHI. We are required to post this Notice in a prominent place
within our facility. We will only use or disclose your PHI as
permitted or required by applicable state law. This Notice applies
to your PHI in our possession including the medical records generated
by us.
We understand that your health information is highly
personal, and we are committed to safeguarding your privacy. Please
read this Notice of Privacy Practices thoroughly. It describes
how we will use and disclose your PHI.
This Notice applies to the delivery of health care
by the Nephrology practice of Robert Lefebvre, MD and Stanley
Szwalek, MD. This Notice also applies to the utilization review
and quality assessment activities of Munson Healthcare and the
Nephrology practice of Robert Lefebvre, MD and Stanley Szwalek,
MD as a member of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: We will use and disclose your
PHI in the provision and coordination of health care to carry
out treatment functions.
We will disclose all or any portion of your patient medical record
information to your consulting physician(s), nurses, pharmacists,
technicians, medical students and other health care providers
who have a legitimate need for such information in your care and
continued treatment.
Different departments will share medical information
about you in order to coordinate specific services, such as lab
work, x-rays and prescriptions.
We also will disclose your medical information to
people or entities outside the Nephrology practice who will be
involved in your medical care after you leave the Nephrology practice,
such as other care providers who will provide services that are
part of your care.
We will share certain information such as your name,
address, employment, insurance carrier, emergency contact information
and appointment scheduling information in an effort to coordinate
your treatment with us and with other health care providers.
We will use and disclose your PHI to inform you
of, or recommend possible treatment options or alternatives that
will be of interest to you.
We will use and disclose PHI to contact you as a reminder that
you have an appointment for medical care at the Nephrology practice.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, we will disclose
your PHI to the correctional institution or law enforcement official.
B. Payment: The Nephrology practice of Robert
Lefebvre, MD and Stanley Szwalek, MD will disclose PHI about you
for the purposes of determining coverage, eligibility, funding,
billing, claims management, medical data processing, stop loss/reinsurance
and reimbursement.
The medical information will be disclosed to an
insurance company, third party payer, third party administrator,
health plan or other health care provider (or their duly authorized
representatives) involved in the payment of your medical bill
and will include copies or excerpts of your medical records which
are necessary for payment of your account. It will also include
sharing the necessary information to obtain pre-approval for payment
for treatment from your health plan.
We will disclose PHI to collection agencies and
other subcontractors engaged in obtaining payment for care.
C. Health Care Operations: We will use and
disclose your PHI during routine health care operations including
quality review, utilization review, medical review, internal auditing,
accreditation, certification, licensing or credentialing activities
of the Nephrology practice, and for educational purposes.
For instance, we will need to share your demographic
information, diagnosis, treatment plan and health status for population
based activities relating to improving health or reducing health
care costs, protocol development, case management and care coordination,
and contacting health care providers and patients with information
about treatment alternatives, in order for us to operate our business
in an efficient, safe and legal manner.
We may also use and disclose your PHI to support
the sale, transfer, or other corporate restructuring of Munson
Healthcare's assets.
D. Other Uses and Disclosures: As part of
treatment, payment and health care operations, we may also use
your PHI for the following purposes:
Medical Research: We may disclose your PHI
without your Authorization to medical researchers who request
it for approved medical research projects; however, with very
limited exceptions such disclosures must be cleared through a
special approval process before any PHI is disclosed to the researchers.
Researchers will be required to safeguard the PHI they receive.
Information and Health Promotion Activities:
We will use and disclose some of your PHI for certain health promotion
activities. For example, your name and address will be used to
send you newsletters or general communications. We will also send
you information based on your own health concerns. We may send
you this information if we have determined that a product or service
may help you. The communication will explain how the product or
service relates to your well-being and can improve your health.
E. More Stringent State and Federal Laws:
The State law of Michigan is more stringent than HIPAA in several
areas. State law is more stringent when the individual is entitled
to greater access to records than under HIPAA and when under state
law the records are more protected from disclosure than under
HIPAA. Certain federal laws also are more stringent than HIPAA.
