215 E. MANSION STREET, SUITE 3D
MARSHALL, MI 49068

269.781.1183 | 269.781.9248 (fax)

269.789.9298 (After hours emergency)
reception1@mansionstobgyn.com

3600 CAPITAL AVE SW, SUITE 205
BATTLE CREEK, MI 49015

269.719.8046 | 269.719.8049 (fax)

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Privacy Policy

 

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

 

OUR RESPONSIBILITIES

Mansion Street Women's Health, P.L.L.C. takes the privacy of your health information seriously. We are required by law to maintain that privacy of your protected health information, and to provide you with this Notice of Privacy Practices. This Notice is provided to tell you about our duties and practices with respect to your health information. We are required to abide by the terms of this Notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

These are the ways we may use and disclose health information that identifies you. Except for the following purposes, we will use and disclose health information only with your written permission. For each category we explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment

We may use health information about you to provide you with treatment, health care or other related services. We may disclose your health information to doctors, nurses, aids, technicians or other Covered Entity employees who are involved in taking care of you. Additionally, we may use or disclose your health information to manage or coordinate your treatment, health care or other related services. (Example: Getting information about a visit here, back to your primary care physician so lab reports, etc. are not duplicated, or if you needed a referral to another Specialist, we may send notes from your most recent or a prior visit to give them the information needed to care for you. Specifically, we may disclose health information to doctors, nurses, technicians, or other personnel, including people outside of our office, who are involved in your medical care.)

For Payment

We may use and disclose your health information to bill and collect for the treatment and services we provide to you. We may send your health information to an insurance company or other third party for payment purposes. (Example: If your health plan needs to know why you needed a certain procedure, they may request office notes.)

For Health Care Operations

We may use and disclose your health information for health care operations. These uses and disclosures are necessary to run the Mansion Street Women’s Health, P.L.L.C. to make sure you receive competent, quality health care, and to maintain and improve the quality of health care we provide. For example, we may use and disclose information to make sure the care you receive is of the highest quality (i.e. peer review). We may also share information with other entities that have a relationship with you, (i.e., your health plan) for their health care operations and activities.

As Required By Law

We may disclose your health information when required to do so by federal, state or local law. (Example: If subpoenaed for a Worker’s Compensation Claim)

For Public Health Purposes

We may disclose your health information for public health activities. While there may be others, public health activities generally include the following:

  • Preventing or controlling disease, injury or disability;

  • Reporting births and deaths;

  • Reporting defective medical devices or problems with medications;

  • Notifying people of recalls of products they may be using; and

  • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. (Example: The National Cancer Registry, reportable sexually transmited diseases, etc.)

  1. About Victims of Abuse

  2. We may disclose your health information to notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law. (Example: A pregnant patient under age 16 years in certain circumstances, or any suspicions of child abuse or neglect.)

    Health Oversight Activities

    We may disclose your health information to a health oversight agency for activities authorized by law. This oversight activities might include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws. (Example: If we were audited by Medicare or HIPAA agencies.)

    Judicial Purposes

    We may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request, in which you were given an opportunity to object to the request, or to obtain an order protecting the information requested.

    Law Enforcement

    We may release health information if asked to do so by a law enforcement official, if such disclosure is:

Required by Law;

  • In response to a court order, subpoena, warrant, summons or similar process;

  • To identify or locate a suspect, fugitive, material witness, or missing person;

  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

  • About a death we believe may be the result of criminal conduct;

  • About criminal conduct on our premises; or

  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors

In certain circumstances, we may disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about individuals to funeral directors as necessary to carry out their duties.

Organ and Tissue Donation

We may disclose your health information to organ-izations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. (Example: If you needed an organ transplant or desired to be a donor.)

Research

Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery to all individuals who received one 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 from our office. Lastly, if certain criteria are met, We may disclose your health information to researchers after your death when it is necessary for research purposes. (Example: The Women’s Health Initiative Study for post-menopausal women)

To Avert a Serious Threat to Health or Safety

We may use and disclose your health information when we believe it is 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 or lessen the threat or to law enforcement authorities in particular circumstances. (Example: A suicidal patient or a patient who threatens to harm another person; it would be our duty to notify that person.)

Military and Veterans

If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

National Security and Intelligence Activities

We may release your health information to authorized federal officials for lawful intelligence, counter-intelligence, and other national security activities authorized by law.

Custodial Situations

If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose your health information to a correctional institution or law enforcement official.

Workers’ Compensation

We may disclose your health information as authorized by and to the extent necessary to comply with workers’ compensation laws or laws relating to similar programs. These programs provide benefits for work related illnesses or injuries. We may also release health information for a disability claim or life insurance policy. (Example: If you had a Worker’s Compensation Claim.)

Treatment Alternatives, Appointment Reminders and Health-Related Benefits

We may use and disclose your health information to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you. Additionally, we may use and disclose your health information to provide appointment reminders. We may also call you with laboratory results and may leave a message on your answering machine with normal results or that we called. Finally, we may release health information, at your request, to pharmacists for prescriptions and to your employer for work excuses. If you do not wish the Mansion Street Women’s Health, P.L.L.C.. to contact you about treatment alternatives, health-related benefits, appointment reminders, or lab results you must notify the person listed on the last page of this Notice, and state which of those activities you wish to be excluded from. (Example: We routinely send out reminder postcards for your upcoming appointments and a reminder phone call one to three days prior to your visit. We also routinely call with your lab results.)

