NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Effective Date: 10/15/2013
OUR LEGAL DUTY
We create, receive and keep records relating to your healthcare in order to coordinate your healthcare services. We are required by law to protect the privacy of your health information, provide this notice about our information practices, and follow the practices that are described in this notice. Additionally, we are required to notify you following any breach of unsecured health information that affects you. This Notice will tell you about the different ways in which we may use and disclose health information
We may change our health information practices at any time. Before we make a significant change in our practices, we will notify you if possible via email and post the new notice on our web site at www.curushealth.com. You can request a copy of our notice at any time. You have the right to obtain a paper copy of this notice upon request, even if you have agreed to receive this notice electronically.
USES AND DISCLOSURES OF HEALTH INFORMATION
Although not an exhaustive list, the following categories describe different ways in which we may use and disclose your health information.
Treatment. We may use and disclose your health information to coordinate management of your care. In this respect, we may share your health information as necessary among your healthcare professionals and other personnel involved in your care in order to provide you the healthcare that you need.
Payment. We may use and disclose your health information to assist in facilitating payment for the healthcare provided to you. For example, we may need to give your health plan information about treatment you received so that we can coordinate payment for the care provided to you.
Health Care Operations. We may use and disclose your health information for healthcare operational purposes. These activities include, but are not limited to, quality assessment and improvement activities, conducting training programs, conducting or arranging for medical reviews, legal services or auditing, performing staff performance reviews, and business planning and development.
Business Associates. We may share your health information with thirdparty “business associates” who perform various activities for us (e.g., billing, transcription or legal services). These business associates will also be required to protect your health information.
Appointment Reminders. We may use and disclose your health information to provide you appointment reminders or information about treatment alternatives or other healthrelated benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose your health information to your family Members, other relatives, a close personal friend, or any person you identify who is involved in your healthcare. We may also give information to someone who helps pay for your care.
Health Oversight Activities. We may disclose your health information to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health care programs such as Medicare or Medicaid.
As Required by Law. We may use or disclose your health information when required to do so by any other law not already referred to in the preceding categories.
In other situations, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization at any time to stop any further uses and disclosures of your health information. However, please be aware that we cannot take back any uses or disclosures of health information already made with your authorization before you provided us with written notice of your revocation.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding the health information we maintain about you:
Right to Request Confidential Communications. You have the right to request that your health information be communicated to you in a confidential manner such as sending mail to an address other than your home; provided that such request is made in writing, signed and dated, to the address provided below.
Right to Request Additional Restrictions. You may request that we restrict or limit the uses and disclosures of your health information for treatment, payment and health care operations, or the health information we use or disclose about you to someone who is involved in your care or the payment for your care, like a family Member or friend. While we consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction, except if the disclosure is to a health plan for purposes of carrying out payment or health operations (not treatment), and the health information relates solely to health care for which the health care provider involved has been paid out of pocket in full. To request restrictions, you must make your request in writing, signed and dated, to the address below.
Right to Inspect and Copy Your Health Information. You have the right to inspect and obtain a copy of your health information maintained by us, including medical and billing records and any other records we use for making decisions about you. However, this right does not include inspection and copying of the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, and health information that is subject to law that prohibits access to health information. Your request to inspect and copy your records must be submitted in writing, signed and dated, to the address below. We may charge a fee for processing your request.
Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures we have made of your health information for the last six years before the date of your request. This right to an accounting is subject to certain exceptions. For example, the accounting will not include disclosures:
- made for treatment, payment or health care operations;
- made to you;
- made pursuant to a written authorization;
- required to maintain a directory of the individuals in our facility or to individuals involved with your care;
- required for national security or intelligence purposes;
- to correctional institutions or law enforcement officers; and
- certain other reasons.
In addition, we may suspend your right to receive an accounting of disclosures if required to do so by a health oversight agency or law enforcement official for the period of time specified by such agency or official. Your request for an accounting of disclosures must be submitted in writing, signed and dated, to the address below.
COMPLAINTS
If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the person listed below. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request. Under no circumstance will you be retaliated against for filing a complaint.
CONTACT INFORMATION
Requests to inspect and copy your records, amend your health information, or obtain an accounting of disclosures, as well as any questions, complaints, or requests for additional information about our health information privacy practices, should be made in writing to the following address:
ATTENTION: Susan Schram Steinberg
Total Life Concierge
101 W. Big Beaver Road, Suite 1400 Troy, MI 48084
TELEPHONE: (888) 674-4852