We will continue to abide by these more stringent state and federal
laws. The federal laws include applicable internet privacy laws,
such as the Children's Online Privacy Protection Act and the federal
laws and regulations governing the confidentiality of health information
regarding substance abuse treatment.
In Michigan patients have more rights of access
to behavioral health information under Michigan law than under
HIPAA and the state law defines a minimum necessary standard for
release of mental health information. Disclosure is permitted
with consent and for treatment without consent but only in an
emergency. Minors in Michigan have more rights to confidentiality
and protection of certain information (reproductive health, behavioral
health and substance abuse) than under HIPAA. State law requires
facilities to adopt policies regarding release of information
outside the facility. If the facility policy requires consent
for release, then consent will be required. State law genetic
and HIV testing and disclosure consents remain in place.
II. Permitted Use or Disclosure with an Opportunity
for You to Agree or Object
A. Family/Friends: With your permission,
we will disclose PHI about you to a friend or family member who
is involved in your medical care. We will also give information
to someone who helps you pay for your care. In addition, we will
disclose PHI about you to an agency assisting in a disaster relief
effort so that your family can be notified about your condition,
status and location. You have a right to request that your PHI
not be shared with some or all of your family or friends.
B. Promotional Communications: We do not
share or sell your PHI to companies that market health care products
or services directly to consumers for use by those companies to
contact you, such as drug companies. We do maintain a database
of individuals for promotional communications, disease management,
and health promotion purposes. We send information to the individuals
in this database about the programs and services of the Nephrology
practice. If you wish to be deleted from this database, you may
notify the Privacy Official of Munson Healthcare.
III. Use or Disclosure Requiring Your Authorization
A. Marketing: We are not permitted to provide
your PHI to any other person or company for marketing to you of
any products or services other than our products or services without
a signed authorization from you.
B. Research: We will use or disclose your
PHI as part of research that includes providing you with treatment.
For example, if you are part of a research study that includes
treatment, we may require that you sign an authorization to allow
the researchers to use or disclose your PHI for this research.
C. Other Uses: Any uses or disclosures that
are not for treatment, payment or operations and that are not
permitted or required for public policy purposes or by law will
be made only with your written authorization. Written authorizations
will let you know why we are using your PHI. You have the right
to revoke an authorization at any time, except to the extent that
we have taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public Policy
or Law without your Authorization
A. Law Enforcement Purposes: The Nephrology
practice of Robert Lefebvre, MD and Stanley Szwalek, MD will disclose
your PHI for law enforcement purposes as required by law, such
as responding to a court order or subpoena, identifying a criminal
suspect or a missing person, or providing information about a
crime victim or possible criminal conduct as part of a criminal
investigation.
Required by Law: We will disclose PHI about
you when required by federal, state or local law to make reports
or other disclosures. We also will make disclosures for judicial
and administrative proceedings such as lawsuits or other disputes
in response to a court order or subpoena. We will disclose your
medical information to government agencies concerning victims
of abuse, neglect or domestic violence. We will report drug diversion
and information related to fraudulent prescription activity to
law enforcement and regulatory agencies. Specialized government
functions will warrant the use and disclosure of PHI. These government
functions will include military and veteran's activities, national
security and intelligence activities, and protective services
for the President and others. We will make certain disclosures
that are required in order to comply with workers' compensation
or similar programs.
B. Health or Safety: Following the requirements
of the Michigan Department of Commerce, we will use and disclose
PHI to avert a serious threat to health and safety of a person
or the public. We will use and disclose PHI to Public Health Agencies
for immunizations, communicable diseases, etc. We will use and
disclose PHI for activities related to the quality, safety or
effectiveness of FDA-regulated products or activities, including
collecting and reporting adverse events, tracking and facilitating
product recalls, etc. and post marketing surveillance. Any patient
receiving a medical device subject to FDA tracking requirements
may refuse to disclose, or refuse permission to disclose, their
name, address, telephone number and social security number, or
other identifying information for the purpose of tracking.
