Your Privacy & Your Rights

Under federal HIPAA regulations and Michigan law, I may use and disclose your protected health information for the following purposes without your separate written authorization:

• For treatment. To provide, coordinate, or manage your clinical therapy and related services. For example, I may share information with other health care providers involved in your care, such as your primary care physician, when needed for your treatment.
• For payment. To obtain payment for the services I provide. For example, I may need to give your health plan information about the services you received so they will pay for them.
• For health care operations. To support the business activities of the practice, such as quality assessment, licensing compliance, and administrative functions.

• As required by law. I will disclose health information when required to do so by federal, state, or local law.
• Abuse or neglect. Michigan law requires me to report suspected abuse or neglect of a child or a vulnerable adult to the appropriate authorities.
• Serious threat to health or safety. I may disclose information if I believe it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, consistent with my duties under Michigan law and professional ethics.
• Court orders and legal proceedings. I may disclose information in response to a court order, subpoena, or other lawful process, to the extent such disclosure is authorized or required by law.
• Health oversight. To a health oversight agency for activities authorized by law, such as audits, investigations, and licensure.
• Coroners, medical examiners, and funeral directors. As necessary to carry out their duties consistent with applicable law.

Michigan’s mental health laws may provide additional protections for mental health and substance use records. Where state law is more protective than federal law, the more protective standard applies.

The following uses and disclosures of your health information will be made only with your explicit written authorization:

• Most uses and disclosures of psychotherapy notes.
• Uses and disclosures of substance use disorder treatment records protected by 42 CFR Part 2, where applicable.
• Any use or disclosure of your information for marketing purposes.
• Disclosures that constitute a sale of your protected health information.

You may revoke an authorization in writing at any time, except to the extent I have already acted in reliance on it.

• Right to inspect and copy. You have the right to inspect and obtain a paper or electronic copy of your clinical records. I may charge a reasonable, cost-based fee for copies and postage.
• Right to amend. If you believe your records are inaccurate or incomplete, you may request an amendment. I may deny your request under certain circumstances and will provide a written explanation.
• Right to an accounting of disclosures. You may request a list of certain disclosures I have made of your health information, excluding routine treatment, payment, and operations disclosures.
• Right to request restrictions. You may request additional limits on how I use or disclose your information for treatment, payment, or operations. I am not required to agree to most restrictions, except for disclosures paid out of pocket in full to a health plan.
• Right to confidential communications. You may request that I communicate with you in a certain way or at a certain location, such as by mail to a specific address. I will accommodate reasonable requests.
• Right to a paper copy of this notice. You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

• Maintaining privacy. I am required by law to maintain the privacy and security of your protected health information.
• Providing notice. I must provide you with this notice of my legal duties and privacy practices, and follow the terms currently in effect.
• Breach notification. I will notify you in writing following a breach of your unsecured protected health information, as required by law.
• Changes to this notice. I reserve the right to change the terms of this notice and to make the revised notice effective for all information I maintain. The current notice will be posted in the office and made available upon request.

If you believe your privacy rights have been violated, you may file a complaint with me and with the U.S. Department of Health and Human Services, Office for Civil Rights. I will not retaliate against you for filing a complaint.

You may contact me for more information or to file a complaint using the contact information at the top of this notice.