Notice of Privacy Practices
To our patients. This notice describes how health information about you, as a patient of this clinic, may be used and disclosed, and how you can get
access to your health information. Please review it carefully.
Our commitment to your privacy
Our center is dedicated to maintaining the privacy of your health information. Life Choices Medical Clinic (LCMC) is required by law to maintain the
confidentiality of your health information. LCMC realizes that these laws are complicated, but we must provide you with the following important
information:
The following circumstances may require us to use or disclose your health information:
Treatment: To provide, coordinate or manage your health care and related services. LCMC may consult with other health care providers regarding your
treatment and coordinate and manage your health care with others. LCMC may use or disclose protected health information about your treatment activities
to another health care provider.
Health Care Operations: LCMC may use or disclose protected health information to allow us to improve the quality of care LCMC, which may include
training programs for our staff.
• Cooperating with outside legal entities
• To public health authorities and health oversight agencies that are authorized by law to collect information.
• Lawsuits and similar proceedings in response to a court or administrative order.
• If required to do so by a law enforcement official.
• When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. LCMC
will only make disclosures to a person or organization able to help prevent the threat.
• If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
• To federal officials for intelligence and national security activities authorized by law.
• To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
• For Workers Compensation and similar programs.
Additional uses: Additional uses which fall outside of those outlined by the U.S. Department of Health and Human Services for allowable use of protected
health information require that Life Choices of Central Michigan/Life Choices Medical Clinic must obtain a separate written consent from you.
Your rights regarding your health information:
You can request that LCMC communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you
may ask that LCMC contact you at home, rather than work. LCMC will accommodate reasonable requests.
You can request a restriction in our use or disclosure of your health information for treatment or health care operations. Additionally, you have the right to
request that LCMC restrict our disclosure of your health information to only certain individuals involved in your care, such as family members and friends.
LCMC is not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in
emergencies, or when the information is necessary to treat you.
You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you. Health information includes patient
medical records but not peer counseling notes. You must submit your request in writing.
You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for our practice. To
request an amendment, your request must be made in writing and submitted to our Privacy Official. You must provide us with a reason that supports your request for the amendment.
access to your health information. Please review it carefully.
Our commitment to your privacy
Our center is dedicated to maintaining the privacy of your health information. Life Choices Medical Clinic (LCMC) is required by law to maintain the
confidentiality of your health information. LCMC realizes that these laws are complicated, but we must provide you with the following important
information:
The following circumstances may require us to use or disclose your health information:
Treatment: To provide, coordinate or manage your health care and related services. LCMC may consult with other health care providers regarding your
treatment and coordinate and manage your health care with others. LCMC may use or disclose protected health information about your treatment activities
to another health care provider.
Health Care Operations: LCMC may use or disclose protected health information to allow us to improve the quality of care LCMC, which may include
training programs for our staff.
• Cooperating with outside legal entities
• To public health authorities and health oversight agencies that are authorized by law to collect information.
• Lawsuits and similar proceedings in response to a court or administrative order.
• If required to do so by a law enforcement official.
• When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. LCMC
will only make disclosures to a person or organization able to help prevent the threat.
• If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
• To federal officials for intelligence and national security activities authorized by law.
• To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
• For Workers Compensation and similar programs.
Additional uses: Additional uses which fall outside of those outlined by the U.S. Department of Health and Human Services for allowable use of protected
health information require that Life Choices of Central Michigan/Life Choices Medical Clinic must obtain a separate written consent from you.
Your rights regarding your health information:
You can request that LCMC communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you
may ask that LCMC contact you at home, rather than work. LCMC will accommodate reasonable requests.
You can request a restriction in our use or disclosure of your health information for treatment or health care operations. Additionally, you have the right to
request that LCMC restrict our disclosure of your health information to only certain individuals involved in your care, such as family members and friends.
LCMC is not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in
emergencies, or when the information is necessary to treat you.
You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you. Health information includes patient
medical records but not peer counseling notes. You must submit your request in writing.
You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for our practice. To
request an amendment, your request must be made in writing and submitted to our Privacy Official. You must provide us with a reason that supports your request for the amendment.
You are entitled to receive a copy of this Notice of Privacy Practices. To obtain a copy of this notice, contact our Privacy Official.
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and
Human Services. To file a complaint with our practice, contact our Privacy Official. All complaints must be submitted in writing. You will not be penalized
for filing a complaint.
Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.
In accordance with the standards of implementation specifications of 45 C.F.R. § 164.524, Provider may grant an individual access to inspect and
obtain a copy of protected health information about the individual in a designated record set.
The designated record set that is subject to access by an individual is as follows: a) Medical Records
The titles of the persons or offices responsible for receiving and processing requests for access by individuals are as follows: Privacy Official.
You can reach the Privacy Official at: Life Choices of Central Michigan, 1985 Parkland Drive, 989–773–6008. A message may be left for
our Privacy Official any time and your call will be returned within 7 business days.
For more information, visit: www.hhs.gov/hipaa
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and
Human Services. To file a complaint with our practice, contact our Privacy Official. All complaints must be submitted in writing. You will not be penalized
for filing a complaint.
Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.
In accordance with the standards of implementation specifications of 45 C.F.R. § 164.524, Provider may grant an individual access to inspect and
obtain a copy of protected health information about the individual in a designated record set.
The designated record set that is subject to access by an individual is as follows: a) Medical Records
The titles of the persons or offices responsible for receiving and processing requests for access by individuals are as follows: Privacy Official.
You can reach the Privacy Official at: Life Choices of Central Michigan, 1985 Parkland Drive, 989–773–6008. A message may be left for
our Privacy Official any time and your call will be returned within 7 business days.
For more information, visit: www.hhs.gov/hipaa
