Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

INTRODUCTION

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal law that requires that individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, is kept confidential. This Act gives you rights to be informed and in control of how your health information is used. HIPAA provides penalties for misuse of personal health information.

DISCLOSURE OF INFORMATION

We may use and disclose your protected health information only for each of the following purposes: treatment, payment and health care operations.

• Treatment (providing, coordinating, or managing health care and related services by one or more health care providers). Protected Health Information may be released if you are at risk of harming yourself or others. You will be asked to sign a written release of information to release any other information.
• Payment (such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review). An example of this would be sending a bill for your visit to your insurance company for payment.
• Health care operations (such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service). An example would be an internal quality assessment review.

We may also create and distribute health information by removing all references to you as an individual for purposes of research. This information would not identify you.

We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request. This does not cover any information that has already been released with your permission.

YOUR RIGHTS

You have the following rights with respect to your protected health information (PHI), which you can exercise by presenting a written request to the Recipient Rights Advisor:

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you.
• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
• The right to inspect and copy your protected health information. The right to submit a written statement or correction to your protected health information.
• The right to receive an accounting of disclosures of protected health information. The right to obtain a paper copy of this notice from us upon request.

OTHER DISCLOSURES

Locating Responsible Parties Your PHI may be disclosed in order to locate, identify or notify a family member, your personal representative, or other person responsible for your care.

Disasters Your PHI may be disclosed to any public or private entity authorized by law or by its charter to assist in disaster relief efforts.

Required by Law Your PHI may be disclosed when we are required to do so by law. For example, your PHI may be released when required by privacy laws, workers' compensation or similar laws, public health laws, court or administrative orders, subpoenas, certain discovery requests, or other laws, regulations or legal processes.

Military and National Security Under certain circumstances your PHI may be disclosed to military authorities if you are a member of Armed Forces. When required by law, your PHI may be disclosed for intelligence, counterintelligence, and other national security activities.

PRIVACY PRACTICES

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

This notice is effective as of April 14, 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a written complaint with our office, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.

Gerontology Network
Attn: Regina McClurg
Recipient Rights Advisor
4695 Danvers Drive SE, Suite B
Grand Rapids MI 49503
(616) 977-3300 Ext. 213
(800) 243-3144

The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: (877) 696-6775