LUTHERAN HOMES OF MICHIGAN, INC.

NOTICE OF PRIVACY INFORMATION PRACTICES

Effective date:  April 14, 2003

Date(s) of revision:  April 1, 2005; Sept 10, 2009

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

General description and purpose of notice:

This notice describes our information privacy practices and that of any health care professional authorized to enter information into your medical record created and/or maintained at our facility/agency and all facility/agency employees, staff, volunteers and other personnel.  All of the entities identified below will follow the terms of this notice.  These entities may share your health information with each other for purposes of treatment, payment, or health care operations as described further in this notice:

• Lutheran Homes of Michigan, Inc.
• Lutheran Home – Frankenmuth
• Lutheran Home – Livonia
• Lutheran Home – Monroe
• Lutheran Home Care Agency
• Hospice of Hope
• Meadow View Manor
• Shattuck Manor
• McBrite Manor

Uses or disclosures that do not require your written authorization:

Treatment: we may use your health information to plan, coordinate, and provide your care.  For example, we may disclose your health information for treatment purposes to physicians and other health care professionals outside our agency who are involved in your care.

Payment – we may use your health information to prepare documentation required by your insurance (Medicare, Medicaid, etc) in order to receive payment.

Health Care Operations – We may use or disclose your health information in order to improve the quality of our services, conduct assessment and improvement plans, review treatment or general administration.

Where we are required or permitted to do so, we may use or disclose your health information in the following circumstances:

• Federal government investigation, when required by the Secretary of Health and Human Services to investigate or determine our compliance with federal regulation.
• Federal, state or local law requirements
• Public health activities (i.e. to report communicable diseases or death; or matters involving the FDA)
• Reporting of abuse, neglect or domestic violence.
• Health oversight activities by a health oversight agency.  (i.e. a government authorized organization)
• Judicial or administrative proceedings (i.e. responding to a court order or subpoena).
• Law enforcement purposes, (i.e. to report certain types of wounds or to identify a suspect)
• Use by coroners, medical examiners, or funeral directors.
• Facilitating organ, eye, or tissue donation.
• Research, provided that very strict controls are enforced.
• Averting a serious threat to your health or safety or that of the public.
• Specialized government functions such as military or veterans’ affairs; national security, and intelligence activities.
• Worker’s compensation.

Uses or discloses which require your written authorization:

Your written authorization, which you may revoke, is required if we use or disclose your health information for any other purpose, in particular:

• Our use of psychotherapy notes beyond treatment, payment and health care operations.

• Marketing of goods or services to you.

Your Rights Regarding Health Information About You:

Right to Request Restrictions - You have the right to request restrictions on our uses and disclosures of your health information, however we may refuse to accept the restriction.

Right to Request Confidential Communications You have the right to request that we communicate with you confidentially. Your request must be in writing.

Right to Request Access to Your Health Information.

You have the right to request access to your health information in order to inspect or copy it. Your request must be in writing.

Right to Request and Amendment of your Health Information.

You have the right to request an amendment to your health information. Your request must be in writing and provide a reason for the amendment.

Right to Request an Accounting of Disclosures of Your Health Information.

You have the right to request an accounting of our disclosures of your health information for purposes other than treatment, payment and health care operations. 

We are not required to provide an accounting for disclosures before April 14, 2003 or for more than 6 years prior to the date of your request.

Right to Obtain a Paper Copy of This Notice. If you received this notice electronically, you have the right to receive a paper copy.

Uses or Disclosures of Your Health Information to Which You May Object:

We may use or disclose your health information for the following purposes unless instructed not to:

• Informing family and friends. We may disclose your health information to family, friends or others identified who are involved in your care.
• Fund Raising Activities – We may contact you or your family for fund raising purposes. If you do not wish to be contacted for this purpose, please contact us and indicate that you do not wish to receive fundraising communication from us.
• Informing you about treatment alternatives or other health-related benefits and services that may be of interest to you.
• Assistance in disaster relief efforts.

Our Duties in Protecting your Health Information:

We are required by law to maintain the privacy of your health information.

We must inform patients or their legal representatives of our legal duties and privacy practices with respect to health information. This Notice discharges that duty.

We must abide by the terms of the Notice currently in effect.

We reserve the right to change the terms of this Notice and to make the new provisions effective for all health information that we maintain. At any time, you may obtain a copy of the current privacy notice from us or view it on our website at www.AgingEnriched.org.

Questions or Complaints:

You may complain to us and to the Secretary of Health and Human Services if you believe your privacy rights have been violated.

You will not be retaliated against for filing a complaint.

You may direct questions or file a complaint with our facility/agency by writing to our Privacy Officer at the contact information listed below:

Lutheran Homes of Michigan, Inc.

Attn:  Privacy Officer

P.O. Box 329

Frankenmuth, MI 48734

(989)652-3470

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www.AgingEnriched.org