MUNSON HEALTHCARE, MERCY
HOSPITAL CADILLAC, AND MERCY HOSPITAL GRAYLING AMBULATORY PHARMACIES
NOTICE OF PRIVACY PRACTICES
Effective Date: 4/14/2003
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 are receiving health care
at an ambulatory pharmacy that is part of Munson Healthcare, Mercy
Hospital Cadillac, or Mercy Hospital Grayling. We are required
by law to maintain the privacy of individually identifiable patient
health information (this information is "protected health
information" and is referred to herein as "PHI").
We are also required to provide patients with a Notice of Privacy
Practices regarding PHI. We are required to post this Notice in
a prominent place within our pharmacies. We will only use or disclose
your PHI as permitted or required by applicable state law. This
Notice applies to your PHI in our possession including the medical
records generated by us.
We understand that your health
information is highly personal, and we are committed to safeguarding
your privacy. Please read this Notice of Privacy Practices thoroughly.
It describes how the Munson Healthcare, Mercy Hospital Cadillac
and Mercy Hospital Grayling ambulatory pharmacies will use and
disclose your PHI.
This notice applied to the delivery
of pharmaceutical care by any current or future Munson Healthcare,
Mercy Hospital Cadillac or Mercy Hospital Grayling associated
ambulatory pharmacy.
I. Permitted Use or Disclosure
A. Treatment: We will
use and disclose your PHI in the provision and coordination of
health care to carry out pharmaceutical care functions.
We will disclose all or any portion of your medication record
to your attending physician, consulting physician(s), nurses,
pharmacists, students, and other health care providers who have
a legitimate need for such information in your care. Different
departments of Munson Healthcare, Mercy Hospital Cadillac or Mercy
Hospital Grayling will share medical information about you in
order to coordinate services.
We will disclose your medical information and/or release your
prescriptions to people or outside entities who will be involved
in your medical care such as other care providers or family members
who also provide services that are part of your care.
We will share certain information
such as your name, address, employment, insurance carrier, emergency
contact information and appointment scheduling information in
an effort to coordinate your medical, pharmaceutical care or pharmaceutical
care related services with us and with other health care providers.
We will use and disclose your PHI to inform you of, or recommend
possible pharmaceutical care options or alternatives that will
be of interest to you.
We will use and disclose PHI
to contact you with regard to information needed to fill your
prescriptions or regarding other information concerning your prescriptions,
including refill reminders.
If you are an inmate of a correctional
institution or under the custody of a law enforcement officer,
we will disclose your PHI to the correctional institution or law
enforcement official.
B. Payment: We will disclose
PHI about you for the purposes of determining coverage, eligibility,
funding, billing, claims management, medical data processing,
stop loss/reinsurance and reimbursement.
The medical information will
be disclosed to an insurance company, third party payer, third
party administrator, health plan, your employer (in workers' compensation
cases) or other health care provider (or their duly authorized
representatives) involved in the payment of your pharmacy bill
and will include copies or excerpts of your prescription records
which are necessary for payment of your account. It will also
include sharing the necessary information to obtain pre-approval
for payment for a prescription filled under your pharmacy benefits
plan.
The medical information may also
be released to independent health care providers involved in your
medical or pharmaceutical care.
We will disclose PHI to collection agencies and other subcontractors
engaged in obtaining payment for care.
C. Health Care Operations:
We will use and disclose your PHI during routine pharmaceutical
care operations including quality review, utilization review,
medical review, internal auditing, accreditation, certification,
licensing or credentialing activities of the Munson Healthcare,
Mercy Hospital Cadillac and Mercy Hospital Grayling ambulatory
pharmacies, and for educational purposes.
For instance, we may share your
demographic information, diagnosis, pharmaceutical care plan and
health status for population based activities relating to improving
health or reducing health care costs, protocol development, case
management and care coordination, and contacting health care providers
and patients with information about treatment alternatives, in
order for us to operate our business in an efficient, safe and
legal manner.
We may also use and disclose
your PHI to support the sale, transfer, or other corporate restructuring
of any of our pharmacies' assets.