V. Your Health Information Rights
Although we must maintain all records concerning
your treatment by us, you have the following rights concerning
your PHI:
A. Right to Inspect and Copy: You have the
right to access your PHI and to inspect and have a copy made of
your PHI as long as we maintain it except for: psychotherapy notes,
information that may be used in anticipation of, or that will
be used in a civil, criminal or administrative action or proceeding,
and where prohibited or protected by law.
We will deny your request for access to your PHI
without giving you an opportunity to review that decision if:
You don't have the right to inspect the information;
or it is otherwise prohibited or protected by law;
You are an inmate at a correctional institution
and obtaining a copy of the information would risk the health,
safety, security, custody or rehabilitation of you or other
inmates;
The disclosure of the information would threaten
the safety of any officer, employee or other person at the correctional
institution or who is responsible for transporting you;
You are involved in a clinical research project
and we created or obtained the PHI during that research. Your
access to the information will be temporarily suspended for
as long as the research is in progress;
We obtained the information that you seek access
to from someone other than the health care provider under a
promise of confidentiality and your access request is likely
to reveal the source of the information; or
Under other limited circumstances. In these instances,
however, we will allow the review of its decision by a health
care professional that we have chosen. This person will not
have been involved in the original decision to deny your request.
You agree to pay a reasonable copying charge. You
must make your requests to access and copy your PHI in writing
to Robert Lefebvre, MD and Stanley Szwalek, MD. We will respond
to your request within 30 days of its receipt. If we cannot, we
will notify you in writing to explain the delay and the date by
which we will act on your request. In any event, we will act on
your request within 60 days of its receipt.
B. Right to Amend: You have the right to
amend your PHI for as long as we maintain it. However, we will
deny your request for amendment if:
We did not create the information;
The information is not part of the designated
record set;
The information would not be available for your
inspection (due to its condition or nature); or
The information is accurate and complete.
If we deny your request for changes in your PHI,
we will notify you in writing with the reason for the denial.
We will also inform you of your right to submit a written statement
disagreeing with the denial. You may ask that we include your
request for amendment and the denial any time that we disclose
the information that you wanted changed. We may prepare a rebuttal
to your statement of disagreement and will provide you with a
copy of that rebuttal.
You must make your request for amendment of your
PHI in writing to Robert Lefebvre, MD and Stanley Szwalek, MD,
including your reason to support the requested amendment. We will
respond to your request within 60 days of its receipt. If we cannot,
we will notify you in writing to explain the delay and the date
by which we will act on your request. In any event, we will act
on your request within 90 days of its receipt.
C. Right to an Accounting: You have a right
to receive an accounting of the disclosures of your PHI that we
made, except for the following disclosures:
To carry out treatment, payment or health care
operations;
To you;
To persons involved in your care;
For national security or intelligence purposes;
To correctional institutions or law enforcement
officials; or
That occurred prior to April 14, 2003.
For each disclosure, you will receive: the date
of the disclosure, the name of the receiving organization and
address if known, a brief description of the PHI disclosed and
a brief statement of the purpose of the disclosure or a copy of
the written request for the information, if there was one.
You must make your request for an accounting of
disclosures of your PHI in writing to Robert Lefebvre, MD and
Stanley Szwalek, MD. You must include the time period of the accounting,
which may not be longer than 6 years. We will respond to your
request within 60 days from its receipt. If we cannot, we will
notify you in writing to explain the delay and the date by which
we will act on your request. In any event we will act on your
request within 90 days of its receipt.
In any given 12-month period, we will provide you
with an accounting of the disclosures of your PHI at no charge.
Any additional requests for an accounting within that time period
will be subject to a reasonable fee for preparing the accounting.
D. Right to Request Restrictions: You have
the right to request restrictions on certain uses and disclosures
of your PHI:
To carry out treatment, payment or health care
operations functions; or
Restricting specific information to only specified
family members, relatives, close personal friends or other individuals
involved in your care.
