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.
We at North Flight are 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 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.
North Flight understands 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 North Flight will use and disclose your PHI.
This Notice applies to the delivery of health care
by North Flight. This Notice also applies to the utilization review
and quality assessment activities of Munson Healthcare and North
Flight as a member of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: North Flight will use and disclose
your PHI in the provision and coordination of health care to carry
out treatment functions.
North Flight will disclose all or any portion of your PHI to your
attending physician, 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.
North Flight also will disclose your medical information
to people or entities outside North Flight who will be involved
in your medical care, such as other care providers and family
who will provide services that are part of your care.
North Flight will share certain information such as your name,
address, employment, insurance carrier, and emergency contact
information in an effort to coordinate your treatment with us
and with other health care providers.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, North Flight
will disclose your PHI to the correctional institution or law
enforcement official.
B. Payment: North Flight 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.
The medical information may also be released to
independent health care providers who were involved in your treatment
(for example, Emergency Room physicians) or emergency delivery
so that they may seek payment for caring for you.
North Flight will disclose PHI to collection agencies
and other subcontractors engaged in obtaining payment for care.
C. Health Care Operations: North Flight 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 North Flight, and for educational
purposes.
For instance, North Flight 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.
North Flight may also use and disclose your PHI
to support the sale, transfer, or other corporate restructuring
of North Flight's assets.
D. 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.
North Flight 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: At the time that North
Flight service is rendered, North Flight will disclose PHI about
you to a friend or family member who is involved in your medical
care. The information disclosed will be relevant to the family
member's involvement in your care and to the services rendered.
In addition, North Flight 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: North Flight
does 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.
III. Use or Disclosure Requiring Your Authorization
A. Marketing: North Flight is not permitted
to provide your PHI to any other person or company for marketing
to you of any products or services other than the North Flight's
products or services unless you have signed an authorization.
B. Research: North Flight 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, North Flight 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
North Flight has taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public Policy
or Law without your Authorization
A. Law Enforcement Purposes: North Flight
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: North Flight will disclose
PHI about you when required by federal, state or local law to
make reports or other disclosures. North Flight also will make
disclosures for judicial and administrative proceedings such as
lawsuits or other disputes in response to a court order or subpoena.
North Flight will disclose your medical information to government
agencies concerning victims of abuse, neglect or domestic violence.
North Flight 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.
North Flight will make certain disclosures that are required in
order to comply with workers' compensation or similar programs.
B. Coroners, Medical Examiners, Funeral Directors:
North Flight will disclose your PHI to a coroner or medical examiner.
For example, this will be necessary to identify a deceased person
or to determine a cause of death. North Flight will also disclose
your medical information to funeral directors as necessary to
carry out their duties.
C. Health or Safety: Following the requirements
of the Michigan Department of Commerce, North Flight will use
and disclose PHI to avert a serious threat to health and safety
of a person or the public. North Flight 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 at North Flight must maintain all records
concerning your treatment by North Flight, 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.
North Flight 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 North Flight 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;
North Flight 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, North Flight will allow the review of its decision
by a health care professional that North Flight has 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 North Flight. North Flight will respond to your request within
30 days of its receipt. If North Flight cannot, North Flight will
notify you in writing to explain the delay and the date by which
we will act on your request. In any event, North Flight 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 North Flight maintains it. However,
North Flight will deny your request for amendment if:
North Flight 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 North Flight denies your request for changes
in your PHI, North Flight will notify you in writing with the
reason for the denial. North Flight will also inform you of your
right to submit a written statement disagreeing with the denial.
You may ask that North Flight include your request for amendment
and the denial any time that North Flight discloses the information
that you wanted changed. North Flight 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 North Flight, including your reason to support
the requested amendment. North Flight will respond to your request
within 60 days of its receipt. If North Flight cannot, North Flight
will notify you in writing to explain the delay and the date by
which North Flight will act on your request. In any event, North
Flight 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 North
Flight 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 in custodial situations; 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 North Flight. You must include
the time period of the accounting, which may not be longer than
6 years. North Flight will respond to your request within 60 days
from its receipt. If North Flight cannot, North Flight will notify
you in writing to explain the delay and the date by which North
Flight will act on your request. In any event, North Flight will
act on your request within 90 days of its receipt.
In any given 12-month period, North Flight 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 how we use and disclose your
PHI to carry out treatment, payment, or health care operations
functions. For example, you may ask that your PHI not be shared
with your family. North Flight 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 North Flight 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 North Flight or with the Secretary
of the Department of Health and Human Services. To file a complaint
with North Flight, please contact the Director of North Flight
at:
1105 6th Street
Traverse City, MI 49684 (231) 935-7633
All complaints must be submitted in writing. North
Flight assures 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 North Flight's mission to improve the health of the community,
North Flight will share your PHI with other organizations as described
below who have agreed to abide by the terms described below:
A. Business Associates: North Flight will
use and disclose your PHI to business associates contracted to
perform business functions on its behalf including Munson Healthcare,
who performs certain business functions for North Flight. Whenever
an arrangement between North Flight and another company involves
the use or disclosure of your PHI, that business associate will
be required to keep your information confidential.
B. Membership in Munson Healthcare: North
Flight, 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, North Flight and other 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 North Flight and/or for the health care operations permitted
by HIPAA with respect to our mutual patients.
VIII. Additional Information
For further information regarding the issues covered
by this Notice of Privacy Practices, please contact Munson Healthcare's
Privacy Official at (231) 935-2335.
IX. Changes to this Notice
North Flight will abide by the terms of the Notice
currently in effect. North Flight reserves the right to change
the terms of its Notice and to make the new Notice provisions
effective for all PHI that it maintains. North Flight 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.
