Privacy Information

Partners in Internal Medicine

NOTICE OF PRIVACY PRACTICES

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.

Effective Date of Notice: April 14, 2003
Revision Date: November 3, 2005

OUR RESPONSIBILITIES

Partners in Internal Medicine takes the privacy of your health information seriously and is committed to protecting your medical information. We are required by law to maintain privacy and to provide you with this Notice of Privacy Practices. This Notice is provided to inform you about our duties and practices with respect to your information. This Notice applies to all the records of your care generated by this office, whether made by your personal physician or one of the office's employees. This Notice describes how we protect your health information and what rights you have regarding your medical information.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION:

The most common reason why we use or disclose your health information is for treatment, payment or health care operations. The following describes the different ways that your medical information may be used or disclosed by this office. For clarification we have included some examples. Not every possible use or disclosure is specifically mentioned. However, all of the ways we are permitted to use and disclose your medical information will fit within one of these general categories:

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 (office, notes, testing, etc.) to doctors, nurses, aids, technicians or employees of Partners In Internal Medicine who are involved in taking care of you. Additionally, we may use or disclose your health information pertinent to your medical condition to manage or coordinate your treatment and/or to assist in diagnosis.
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. For example, we may need to give your health information regarding treatment you received here so your health plan will pay us or reimburse for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. In addition, we may need to provide information to a Collection Agency or Attorney in order to collect unpaid amounts.
Health Care Operations - We may use and disclose your health information for health care operations. These uses and disclosures are necessary to run our office and to make sure you receive competent, quality health care, as well as maintain and improve the quality of health care we provide. For example, we may use medical information to review our treatment and services in addition to evaluating the performance of our staff in caring for you. We may also combine medical information about many of our patients to decide what additional services the office should offer, what services are not needed, and whether certain new treatments are effective. Other examples of how we may use or disclose your health information for health care operations are: financial, billing audits, internal quality assurance, personnel decisions, participation in manage care plans, defense of legal matters, business planning and outsider storage of our records. We may also disclose information to doctors, nurses, technicians, and other office personnel for review and learning purposes. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning the identity of specific patients. We will also disclose your health information when required to do so by federal, state or local law.
For Public Health Purposes - We may disclose your health information for public health activities, such as 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.
Other uses such as:

Appointment Reminders
Victims of Abuse
Health Oversight/Activities
Judicial Purposes
Law Enforcement
Coroners, Medical Examiners & Funeral Directors
Organ & Tissue Donation
Military & Veterans
National Security and Intelligence Activities
Custodial Situations
Workers' Compensation
Treatment Alternatives
Individuals involved in your care or payment of your care

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

Right to Request Restrictions - You have the right to request a restriction or limitation on the 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. 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 need to request a Request Disclosure Form and complete it. Request must be submitted to Partners in Internal Medicine, Attention Medical Group Administrator at 2200 Green Rd., Ste B, Ann Arbor, Michigan 48105. 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 - We communicate with you regarding your health care either through your home phone, work phone, cell 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 Partners in Internal Medicine, Attention Medical Group Administrator at 2200 Green Rd., Ste B, Ann Arbor, MI 48105. 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 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. To inspect and copy health information that may be used to make decisions about you, you can submit your request in writing or sign a Medical Release of Protected Health Information form to Partners in Internal Medicine, Attention Operations Director at 2200 Green Rd., Ste B, Ann Arbor, Michigan 48105. If you request to access and inspect or request a copy of the information, we will charge a fee for labor, mailing or other supplies associated with your request. However, there is no charge for requests that involves forwarding your records to another physician office directly.
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 Partners in Internal Medicine. To request an amendment, your request must be made in writing and submitted to Partners in Internal Medicine, Attention Operations Director at 2200 Green Rd., Ste B, Ann Arbor, Michigan 48105. 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 Covered Entity;
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 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 Partners in Internal Medicine, Attention Operations Director at 2200 Green Rd., Ste B, Ann Arbor, Michigan 48105. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. 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. To obtain a paper copy of this Notice, contact Operations Director at 2200 Green Rd., Ste B, Ann Arbor, Michigan 48105. You may obtain a copy of this Notice at our web site at www.piim.org.
Changes to this Notice - By law, we must abide by the terms of this Notice of Privacy Practices. 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 post a copy of the current Notice in a clear and prominent location to which you have access in our office. This Notice is also available upon request and is also posted on our web site. The Notice will contain on the first page the effective date. In addition, if we revise the Notice, and you are still with the Partners in Internal Medicine, 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 Partners in Internal Medicine or with the Secretary of the Department of Health and Human Services. To file a complaint with Partners in Internal Medicine, contact the Medical Group Administrator at (734) 994-7446. 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:

Partners in Internal Medicine
Contact Person: Operations Director
2200 Green Rd., Ste B
Ann Arbor, MI 48105
(734) 994-7446
(734) 623-8590 fax

Privacy Information

Hospital Affiliations

Useful Links

Contact Us