D. Other Uses and Disclosures:
As part of treatment, payment and health care operations,
we may also use your PHI for the following purposes:
Medical Research: We may
disclose your PHI without your Authorization to medical researchers
who request it for approved medical research projects; however,
with very limited exceptions such disclosures must be cleared
through a special approval process before any PHI is disclosed
to the researchers. Researchers will be required to safeguard
the PHI they receive.
Information and Health Promotion
Activities: We will use and disclose some of your PHI for
certain health promotion activities. For example, your name and
address will be used to send you newsletters or general communications.
We will also send you information based on your own health concerns.
We may send you this information if we determine that a product
or service may help you. The communication will explain how the
product or service relates to your well-being and can improve
your health.
E. More Stringent State and
Federal Laws: The State law of Michigan is more stringent
than HIPAA in several areas. State law is more stringent when
the individual is entitled to greater access to records than under
HIPAA and when under state law the records are more protected
from disclosure than under HIPAA. Certain federal laws also are
more stringent than HIPAA. We will continue to abide by these
more stringent state and federal laws. The federal laws include
applicable Internet privacy laws, such as the Children's Online
Privacy Protection Act and the federal laws and regulations governing
the confidentiality of health information regarding substance
abuse treatment.
In Michigan patients have more
rights of access to behavioral health information under Michigan
law than under HIPAA and the state law defines a minimum necessary
standard for release of mental health information. Disclosure
is permitted with consent and for treatment without consent but
only in an emergency. Minors in Michigan have more rights to confidentiality
and protection of certain information (reproductive health, behavioral
health and substance abuse) than under HIPAA. State law requires
facilities to adopt policies regarding release of information
outside the facility.
II. Permitted Use or Disclosure
with an Opportunity for You to Agree or Object
A. Family/Friends: We
will disclose PHI about you to a friend or family member who is
involved in your medical or pharmaceutical care. We will also
give information to someone who helps you pay for your care. In
addition, we will disclose PHI about you to an agency assisting
in a disaster relief effort so that your family can be notified
about your condition, status and location. You have a right to
request that your PHI not be shared with some or all of your family
or friends.
B. Promotional Communications:
We do not share or sell your PHI to companies that market health
care products or services directly to consumers for use by those
companies to contact you, such as drug companies.
III. Use or Disclosure Requiring
Your Authorization
A. Marketing: We will
not be permitted to provide your PHI to any other person or company
for marketing to you of any products or services other than our
pharmacy products or services unless you have signed an authorization.
B. Research: We will use
or disclose your PHI as part of research that includes providing
you with treatment. For example, if you are part of a research
study that includes treatment, we may require that you sign an
authorization to allow the researchers to use or disclose your
PHI for this research.
C. Other Uses: Any uses
or disclosures that are not for treatment, payment or operations
and that are not permitted or required for public policy purposes
or by law will be made only with your written authorization. Written
authorizations will let you know why we are using your PHI. You
have the right to revoke an authorization at any time, except
to the extent that we have taken action in reliance on the authorization.
IV. Use or Disclosure Permitted
by Public Policy or Law without your Authorization
A. Law Enforcement Purposes:
Munson Healthcare, Mercy Hospital Cadillac and Mercy Hospital
Grayling ambulatory pharmacies will disclose your PHI for law
enforcement purposes as required by law, such as responding to
a court order or subpoena, identifying a criminal suspect or a
missing person, or providing information about a crime victim
or possible criminal conduct as part of a criminal investigation.
B. Required by Law: We
will disclose PHI about you when required by federal, state or
local law to make reports or other disclosures. We will also make
disclosures for judicial and administrative proceedings such as
lawsuits or other disputes in response to a court order or subpoena.
We will report drug diversion and information related to fraudulent
or suspected fraudulent prescription activity to law enforcement,
regulatory agencies or other providers involved in your pharmaceutical
care. Specialized government functions will warrant the use and
disclosure of PHI. These government functions will include military
and veteran's activities, national security and intelligence activities,
and protective services for the President and others. We will
make certain disclosures that are required in order to comply
with workers' compensation or similar programs.
C. Health or Safety: Following
the requirements of the Michigan Department of Commerce, we will
use and disclose PHI to avert a serious threat or a potentially
serious threat to health and safety of a person or the public.
We will use and disclose PHI for activities related to the quality,
safety or effectiveness of FDA-regulated products or activities,
including collecting and reporting adverse events, tracking and
facilitating product recalls, etc. and post marketing surveillance.
