Your Rights
When it comes to your health information, you have certain rights.This section explains your rights and some of our responsibilities to help you.
Get an Electronic Copy of Your Medical Record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say no to your request, but well tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say yes to all reasonable requests.
Ask Us to Limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say no if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say yes unless a law requires us to share that information
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times weve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). Well provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint
You can complain if you feel we have violated your rights by contacting us using the information on page 1.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1- 877-696-6775, or visiting .hh.g/c/iac/hiaa/cai/.
We will not retaliate against you for filing a complaint.
Your Choices
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
Our uses and disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you, however we will never share any substance abuse treatment records without your written permission.Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with Public Safety Issues
We can share health information about you for certain situations such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyones health or safety
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that were complying with federal privacy law.
Address workers’ compensation, law enforcement and other government requests
We can use or share health information about you:
For workers compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective
services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security
of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. You tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.Changes to the terms of this notice
Changes to the terms of this notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
If you believe your privacy rights have been violated, you may make a written complaint to Nancy Brennan, LLMSW, Owner of SMHA, at the address at the top of the first page, and she will respond within seven days of receiving it. Neither your therapist nor SMHA will retaliate against you for exercising your privacy rights.
Client Rights
You have the right not to be abused physically, sexually, or psychologically, including no threats, humiliation, harassment, fiduciary abuse or exploitation, conflict of interest, or inappropriate influence. SMHA does not use physical seclusion or restraints. In emergencies, if health or safety is at risk, reasonable interventions will be made to protect clients and staff.
You have the right to be fully informed about services, including answers to all reasonable questions. You have the right to privacy and confidentiality, as provided by law.
SMHA Privac Notice effective Ma
Southfield Mental Health Associates, P.C.
If you believe you have experienced an ethical or privacy violation or if you are dissatisfied with any aspect of your services, you have the right to speak with the owner, Nancy Brennan, acting as a Consumer Relations Officer (248) 727-7270. Ms. Brennan will respond in writing within three days or as soon as mutually agreeable. No retaliation or barrier to service will result from bringing a complaint.
If you are still not satisfied, you have the right to file a complaint with the Michigan Community Health Department, Office of Recipient Rights, 320 South Walnut St., Lansing, MI 48933.
Client Rights
Clients agree to attend scheduled appointments and pay agreed fees, including a charge for appointments not kept or canceled less than twenty-four hours in advance.
Clients agree to help maintain a sanitary and healthy environment. Use of tobacco products or illicit drugs is forbidden in client areas. Weapons of any kind are forbidden on SMHA premises. Clients are asked to inform their therapists if they have a communicable disease so that reasonable health precautions may be taken for others.
Clients are urged not to bring prescription medications onto SMHA premises; however, if a health condition requires them to do so, they agree to keep them inaccessible from other clients or staff and to indemnify and hold harmless SMHA and its therapists from any claims arising from access by others.
Clients agree to refrain from violent, aggressive, or any other inappropriate behavior such as loud or foul language. Assaultive aggression or its threat or noncompliance with the above will be grounds for summoning police. Service may be denied to anyone not complying with these client responsibilities; service would be re-instated only on the basis of willingness to comply, as determined by the clinic owner and therapists.
Client Responsibilities
Clients agree to attend scheduled appointments and pay agreed fees, including a charge for appointments not kept or canceled less than twenty-four hours in advance.
Clients agree to help maintain a sanitary and healthy environment. Use of tobacco products or illicit drugs is forbidden in client areas. Weapons of any kind are forbidden on SMHA premises. Clients are asked to inform their therapists if they have a communicable disease so that reasonable health precautions may be taken for others.
Clients are urged not to bring legal/non-prescription or prescription medications onto SMHA premises; however, if a health condition requires them to do so, they agree to keep them inaccessible from other clients or staff and to indemnify and hold harmless SMHA and its therapists from any claims arising from access by others.
Clients agree to refrain from violent, aggressive, or any other inappropriate behavior such as loud or foul language. Assaultive aggression or threat of such, or noncompliance with the above will be grounds for summoning police. Service may be denied to anyone not complying with these client responsibilities; service would be re-instated only on the basis of willingness to comply, as determined by the clinic owner and therapists.
SMHA Privacy Notice effective May 1, 2017