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Effective Date: September 23, 2013


Your Health Information is personal. We are committed to protecting your Health Information. We create a record of the care and services you receive at this office. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by this office whether made by your personal physician or one of the office’s employees.

This notice will tell you about the ways in which we may use and disclose your Health Information. This Notice will also describe your rights and certain obligations we have regarding the use and disclosure of your Health Information. This office is required by law to:

  1. Maintain the privacy of protected health information
  2. Give you this notice of our legal duties and privacy practices regarding health information about you, and
  3. Follow the terms of the Notice that is currently in effect.

How this Office May Use and Disclose Your Health Information

The following describes the ways we may use and disclose health information that identifies you (Protected health information). For clarification we have included some examples. Not every possible use or disclosure is specifically mentioned. However, all of the ways we are permitted to use and disclose your Health Information will fit within one of these general categories. Except for the purposes described below, we will use and disclose Health Information only with your written perm8ission. You may revoke such permission at any time by writing to our practice Privacy Officer.

For Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services. We may disclose Health Information about you to doctors, nurses, technicians and other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

For Payment. We may use and disclose Health Information about you so that we and others may bill and receive payment from you, an insurance company or a third party for the treatment and services you received. For example, we may give your health plan information about treatment you received, so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations. We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use Health Information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine Health Information about many of our patients to decide what additional services the office should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, and other office personnel for review and learning purposes. We may remove information that identifies you from this set of Health Information so others may use it to study health care and health care delivery without learning the identity of the specific patients.

Appointment Reminders, Treatment Alternatives and Health Related Benefits. We may use and disclose Health Information to contact you as a reminder that you have an appointment for treatment or medical care at this office. We may also use and disclose Health Information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Research. Under certain circumstances, we may use and disclose Health Information for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one treatment/medication to those who received another for the same condition. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.

As Required By Law. We will disclose Health Information when required to do so by federal, state or local law. This may include authorizations for national security, protective service for the President and others, and other activities authorized by law.

To Avert A Serious Threat to Health or Safety. We may use and disclose Health Information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose Health Information to a governmental or other oversight agency for activities authorized by law. For example, disclosures of your Health Information may be made in connection with audits, investigations, inspections, and licensure renewals, etc. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may use or disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Coroners and Medical Examiners. We may release Health Information to a coroner or medical examiner to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.

Business Associates. We may disclose Health Information to our business associates who provide us with services if the information is necessary for such functions or services. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Military and Veterans If you are a member of the armed forces, we may release Health Information as required by military command authorities.

Workers Compensation. We may release Health Information for workers’ compensation or similar programs if appropriate.

Uses and Disclosures that Require us to Give you an Opportunity to Object and Opt

1. Individuals Involved in Your Care or Payment for 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. If you areunable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based onour professional judgment.

2. Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with and opportunity to agree or object to such a disclosure whenever we can do so practically.

Your Written Authorization is Required for Other Uses and Disclosures.

The following uses and disclosures of your Protected Health Information will be made only with your written authorization:

  1. Uses and disclosures of Protected Health Information for marketing purposes; and
  2. Disclosures that constitute a sale of your Protected Health Information

Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and w will no longer disclose Protected Health Information under the authorization. However, disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

Your Rights Regarding Your Health Information

You have the following rights regarding the Health Information this office maintains about you:

Right to Inspect and Copy. You have the right to inspect and copy your Health Information with the exception of any psychotherapy notes. To inspectand copy your Health Information, you must submit your request in writing. If you request a copy of the information, we have up to 30 days to make yourProtected Health Information available to you and we may charge a fee for the costs of copying, mailing or other supplies associated with your request.We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-basedbenefit program. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your HealthInformation, you may request that the denial be reviewed. For information regarding such a review contact the Privacy Officer at the Michigan VascularCenter at (810) 732-1620.

Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as anelectronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you ortransmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format yourequest, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request,your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may chargeyou a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information.

Right to Amend. If you feel that Health Information we have about you is incorrect or incomplete, you may ask us to amend the information. You havethe right to request an amendment for as long as the information is kept by this office. To request an amendment, your request must be made in writingand submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment ifit is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  1. Was not created by us;
  2. Is not part of the Health Information kept by this office;
  3. Is not part of the information which you would be permitted to inspect and copy; or
  4. Is accurate and complete.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes otherthan treatment, payment and health care operations or for which you provided written authorization. To request this accounting of disclosures, you mustsubmit your request in writing to the Privacy Officer. Your request must state a period, which may not be longer than six years and may not includedates before February 26, 2003.

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclosure for treatment,payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care orthe payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis ortreatment with your spouse. To request a restriction, you must make your request, in writing, to the Privacy Officer. We are not required to agree to yourrequest unless you are asking us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health careoperation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of- pocket” infull. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Out-of- Pocket-Payments. If you paid out-of- pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item orservice, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan forpurposes of payment or health care operations, and we will honor that request.

Right to Request Confidential Communications. You have the right to request that we communicate with you only in a certain manner. Forexample, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to thePrivacy Officer. We will accommodate all reasonable requests.

Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. Even if you have received this notice electronically, you maystill receive a copy of this notice.

Revisions to This Notice

We reserve the right to revise this Notice. Any revised Notice will be effective for Health Information we already have about you as well as anyinformation we receive in the future. We will post a copy of any revised Notice in this office. Any revised Notice will contain on the first page, in the topright-hand corner, the effective date. In addition, each time you visit the office we will offer you a copy of the current Notice in effect.


If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the Department of Health andHuman Services. To file a complaint with this office, contact the Privacy Officer at (810) 732-1620. All complaints must be submitted in writing.THIS OFFICE WILL NOT PENALIZE YOU IN ANY WAY FOR FILING A COMPLAINT.

Other Uses of Health Information

Other uses and disclosures of your Health Information not covered by this Notice of Privacy Practices will be made only with your written authorization. Ifyou provide us such an authorization in writing to use or disclose Health Information about you, you may revoke that authorization, in writing, at any time.If you revoke your authorization, we will no longer use or disclose Health Information about you for the reasons covered by your written authorization.