Any patient receiving a medical device subject to FDA tracking
requirements may refuse to disclose, or refuse permission to disclose,
their name, address, telephone number and social security number,
or other identifying information for the purpose of tracking.
V. Your Health Information
Rights
Although we must maintain all
records concerning your pharmaceutical care provided by us, you
have the following rights concerning your PHI:
A. Right to Inspect and Copy:
You have the right to access your PHI and to inspect and have
a copy made of your PHI as long as we maintain it except for:
information that may be used in anticipation of, or that will
be used in a civil, criminal or administrative action or proceeding,
and where prohibited or protected by law.
We will deny your request for
access to your PHI without giving you an opportunity to review
that decision if:
You don't have the right to inspect the
information; or it is otherwise prohibited or protected by law;
You are an inmate at a correctional institution
and obtaining a copy of the information would risk the health,
safety, security, custody or rehabilitation of you or other
inmates;
The disclosure of the information would
threaten the safety of any officer, employee or other person
at the correctional institution or who is responsible for transporting
you;
You are involved in a clinical research
project and we created or obtained the PHI during that research.
Your access to the information will be temporarily suspended
for as long as the research is in progress;
We obtained the information that you seek
access to from someone other than the health care provider under
a promise of confidentiality and your access request is likely
to reveal the source of the information; or
Under other limited circumstances. In these
instances, however, we will allow the review of its decision
by a health care professional that we have chosen. This person
will not have been involved in the original decision to deny
your request.
You agree to pay a reasonable
copying charge. You must make your requests to access and copy
your PHI in writing; refer to the appropriate address in the Complaint
section (Section VI) of this Notice. We will respond to your request
within 30 days of its receipt. If we cannot, we will notify you
in writing to explain the delay and the date by which we will
act on your request. In any event, we will act on your request
within 60 days of its receipt.
B. Right to Amend: You
have the right to amend your PHI for as long as we maintain it.
However, we will deny your request for amendment if:
We did not create or do not maintain the
information;
The information is not part of the designated
record set;
The information would not be available
for your inspection (due to its condition or nature); or
The information is accurate and complete
(or was at the time the service was provided).
If we deny your request for changes
in your PHI, we will notify you in writing with the reason for
the denial. We will also inform you of your right to submit a
written statement disagreeing with the denial. We may prepare
a rebuttal to your statement of disagreement and will provide
you with a copy of that rebuttal.
You must make your request for
amendment of your PHI in writing, including your reason to support
the requested amendment; refer to the appropriate address in the
Complaint section (Section VI) of this Notice. We will respond
to your request within 60 days of its receipt. If we cannot, we
will notify you in writing to explain the delay and the date by
which we will act on your request. In any event, we will act on
your request within 90 days of its receipt.
C. Right to an Accounting:
You have a right to receive an accounting of the disclosures of
your PHI that a Munson Healthcare, Mercy Hospital Cadillac or
Mercy Hospital Grayling ambulatory pharmacy made, except for the
following disclosures:
To carry out treatment, payment or health
care operations;
To you;
To persons involved in your care;
For national security or intelligence purposes;
To correctional institutions or law enforcement
officials in custodial situations; or
That occurred prior to April 14, 2003.
For each disclosure, you will
receive: the date of the disclosure, the name of the receiving
organization and address if known, a brief description of the
PHI disclosed and a brief statement of the purpose of the disclosure
or a copy of the written request for the information, if there
was one.
You must make your request for
an accounting of disclosures of your PHI in writing; refer to
the appropriate address in the Complaint section (Section VI)
of this Notice. You must include the time period of the accounting,
which may not be longer than 6 years. We will respond to your
request within 60 days from its receipt. If we cannot, we will
notify you in writing to explain the delay and the date by which
we will act on your request. In any event, we will act on your
request within 90 days of its receipt.
In any given 12-month period,
we will provide you with an accounting of the disclosures of your
PHI at no charge. Any additional requests for an accounting within
that time period will be subject to a reasonable fee for preparing
the accounting.
D. Right to Request Restrictions:
You have the right to request restrictions on certain uses and
disclosures of your PHI:
To carry out treatment, payment or health
care operations functions; or
Restricting specific information to only
specified family members, relatives, close personal friends
or other individuals involved in your care.
