Disclaimer and Privacy Policy
We are required by federal and state laws and regulations to maintain the privacy of your protected health information. We are also required to give you a Notice about our Privacy Practices, our responsibilities and your rights concerning your protected health information. We must follow the Privacy Practices that are described in this Notice while it is in effect. We reserve the right to change our Privacy Practices and the terms of this Notice, provided such changes are permitted by laws and regulations. We reserve the right to make changes in our Privacy Practices and the new terms of our Notice effective for all protected health information. If we make a significant change in our Privacy Practices, we will amend this notice and make the new Notice available upon request. You may request a copy of our Privacy Notice at any time. If you have further questions, please contact our Privacy Officer, Jan Leland, via phone at 734-996-9111 or via mail at 5331 Plymouth Rd, Ann Arbor MI, 48105.
Internet Disclaimer
Copyright
All content of this Web site is the sole property of Ann Arbor Consultation Services (AACS) and is protected by copyright laws. Any reproduction or redistribution of this material is prohibited without the expressed written consent of AACS. Any reproduction of artwork or photographs is strictly prohibited.
Terms of Use
By accessing this site, you agree to be bound by all terms and conditions below, which are intended to be fully effective and binding upon all users. AACS offers this Web site for informational and communication purposes only. The information is not intended to serve as advice or a consultation on health or mental health and should not be used for diagnosis. If you need urgent care, please call your local hospital emergency room.
The information should not be considered complete and should not be used in place of a visit, call, or consultation with your physician or your mental health care provider. The information obtained from this site is not exhaustive and does not cover all disorders, conditions, or their treatments.
Privacy Policy
We respect your personal privacy. We will not release your name, address, or contact information without your consent. In affirmation of this Policy, we want to inform you that all photographs used on our Web site are our employees, and not patients.
Secure Information
While the forms you use are on a secure site, please be aware that e-mail is not secure. WE URGE YOU NOT TO PROVIDE CONFIDENTIAL INFORMATION ABOUT YOUR HEALTH TO US VIA E-MAIL. If you do so, it is at your own risk.
Usage Rules
You warrant that you will not use this service for any purpose that is unlawful or prohibited by copyright or this Agreement. We reserve the right to deny access to any part of this site at our sole discretion. We hold you personally accountable for the material that you send.
Links to Other Web Sites
When links to other Web sites are provided, these are provided as a convenience to visitors. We do not control other Web sites and are not responsible for the content and performance of these sites or for the transactions made with them. In no way does AACS endorse such Web sites or the sponsoring organizations.
Privacy Practices/Privacy Policy
Effective July 1, 2003
THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
We may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
·"PHI" refers to information in your health record that could identify you.
·"Treatment, Payment, and Health Care Operations"
- Treatment is when we provide, coordinate, or manage your health care and other services related to your health care. An example of treatment would be when we consult with another health care provider, such as your family physician or another psychologist.
- Payment is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
- Health Care Operations are activities that relate to the performance and operation of our practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and/or care coordination.
·"Use" applies only to activities within our clinic group, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
·"Disclosure" applies to activities outside of our clinic, such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
AACS may use or disclose PHI for purposes outside of treatment, payment, or health care operations when appropriate authorization is obtained. An "authorization" is written permission above and beyond the general consent that permits only specific disclosures. In those instances when we are asked for information for purposes outside of treatment, payment or health care operations, we will obtain an authorization from you before releasing this information.
You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage; or (3) if the law provides the insurer the right to contest the claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization
In general, it is our preference to seek your permission prior to releasing information about you. However, we may use or disclose PHI without your consent or authorization in the following circumstances:
·Child and Elder Abuse - If we have reasonable cause to suspect child abuse, elder care or neglect, we must report this suspicion to the appropriate authorities as required by law.
·Health Oversight Activities - If we receive a subpoena or other lawful request from the Department of Health or other state or federal agencies, we must disclose the relevant PHI pursuant to that subpoena or lawful request.
·Judicial and Administrative Proceedings - If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment or the records thereof, such information is privileged under state law, and we will not release information without your written authorization or a court order. The privilege does not apply when a third party is evaluating you or where the evaluation is court ordered. You will be informed in advance if this is the case.
·Serious Threat to Health or Safety - If you communicate to use a threat of physical violence against a reasonably identifiable third person and you have the apparent intent and ability to carry out that threat in the foreseeable future, we may disclose relevant PHI and take the reasonable steps permitted by law to prevent the threatened harm from occurring. If we believe that there is an imminent risk that you will inflict serious physical harm on yourself, we may disclose information in order to protect you. If there is a medical emergency, we will disclose any information to emergency medical personnel deemed necessary to provide medical care for you.
·When Legally Required -- AACS will disclose your protected health information when we are required to do so by any Federal, State or local law.
IV. Patient's Rights and Therapist's Duties
Patient's Rights:
·Right to Request Restrictions - You have the right to request restrictions on certain uses and disclosures of protected health information. However, AACS is not required to agree to the restriction you request.
·Right to Receive Confidential Communications by Alternative Means and at Alternative Locations - You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing us. On your request, AACS will send your bills to another address.)
·Right to Inspect and Copy - You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. AACS may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, AACS will discuss with you the details of the request and denial process.
·Right to Amend - You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. AACS may deny your request. On your request, AACS will discuss with you the details of the amendment process.
·Right to an Accounting - You have the right to receive an accounting of disclosures of PHI. On your request, AACS will discuss with you the details of the accounting process. Accounting requests may not be made for periods in excess of six years.
·Right to a Paper Copy - You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to receive the notice electronically.
Clinic's Duties:
·AACS is required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
·AACS reserves the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, AACS is required to abide by the terms currently in effect.
·If AACS revises these policies and procedures, we will inform you with a revised notice at your next appointment.
V. Complaints
If you are concerned that AACS has violated your privacy rights, or you disagree with a decision AACS has made about access to your records, you may contact our Privacy Officer, Jan Leland, at our office at (734) 996-9111. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. We can provide you with the appropriate address upon request.
VI. Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect on July 1, 2003
Ann Arbor Consultation Services
5331 Plymouth Rd.
Ann Arbor, MI 48105
734-996-9111
734-996-1950 (fax)
CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT INFORMATION
The confidentiality of alcohol and drug abuse patient records maintained by this program is protected by federal law and regulations. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug abuser, unless:
(1) The patient consents in writing; OR
(2) The disclosure is allowed by a court order; OR
(3) The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation; OR
(4) The person commits or threatens to commit a crime either at the program or against any person who works for the program.
Violation of the federal law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.
Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.
(See 42 U.S.C. d 290dd-2 for federal law and 42 C.F.R. Part 2 for federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records.)
You have the right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.