Northern Family Intervention Services, Inc.
P.O. Box 398 - Gaylord, Michigan 49734-0398 - 989.732.6448 (Office) - 989.731.0670 (Fax)
NFIS Privacy Statement
~ Effective April 14, 2003 as a result of the Health Information Privacy and Portability Act (HIPPA)
Privacy Notice
THIS NOTICE DESCRIBES HOW PERSONAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Our Privacy Commitment to You
We care about your privacy. The information we collect about you is private. We are required to give you a notice of our privacy practices. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing, we will only disclose your information for purposes of treatment, payment, business operations or when we are required by law to do so.
TREATMENT
We may disclose medical information about you to coordinate your health care. For example, between your Family Specialist and the CMH physician.
PAYMENT
We may use and disclose information so the care you get can be properly billed and paid. For example, sending billing information to a health insurance plan.
BUSINESS OPERATIONS
We may need to use and disclose information for our business operations. For example, we may use information to review the quality of care you receive.
EXCEPTIONS
For certain kinds of records, your permission may be needed even for release for treatment, payment and business operations.
AS REQUIRED BY LAW
We will release information when we are required by law to do so. Examples of such releases would be for law enforcement or national security purposes, subpoena or rather court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety or in other kinds of emergencies.
WITH YOUR PERMISSION
If you give us permission in wiring, we may use and disclose your personal information. If you give us permission, you have the right to change your mind and revoke it. This must in writing , too. We cannot take back any uses or disclosures already made with your permission.
Your Privacy Rights
You have the following rights regarding the health information that we have about you. Your requests must be made in writing to Northern Family Intervention Services, Inc.
RIGHT TO INSPECT AND COPY
In most cases, you have the right to look at or get copies of your records,. You may be charged a fee for the cost of copying your records.
RIGHT TO AMEND
You may ask us to change your records if you feel that there is a mistake. We can deny your request for certain reasons, but we must give you a written reason for our denial.
RIGHT TO A LIST OF DISCLOSURES
You have the right to ask for a list of disclosures made after 4/13/03. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your authorization.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS
You have the right to ask that we share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home address. You do no have to explain the basis of your request.
Changes to this Notice
We reserve the right to revise this notice. A revised notice will be effective for medical information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. If changes are material, a new notice will be mailed to you before it takes effect.
How to Use Your Rights under This Notice
If you want to use your rights under this notice, you may call is or write to us. If your request to us must be made in writing, we will help you prepare your written request if you wish.
COMPLAINTS TO THE NATIONAL GOVERNMENT
If you believe that your privacy rights have been violated, you have the right to file a complaint with the national government. You may write to:
Office of Civil Rights
Dep't. of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201
Phone: 866-627-7748
TTY: 866-788-4989
Email ocrprivacy@hhs.gov
You will not be penalized for filing a complaint with the national government.
COMPLAINTS AND COMMUNICATIONS TO NFIS
If you want to exercise your rights under this notice or if you wish to communicate with us about privacy issues or if you wish to file a complaint, you can write to:
Privacy Officer
Northern Family Intervention Services, Inc.
405 West Main Street
P.O. Box 398
Gaylord, MI 49734
Phone: 989-732-6448