Privacy Notice for office of Dr. Robert Griffith
This notice describes how personal and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Understanding the Type of Information We Have. We get information about you when we receive a referral. It includes your date of birth, sex, and other information. We may also get reports from other providers and other data about your medical care.
Our Privacy Commitment To You. We care about your privacy. The information we collect about you is private. We are required to give you a notice of our privacy practices. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing, we will only disclose your information for the purposes of treatment, payment, business operations, or when required to do so by law.
- Treatment. We may disclose medical information about you to coordinate your care and fulfill a referral request.
- Payment. We may use and disclose information so the care you get can be properly billed and paid for.
- Business Operations. We may need to use and disclose information for our business operations. For example, we may use information to review the quality of care you receive.
- Exceptions. For certain kinds of records, your permission may be needed for any release of information.
- As Required By Law. We will release information when we are required by law to do so. For example, for law enforcement purposes, subpoenas or other court orders, review of our activities by government agencies, or in other kinds of emergencies.
- With Your Permission. If you give us permission in writing, we may use and disclose your personal information. If you give us permission, you have the right to change your mind and revoke it. This must be in writing as well. We can not take back any uses or disclosures made with your permission.
Your Privacy Rights. You have the following rights regarding the health information that we have about you. Your requests must be made in writing to our office.
- Your Right To Inspect and Copy. In most cases, you have the right to look at or get copies of your records; however, there may be limitations. Dr. Griffith may want to review the information with you before providing a copy or summary. You will be charged a fee for the cost of copying your records.
- Your Right To Amend. You may ask us to change your records if you feel there is a mistake. We can deny you request for certain reasons, but we must give you a written reason for our denial.
- Your Right To A List Of Disclosures. You have the right to ask for a list of disclosures made after April 14, 2003. This list will not include the times that information was disclosed for treatment, payment, or business operations. This list will not include information provided directly to you or your family, or information that was sent with your permission.
- Your Right To Request Restrictions On Our Use or Disclosure Of Information. You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to such requests.
- Your Right To Confidential Communications. You have the right to ask that we share information with you in a certain way or a certain place. For example, you may ask us to send information to your work address instead of your home address. You do not have to explain the basis for your request.
Changes To This Notice. We reserve the right to revise this notice. A revised notice will be effective for information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes will also be posted on our web site at www.DrGriffith.net.
How To Use Your Rights Under This Notice. If you want to use your rights under this notice, you should write us. You can set up an appointment for assistance with writing a request if needed. We will need time to retrieve your records.
- Requests and Complaints To Us. If you want to exercise your rights under this notice or if you wish to communicate with us about privacy issues or if you wish to file a complaint, you can write to: Dr. Robert Griffith, 3608 South Burdick Street, Kalamazoo, MI, 49001. You will not be penalized for filing a complaint.
- Requests and Complaints To The Federal Government. If you want to exercise your rights under this notice and you were referred by Disability Determination Services, you need to contact them at P.O. Box 4020, Kalamazoo, MI 49003, phone (800)829-7763. If you believe that your privacy rights have been violated, you have a right to file a complaint with the federal government. You can write to: Office of Civil Rights, Dept. of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C., 20201, (866) 627-7748 or TTY (886) 788-4989. You will not be penalized for filing a complaint with the federal government.
Copies Of This Notice. You have the right to receive an additional 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. Please call or write us to request a copy.