For example, you may ask that
an individual or group of individuals specifically be restricted
from picking up your prescriptions or that information regarding
your pharmaceutical care not be shared with your family. We will
consider your request but are not required to agree to the requested
restrictions.
E. Right to Confidential Communications:
You have the right to receive confidential communications of your
PHI by alternative means or at alternative locations. For example,
you may request that we only contact you at work or by mail. We
will make every attempt to honor your request, but we reserve
the right to deny unreasonable requests.
F. Right to Receive a Copy
of this Notice: You have the right to receive a paper copy
of this Notice of Privacy Practices, upon request.
VI. Complaints
If you believe your privacy rights
have been violated, you may file a complaint with the respective
Munson Healthcare, Mercy Hospital Cadillac or Mercy Hospital Grayling
pharmacy or with the Secretary of the Department of Health and
Human Services. To file a complaint concerning a Munson Healthcare,
Mercy Hospital Cadillac or Mercy Hospital Grayling ambulatory
pharmacy, please contact the person at the appropriate location
noted below:
For Munson Ambulatory Pharmacies
and the MMC (employee) Ambulatory Pharmacy, contact the Retail
Pharmacy Manager at:
MCHC Ambulatory Pharmacy
550 Munson Avenue
Traverse City, MI 49686
For pharmacies located within
Mercy Hospital Cadillac and Mercy Hospital Grayling, please contact
the Director of the respective hospital Pharmacy at:
Mercy Hospital Cadillac
400 Hobart Street
Cadillac, MI 49601
Mercy Hospital Grayling
1100 East Michigan Avenue
Grayling, MI 49738
All complaints must be submitted
in writing directly to the respective location above. We assure
you that there will be no retaliation for filing a complaint.
VII. Sharing and Joint Use
of Your Health Information
In the course of providing care
to you and in furtherance of our mission to improve the health
of the community, we will share your PHI with other organizations
as described below who have agreed to abide by the terms described
below:
A. Business Associates:
We will use and disclose your PHI to business associates contracted
to perform business functions on their behalf. Whenever an arrangement
between a Munson Healthcare, Mercy Hospital Cadillac or Mercy
Hospital Grayling ambulatory pharmacy and another company involves
the use or disclosure of your PHI, that business associate will
be required to keep your information confidential.
B. Membership in Munson Healthcare,
Mercy Hospital Cadillac and Mercy Hospital Grayling: Member
organizations in Munson Healthcare, Mercy Hospital Cadillac and
Mercy Hospital Grayling, including the ambulatory pharmacies,
participate together in an organized healthcare arrangement for
utilization review and quality assessment activities. We have
agreed to abide by the terms of this Notice with respect to PHI
created or received as part of utilization review and quality
assessment activities of Munson Healthcare, Mercy Hospital Cadillac,
Mercy Hospital Grayling and their members. Members of Munson Healthcare,
Mercy Hospital Cadillac and Mercy Hospital Grayling will abide
by the terms of their own Notices of Privacy Practices in using
your PHI for medical care, pharmaceutical care, payment or healthcare
operations. As a part of Munson Healthcare, Mercy Hospital Cadillac
and Mercy Hospital Grayling, their ambulatory pharmacies and other
health care providers in Munson Healthcare, Mercy Hospital Cadillac
and Mercy Hospital Grayling share your PHI for utilization review
and quality assessment activities. Members of Munson Healthcare,
Mercy Hospital Cadillac and Mercy Hospital Grayling also use your
PHI for your medical/pharmaceutical care, payment to Munson Healthcare,
Mercy Hospital Cadillac, Mercy Hospital Grayling or related agencies
and for the health care operations permitted by HIPAA with respect
to our mutual patients.
VIII. Additional Information
For further information regarding
the subjects covered in this Notice of Privacy Practices, please
contact Munson Healthcare's Privacy Official at (231)
935-2335.
IX. Changes to this Notice
We will abide by the terms of
the Notice currently in effect. We reserve the right to change
the terms of its Notice and to make the new Notice provisions
effective for all PHI that we maintain. We will provide you with
the revised Notice at your first visit following the revision
of the Notice.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
