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. This notice applies to services provided to you by Work-Fit and their staff at the following Work-Fit Location:
Each time you visit a health care provider, a record of your visit is made. Usually this record includes the reasons you came for treatment, the physical exam, test results, what was found, the treatment and the plan for future care. This is called your Medical Record. Your Medical Record is used in many ways:
It is the basis for planning your care and treatment.It is a way for the health team, involved in your care, to communicate.It is a legal document that describes the care you got.It is a tool used to educate health professionals.It is a source of facts for research.It is a source of health facts for public health officials.It is a source of data for planning and marketing.It is a way that we can check on our work and improve the care that we give.
Your Medical Record has personal health information. Both state and federal law protect the privacy of this information. We hope that if you understand how this information is used and shared, it will help you to:
Make sure the information you give us is correct.Better understand who, what, when, where and why your health care providers and others may see your personal health information.Be able to make better decisions about who can use your personal health information.
Your Medical Record is the property of the healthcare facility identified above. But the information in the Record belongs to you. You have the right to:Get a paper copy of this notice. Or you could get an email copy if you ask for it.Ask to have the use of your Medical Record restricted in some way. We will consider yourrequest. But we are not bound by law to do as you ask.Ask that we send confidential information to you at another address - or in another way.Look at and get a copy of your Medical Record - unless you cannot by law. There may be a feeto get a copy of your Medical Record.Ask that changes/amendments be added to your Medical Record.Get a record of who saw your Medical Record after April 14, 2003 and how it was used. Theremay be a fee for this.
Contact information is on the last page of this notice if you want to make any of these requests.
We will do the following:
Keep your health information private.Give you notice about how we will obey the privacy laws and keep your health information private.Promise to follow our responsibilities as described this Notice. But we keep the right to:Change the way we handle your health information and give a date by which these new changes will start. (These changes will affect all your health information, old and new.)Change the terms of this Notice.We will tell you if we change the way we handle your health information. In the meantime, we will use or share it only as stated in this Notice - unless you give us your permission to use it in other ways.
1. We will use your health information for treatment.
For example: Information you give a nurse, doctor or other health care provider will be put in your Medical Record. They will be used to plan your treatment. Your health care team will keep a record of your care and treatment in this Record.
We may give copies of reports from your Medical Record to your referring physician, primary care doctor or other provider during the course of your treatment and once you leave the Work-Fit Center. We may give copies of parts of your Medical Record to your specialists. Or we may need to give them to a treatment center to which you are being transferred.
We may use information about you to call you or send you a reminder letter or phone call:
About an appointmentTo set up a regular check-upTo give you information about other kind of treatmentsTo tell you about health products and services we can give you.
2. We will use your health information to improve our services.
We may use your health information to see that all our patients get quality care. We want to see if our staff gives the care they should. We often want to see if we need to offer more services to people, or to see if the treatments we give are working. We may also use your health information as a way to train our staff.
3. Business associates may see some of your health information.
We have companies that work for us. Examples of these are companies that type medical reports, copy records and do data compilation. Some of them may need to see parts of your Medical Record in order to do their work. Every company that works with us and sees parts of your Medical Record must sign a privacy contract with us.
To any public health officials who work to prevent or control disease.To government officials who check out charges of abuse, neglect and domestic violence.To government officials who monitor and license health care providers and facilities.When needed for a court hearing.To law enforcement officials so they canreport on wounds or injuries caused by a crime or accidentfind fugitives, suspects and missing personsidentify a witness, victim, missing person or suspectWhen needed to prevent a threat to public health or safety.When needed for special lawful government work including the military.As required by law for workers compensation programs.
Rules About Release of Your Health Information
We will release your health information for two reasons:
You ask for it or authorize in writing the release of your health information to a third party; andThe federal Health and Human Services Department (or their contractors) asks for it. They would ask for it for legal reasons or to review some special problem.
We may ask to use your personal health information in other ways as well. But we will only do it if we have your written permission/authorization. You have the right to end this permission at any time. But we have the right to use your health information until the time you tell us that you take back your consent.
If you have questions about this notice, orIf you have concerns about these privacy practices, orIf you believe your privacy rights have been abused, please contact:
Privacy Officer:Agility Health Inc.607 Dewey Ave, NW Suite 300 Grand Rapids, MI 48504Attention: Work-Fit Privacy Officer (616) 356-5024
If you believe your privacy rights have been abused, you may also file a complaint with the Office of Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building --- Room 1875, Boston, MA 02203.
There will be no action against you if you file a complaint.
Agility Health Inc.607 Dewey Ave, NW Suite 300 Grand Rapids, MI 48504Attention: Work-Fit Privacy Officer
Effective Date: April 14, 2003