Patient Rights and Privacy Practices

IMPORTANT NOTICE:
Michigan Avenue Podiatry Clinic (MAPC), an Olympia Foot & Ankle LTD Company, is not affiliated with Michigan Avenue Podiatry LLC 1 or any other company with a similar name.

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.

Introduction
This notice gives you information, as required by law, about the duties and practices of Michigan Avenue Podiatry Clinic (hereafter “MAPC”), an Olympia Foot & Ankle LTD Company, to protect the privacy of your personal health information. Because MAPC provides you Podiatric Medical Care & Urgent Care Services, MAPC receives and maintains personal health information about you. MAPC may contract with companies, other government agencies, or individuals to help provide these services to you; therefore, contractors also may receive and maintain your personal health information.

Effective Date of This Notice
The Effective Date of this Notice is January 1, 2007. MAPC is required to follow the terms of this Notice until it is replaced. MAPC reserves the right to change the terms of the Notice at any time and will provide an updated Notice of any such changes.

Purposes for Which MAPC May Use or Disclose Your Personal Health Information Without Your Authorization

  1. Health Care Providers’ Treatment Purposes
    MAPC can use your health information and share it with other professionals who are treating you. For example, MAPC may disclose your personal health information to your doctor, at the doctor’s request, for treatment purposes.

  2. Payment
    MAPC can use and share your information for payment purposes. For example, MAPC may use or disclose your personal health information to provide eligibility information to your doctor when you receive treatment, to pay claims for covered health care services, or to recover costs from other medical insurance or providers.

  3. Health Care Operations
    MAPC can use and share your health information for MAPC’s operations, to improve your care, and to contact you when necessary. For example, MAPC or its contractors may use or disclose your personal health information:

    • To conduct quality assessment and improvement activities;
    • To review applications for services;
    • To engage in care coordination or case management;
    • To manage, plan, or develop MAPC’s services and budget; and
    • To coordinate services with other health-related benefits and services that may be of interest to you.

  4. Health Services
    MAPC or its contractors may contact you to give you information about your test results.

  5. As Required by Law
    MAPC can use and share your health information when required by law. For example, MAPC is required by law to allow the U.S. Department of Health and Human Services to audit MAPC records. MAPC may disclose your personal health information necessary to comply with workers’ compensation or other laws. MAPC also may be required to disclose personal health information about abuse, neglect, or domestic violence to governmental or social service agencies.

  6. Public Health Activities and Public Health Reporting
    For example, MAPC is permitted to disclose protected health information for public health activities (such as investigation and surveillance), interventions, and activities related to public health oversight.

  7. Other Reasons

    • To comply with legal proceedings, such as court orders.
    • To law enforcement officials or to correctional institutions for limited law enforcement and health and safety purposes.
    • With your written authorization, to a family member, friend, or other person to help you with your health care or payment for your health care.
    • To your personal representative appointed by you or designated by law.
    • For research purposes in limited circumstances and where the information will be protected by the researchers.
    • To a coroner, medical examiner, or funeral director to identify a deceased person or to arrange payment benefits.
    • To an organ procurement organization in limited circumstances.
    • To avert a serious threat to your health or safety or the health or safety of others.
    • To a governmental agency authorized to oversee government health care programs.
    • To federal officials for lawful national security purposes.
    • To appropriate military authorities, if you are a member of the armed forces.

Uses and Disclosures With Your Permission

MAPC will not use or disclose your personal health information for any other purposes unless you give MAPC your written authorization to do so. In most cases, you may revoke your written authorization at any time, unless MAPC has relied upon that authorization for a continuing disclosure (for example, for a research study). Your revocation will be effective from the date MAPC receives it onward for all personal health information that MAPC maintains regarding your medical care.

Your Rights

You may make a written request to MAPC to do one or more of the following concerning your personal health information maintained by the clinic:

  1. Request Additional Restrictions
    To put additional restrictions on MAPC’s use and disclosure of your personal health information. MAPC does not have to agree to your request under certain circumstances.

  2. Request Confidential Communications
    To have MAPC communicate with you in confidence about your personal health information by a different means or at a different location than MAPC is currently doing. Your request must specify the alternative means or location for communication.

  3. Access to Your Personal Health Information
    To see and get copies of your personal health information. You may be charged a nominal fee for the copies.

  4. Request a Change to Your Personal Health Information
    MAPC does not have to agree to your request, but any denial will be communicated to you.

  5. Request an Accounting of Disclosures
    To receive a list of disclosures of your personal health information that MAPC and its contractors made for certain purposes over the last six years.

  6. Request Another Copy of This Notice
    To have MAPC provide you with another copy of this Notice.

If you want to exercise any of the rights described above, please contact the Privacy Officer at MAPC.

Complaints

If you believe your privacy rights have been violated by MAPC, you have the right to complain to MAPC or to the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with MAPC at the address below. MAPC will not retaliate against you for filing a complaint with either MAPC or the U.S. Department of Health and Human Services.

Privacy Officer Contact Information

To request additional copies of this Notice, to receive more information about MAPC’s privacy practices or your rights, or to file a complaint, contact the Chief Privacy Officer at:

George P
Management Team
Admin@michiganavenuepodiatry.com