Your Information. Your Rights. Our Responsibilities.
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.
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
- Tell family and friends about your condition
- Provide disaster relief
- Include you in a hospital directory
- Provide mental health care
- Market our services and sell your information
- Raise funds
Our Uses and Disclosures
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
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 or paper 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 we’ll 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 we’ve 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). We’ll 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 if you feel your rights are violated
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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. 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
- Include your information in a hospital directory
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.
In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
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.
We can use your health information and share it with other professionals who are treating you.
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 use or 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 health and 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 anyone’s health or safety
We can use or share your information for health research.
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 we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
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.
- 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. If 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
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 website.
Effective Date 9.19.13
Privacy Officer: Tammie Wright, Administrator: 517-319-9000 or firstname.lastname@example.org
Patients Have the Right to Caring, Respectful, Personal, and Quality Care
As a patient at the Michigan Surgical Center you can expect:
- That your care will be caring and respectful at all times. The healthcare providers will welcome, respect and serve all people regardless of gender, ethnicity, color, national origin, religion, disability, age, HIV status, sexual orientation or source of payment for care received.
- To exercise your rights without being subjected to discrimination or reprisal.
- Sign and spoken language interpreting services available when it is requested and scheduled in advance.
- Treatment, services, and referrals as needed. If we are unable to meet your medical needs, we will arrange a transfer to another facility. Referrals will be made only after you are given full information about why the transfer is needed.
- Pastoral/spiritual care as desired from your pastor, priest, rabbi, or other religious leader.
- To use protective and advocacy services if needed.
To be allowed to voice grievances regarding treatment or care that is or fails to be furnished. To be told how to file a complaint and settle disputes, arguments, or conflicts. These include services such as Ethics Committee or assistance in contacting a regulatory agency as required by law. The following are agencies that can be contacted:
Office of the Medicare Beneficiary Ombudsman:
Michigan Department of Community Health
Bureau of Health Systems, Complaint Investigation Unit
PO Box 30664
Lansing, Michigan 48909
You the patient or, as appropriate, your advocate (representative) have the right to make informed decisions regarding your medical care PRIOR to any medical care. An Advance Directive is your written instruction for the medical treatment you want in the event that you become unable to communicate your wishes. However, unlike an acute care hospital setting, the surgery center does not routinely perform “high risk” procedures. Most procedures performed in this facility are considered to be of minimal risk. Therefore it is our policy, regardless of the contents of any Advance Directive or instructions from a health care surrogate or Attorney in Fact, that if an event occurs during your treatment at this facility we do not honor the directive. We will initiate resuscitative or other stabilizing measures and transfer you to an acute care hospital for further evaluation. At this acute care hospital, further treatment or withdrawal of treatment measurers already begun will be ordered in accordance with your wishes, Advance Directive, or health care Power of Attorney. Your agreement with this policy by you does not revoke or invalidate any current health care directive or health care Power of Attorney. If you have completed such a document as in a Durable Power of Attorney for Health Care (POA), Living Will, Do-Not-Resuscitate Declaration or Declaration of Anatomical Gift, please bring a copy with you on the day of your surgery for your medical record. If you have not completed such a document and would like further information, you may come to the Michigan Surgical Center prior to your surgical date and we will provide you with the necessary documentation. You may also obtain this information by visiting the following website which may answer your questions and provide to you the necessary forms.
(517) 373-3500 or (800) 882-6006 Fax (517) 241-0093
Patients Have the Right to Receive Information About Their Treatment and Health Care Team
You can expect the health care team to provide:
- Explanations of diagnosis and treatment in a way that is clear to you.
- Information about specific treatments or procedures, including their benefits and risks, and the medically reasonable options to these treatments, and the expected outcome before it is performed.
- The names and professional titles of the physician in charge of your care and the names and titles of other health care providers.
- Results of treatments, including unexpected results, from your physician.
- Access to your medical record, although we encourage patients to review the record with their physician. You also have the right to ask for and receive a copy of your own medical record.
- Your chart or other personal health information to third parties only when you have approved (except as required or allowed by law for treatment, payment or healthcare operations).
Patients Have the Right to Make Decisions About Their Own Care
You or your legally designated representative can expect:
- To make decisions about your own health care.
- To have the choice to accept or refuse medical care and treatment to the extent allowed by law and to be told of the medical results of these decisions.
- The opportunity to complete an Advance Medical Directive.
- To have the right to check with another physician, at your own request and expense.
- To seek the advice or opinion of the Ethics Committee.
- To make decisions to include or exclude any or all family members or significant others in the involvement of your care.
- An explanation of your bill.
- You have the right to receive a copy of your bill, regardless of payer.
Patients Have the Right to be Comfortable and Safe
You can expect:
- To have care provided in a safe, secure and efficient environment, free from abuse and harassment. Chemical or physical restraints will only be used in emergencies to protect you and/or others.
- To have ongoing assessment of your pain and be involved in plans to manage pain.
- To have information about pain and pain relief options.
- A concerned staff, dedicated to preventing pain.
- Health professionals who respond quickly to reports of pain.
- To receive care in a setting that maintains your dignity through personal space and clothing suited to your condition.
- To be told of the experimental nature of suggested procedures or treatments and have the right to refuse those treatments without affecting your care.
Patients Have the Right to Have Privacy and Confidentiality
You can expect:
- To have personal privacy, including privacy of personal medical information.
- To have the right to refuse to talk with or see anyone not officially connected with the Michigan Surgical Center. This includes visitors or others not directly involved in providing care.
- To have the use of a telephone for private conversations.
- To be interviewed and examined in a setting that provides reasonable privacy in sight and sound.
- To have a person of the same sex present during certain types of exams or procedures.
- To remain disrobed only as long as is needed to complete the medical purpose which required disrobing.
- To be asked for written consent for any filming or recording to be used for any purpose other than identification, diagnosis, and treatment.
- To be asked for written consent for release of your medical record, or other personal information to third parties which is not to be used for any purpose other than as required by law for treatment, payment, or healthcare operations.
In order to provide you with the best care, we ask that you:
- Provide a complete, accurate and honest medical history and information including:
- Nature of your illness
- Past illnesses, hospitalizations, and changes in health conditions prior to surgery
- Specific problems, symptoms, pain or concerns during your stay
- Medication (prescriptions, over the counter and herbal) history (including dose and frequency), reactions to medications (food and latex) and concerns
- Changes in your medical condition
- Keep his/her appointment.
- Speak up and ask questions if you do not understand the treatment plan and your role in the plan.
- Make informed decisions about your care.
- Follow the jointly agreed upon recommendations, advice and treatment course arranged by the health care team during preoperative, operative, and post-operative instructions and that you have willingly agreed to the treatment.
- Securing someone to stay with the patient for 24 hours following the surgery.
- Follow the Michigan Surgical Center policies about patient care and conduct to support quality care and a safe environment, such as:
- Conducting yourself in a way that respects the rights of other patients and employees of the surgical center
- Following our Smoke Free Campus Environment
- Knowing the name of your surgeon
- Provide complete, accurate and timely information about the sources of payment for the care the surgical center provides and fulfill financial obligations to the surgical center in a timely manner.
- Accept and recognize responsibility for the medical results if you refuse treatment or do not follow the health care provider’s instructions.
- Inform the Michigan Surgical Center in the case of any problems following surgery.