For example, you may ask that your name not be used
in the waiting room or that information about your condition not
be shared with your family. We will consider your request but
is not required to agree to the requested restrictions.
E. Right to Confidential Communications:
You have the right to receive confidential communications of your
PHI by alternative means or at alternative locations. For example,
you may request that we only contact you at work or by mail. We
will make every attempt to honor your request, but we reserve
the right to deny unreasonable requests.
F. Right to Receive a Copy of this Notice:
You have the right to receive a paper copy of this Notice of Privacy
Practices, upon request.
VI. Complaints
If you believe your privacy rights have been violated,
you may file a complaint with the Nephrology practice or with
the Secretary of the Department of Health and Human Services.
To file a complaint with the Nephrology practice, please contact
the Operations Manager of Robert Lefebvre, MD and Stanley Szwalek,
MD at:
4062 West Royal Drive
Traverse City, MI 49684 (231) 935-5904
All complaints must be submitted in writing directly
to the Operations Manager. We assure you that there will be no
retaliation for filing a complaint.
VII. Sharing and joint use of your Health Information
In the course of providing care to you and in furtherance
of the Munson Healthcare's mission to improve the health of the
community, the Nephrology practice of Robert Lefebvre, MD and
Stanley Szwalek, MD will share your PHI with other organizations
as described below who have agreed to abide by the terms described
below:
A. Medical Staff: Robert Lefebvre, MD, Stanley
Szwalek, MD and their staff participate together in an organized
health care arrangement to deliver health care to you. Robert
Lefebvre, MD, Stanley Szwalek, MD and their staff have agreed
to abide by the terms of this Notice with respect to PHI created
or received as part of delivery of health care services to you
in the Nephrology practice of Robert Lefebvre, MD and Stanley
Szwalek, MD. Robert Lefebvre, MD, Stanley Szwalek, MD and their
staff will have access to and use your PHI for treatment, payment
and health care operations purposes related to your care at the
Nephrology practice.
B. Business Associates: We will use and disclose
your PHI to business associates contracted to perform business
functions on our behalf including Munson Healthcare, its parent
who performs certain business functions for the Nephrology practice
of Robert Lefebvre, MD and Stanley Szwalek, MD. Whenever an arrangement
between the Nephrology practice and another company involves the
use or disclosure of your PHI, that business associate will be
required to keep your information confidential.
C. Membership in Munson Healthcare: The Nephrology
practice of Robert Lefebvre, MD and Stanley Szwalek, MD, other
members of Munson Healthcare and Munson Healthcare participate
together in an organized health care arrangement for utilization
review and quality assessment activities. We have agreed to abide
by the terms of this Notice with respect to PHI created or received
as part of utilization review and quality assessment activities
of Munson Healthcare and its members. Members of Munson Healthcare
will abide by the terms of their own Notice of Privacy Practices
in using your PHI for treatment, payment or healthcare operations.
As a part of Munson Healthcare, the Nephrology practice of Robert
Lefebvre, MD and Stanley Szwalek, MD and the various hospitals,
nursing homes, and health care providers in Munson Healthcare
share your PHI for utilization review and quality assessment activities
of Munson Healthcare, the parent company, and its members. Members
of Munson Healthcare also use your PHI for your treatment, payment
to the Nephrology practice and/or for the health care operations
permitted by HIPAA with respect to our mutual patients.
VIII. Additional Information
For further information regarding the subjects covered
in this Notice of Privacy Practice, please contact Munson Healthcare's
Privacy Official at (231) 935-2335.
IX. Changes to this Notice
The Nephrology practice of Robert Lefebvre, MD and
Stanley Szwalek, MD will abide by the terms of the Notice currently
in effect. We reserve the right to change the terms of this Notice
and to make the new Notice provisions effective for all PHI that
we maintain. We will provide you with the revised Notice at your
first visit following the revision of the Notice.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
