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Notice of Privacy Practices

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.

USE AND DISCLOSURE OF HEALTH INFORMATION

The Dickinson Iron District Health Department (DIDHD) may use your health information, information that constitutes protected health information (PHI) as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. We have established policies to guard against unnecessary disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Provide Treatment. The DIDHD may use your health information to coordinate care within the Department and with others involved in your care, such as your attending physician and other health care professionals who have agreed to assist us in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. We also may disclose your health care information to individuals outside of the Department involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment. The DIDHD may include your health information in invoices to collect payment from third parties for the care you receive from us. For example, we may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the DIDHD. We also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for care and the services that will be provided to you.

To Conduct Health Care Operations. The DIDHD may use and disclose health information for its own operations in order to facilitate the function of the DIDHD and as necessary to provide quality care to all of our patients. Health care operations includes such activities as:

  • Quality assessment and improvement activities.
  • Activities designed to improve health or reduce health care costs.
  • Protocol development, case management and care coordination.
  • Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.
  • Professional review and performance evaluation.
  • Training programs including those in which students, trainees or practitioners in health care learn under supervision.
  • Training of non-health care professionals.
  • Accreditation, certification, licensing or credentialing activities.
  • Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
  • Business planning and development including cost management and planning related analyses and formulary development.
  • Business management and general administrative activities of the Agency.
  • We may call your name in the waiting room when you are here for an appointment.
  • We may use or disclose your health information, as necessary, to contact you to remind you of an appointment or a home visit.
  • We may contact you as part of a community information mailing.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED WITHOUT YOUR WRITTEN AUTHORIZATION.

When Legally Required or Permitted by Law. The DIDHD will disclose your health information when it is required to do so by any Federal, State or local law. We may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when we make reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

As permitted or required by State law, we may disclose your health information to a law enforcement official for certain law enforcement purposes.

For Public Health Activities. The DIDHD may disclose your health information for public health activities and purposes in order to:

  • Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
  • Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
  • Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
  • Notify an employer about an individual who is a member of the workforce as legally required.

Workplace Medical Surveillance.

When the DIDHD provides health care to an individual at the request of the individual's employer we may disclose that health information at the request of an employer, for the purpose of workplace medical surveillance or the evaluation of work-related illness and injuries to the extent the employer needs that information to comply with OSHA, MSHA, or the requirements of State laws having a similar purpose. For example, your employer may request the DIDHD administer a Hepatitis B vaccination to an employee. This health information may be disclosed to the employer.

To Report Abuse or Neglect.

The DIDHD is required to disclose your PHI to a government authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been the victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information.

To Conduct Health Oversight Activities.

The DIDHD may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.

For Activities Related to Death.

The DIDHD may disclose your PHI to coroners, medical examiners and funeral directors so they can carry out their duties, such as identifying the body, determining cause of death, or in the case of funeral directors, to carry out funeral preparation activities. If necessary for funeral directors, we may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye Or Tissue Donation.

The DIDHD may use or disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

For Research Purposes.

The DIDHD may, under very select circumstances, use your health information for research. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process.

In the Event of A Serious Threat To Health Or Safety.

The DIDHD may, consistent with applicable law and ethical standards of conduct, disclose your PHI if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

For Military, National Security, or Incarceration/law enforcement custody.

If you are involved with the military, national security or intelligence activities, or you are in the custody of law enforcement officials or an inmate in a correctional institution, we may disclose your health information to the proper authorities so they may carry out their duties under the law.

For Worker's Compensation.

The DIDHD may release your PHI for worker's compensation or similar programs.

Individuals Involved in Your Care.

Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. For example, we may contact an individual you have identified as a message contact or person to contact in an emergency.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, the DIDHD will not disclose your protected health information other than with your written authorization. If you or your representative authorizes us to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your protected health information that the DIDHD maintains:

  • Right to request restrictions. You may request restrictions on certain uses and disclosures of your PHI. You have the right to request a limit on the DIDHD's disclosure of your health information to someone who is involved in your care or the payment of your care. However, we are not required to agree to your request, except that we are required to agree to restrict disclosure of health information to a health plan when you (the patient) paid for the service or item in question out of pocket in full. If you wish to make a request for restrictions, please contact the Office Supervisor at (906) 774-1868.
  • Right to receive confidential communications. You have the right to request that the DIDHD communicate with you in a certain way. For example, you may ask that we only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact the Office Supervisor at (906) 774-1868. The DIDHD will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
  • Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Office Supervisor at (906) 774-1868. If you request a copy of your health information, the DIDHD may charge a reasonable fee for copying and assembling costs associated with your request.
  • Right to amend health care information. You or your representative have the right to request that the DIDHD amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by us. A request for an amendment of records must be made in writing to the Office Supervisor at DIDHD, 818 Pyle Drive, Kingsford, MI 49802. The DIDHD may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by us, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in the opinion of the DIDHD, the records containing your health information are accurate and complete.
  • Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by the DIDHD for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Office Supervisor at DIDHD, 818 Pyle Drive, Kingsford, MI 49802. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. The DIDHD would provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
  • Right to a paper copy of this notice. You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact the Office Supervisor at (906) 774-1868. The patient or a patient's representative may also obtain a copy of the current version of the DIDHD's Notice of Privacy Practices at its website, www.didhd.org.
  • Right to Receive Notification of Breach. You have the right to be notified when a breach of your unsecured health information has occurred.

DUTIES OF THE DICKINSON-IRON DISTRICT HEALTH DEPARTMENT

The DIDHD is required by law to maintain the privacy of your protected health information and to provide to you and your representative this Notice of its duties and privacy practices. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of our Notice and to make the new Notice provisions effective for all health information that we maintain. If we change our Notice, we will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative have the right to express complaints to the DIDHD and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to the DIDHD should be made in writing to the Director/Health Officer at DIDHD, 818 Pyle Drive, Kingsford, MI 49802. The DIDHD encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON

The DIDHD has designated the Office Supervisor as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at DIDHD, 818 Pyle Drive, Kingsford, MI 49802, (906) 774-1868.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT:

Office Supervisor, DIDHD
818 Pyle Drive, Kingsford, MI 49802
(906) 774-1868

Copyright © 2004 by the Dickinson-Iron District Health Department
818 Pyle Drive, Kingsford, MI 49802 - Phone: 1-906-774-1868
601 Washington Ave, Iron River, MI 49935 - Phone: 1-906-265-9913
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