Support Group Activities

We may disclose health information to a foundation related to your case so the foundation may contact you to provide support information. In these cases, we would release only contact information, such as your name, address and phone number. A diagnosis may be released to get you information for a support group or charity (i.e. Endometriosis Foundation or American Cancer Society). If you do not want the Mansion Street Women’s Health, P.L.L.C. to release this information, you must notify in writing the person listed on the last page of this Notice. (Example: We may wish to donate to a charitable organization in your name; i.e. we may honor our cancer patients with a luminary at the Cancer Relay For Life.)

Mansion Street Women's Health, P.L.L.C..’s Mailing List

We may include certain limited information about you in the Mansion Street Women's Health, P.L.L.C.’s mailing list. This information may include your name, address, and phone number. If you do not wish to be included in our mailing list, please notify the Office Manager at 269 781-1183. (Example: Providing a patient list of names and addresses to process a bulk mailing announcing a new physician.) This would be for our business use only. Our list is not sold or given to anyone for any purpose other than the care of Mansion Street Women’s Health, P.L.L.C. patients.

Individuals Involved in Your Care or Payment for Your Care

At your request, we may release health information about you to a family member or any other person identified by you who is involved in your health care. Information may also be given to someone who helps pay for your care. If your condition warrants, it may be necessary to tell your family, personal representative, or other person responsible for your health care your condition and that you are a patient at Mansion Street Women's Health, P.L.L.C.

Business Associates

We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. 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.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose your health information, 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. You understand that we are unable to take back any disclosures we have already made under the authorization, and that we are required to retain our records of the care that we provided to you.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding health information we maintain about you:

Right to Request Restrictions

You have the right to request a restriction or limitations on your health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to:

Mansion Street Women’s Health, P.L.L.C.
Office Manager
215 E. Mansion Street, Suite 3-D
Marshall, MI 49068

In your request you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

Right to Request Confidential Communications

Typically, we communicate with you regarding your health care either through your home phone or through the mail at your home address. You have the right to request that we communicate with you or your responsible party about your health care in an alternative way or at a certain location.

To request confidential communications, you must make your request in writing to:

Mansion Street Women’s Health, P.L.L.C.
Office Manager
215 E. Mansion Street, Suite 3-D
Marshall, MI 49068

We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Inspect and Copy

You have the right to inspect and copy health information that may be used to make decisions about your care. This includes medical and billing records other than psycotherapy notes.

To inspect and copy health information that may be used to make decisions about you, you can submit your request in writing or orally to:

    Mansion Street Women’s Health, P.L.L.C.
    Office Manager
    215 E. Mansion Street, Suite 3-D
    Marshall, MI 49068

    If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

    Right to Amend

    You have the right to ask us to amend your health and/or billing information for as long as the information is kept by the Mansion Street Women's Health, P.L.L.C. To request an amendment, your request must be made in writing and submitted to:

    Mansion Street Women’s Health, P.L.L.C.
    Office Manager
    215 E. Mansion Street, Suite 3-D
    Marshall, MI 49068

    In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it 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:

    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

    • Is not part of the health information kept by or for the Mansion Street Women’s Health, P.L.L.C.;

    • Is not part of the information which you would be permitted to inspect and copy; or ;

    • Is accurate and complete.

Right to an Accounting of Non-Routine Disclosures

You have the right to request a list of certain disclosures that we have made of your health information.

To request this list of disclosures, you must submit your request in writing to:

Mansion Street Women’s Health, P.L.L.C.
Office Manager
215 E. Mansion Street, Suite 3-D
Marshall, MI 49068

Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (For example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists, during such twelve-month period, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

You may obtain a copy of this Notice at our web site at www.mansionstreetobgyn.com/privacy.htm.

To obtain a paper copy of this notice, contact :

Mansion Street Women’s Health, P.L.L.C.
Office Manager
215 E. Mansion Street, Suite 3-D
Marshall, MI 49068

WHO THIS NOTICE APPLIES TO

This Notice describes the Mansion Street Women's Health, P. L.L.C..’s practices and those of:    

  • Any health care professional authorized to enter information into or consult your medical record. (i.e. staff, residents, students)

  • All departments and units of the Mansion Street Women's Health, P.L.L.C.

  • Any member of a volunteer group we allow to help you. (i.e. a support group like Mothers of Multiples, etc)

  • All employees, staff and other Mansion Street Women's Health, P.L.L.C. personnel.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice is also available to you upon request. The Notice will contain on the first page, in the top right-hand corner, the effective date. In addition, if we revise the Notice, and you are still with the Mansion Street Women's Health, P.L.L.C,, we will offer you a copy of the current Notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Mansion Street Women's Health, P. L.L.C., Office Manager, or with the Secretary of Department of Health and Human Services. To file a complaint with the Mansion Street Women's Health, P.L.L.C., contact the Office Manager at 269 781-1183. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

If you have any questions about this Notice, please contact:

Mansion Street Women's Health, P.L.L.C.
Office Manager
215 East Mansion Street, Suite 3-D
Marshall, MI 49068

                                                           

 

 

 

 

Downloadable Privacy Policy

 

Notice of Privacy Policy