Overview:

The law requires us to keep your protected health information ("PHI") private in accordance with this Notice of Privacy Practices ("Notice"), as long as this Notice remains in effect. We are also required to provide you with a paper copy of this Notice, which contains our privacy practices, our legal duties and your rights concerning your PHI.

We may revise our privacy practices and the terms of our Notice at any time, as permitted or required by applicable law. Any revisions to our Notice may be retroactive. Our Notice will be updated and made available to our patients prior to any significant revisions of our privacy practices and policies. This Notice is effective April 14, 2003.

Uses and Disclosure:

Treatment
We may use or disclose your PHI to any physicians or other health care providers involved with the medical services provided to you, such as release of your name and insurance information to a specialist providing medical tests.

Payment
Your PHI may be used or disclosed to collect payment for the medical services provided to you, such as release of the date and type of treatment we provided to you for a claim for payment made to your health insurance company.

Health Care Operations
We may use or disclose your PHI as part of our internal health care operations, such as quality of care audits of our staff and affiliates, training programs, accreditation, certification, licensing or credentialing activities.

Continuing Care
We may provide you with appointment reminders or information concerning health issues, benefits and services, or treatment alternatives based upon your PHI that we believe may be of interest to you.

Family and Friends
With your permission, or in some emergencies, we may disclose your PHI to your family members, friends or other people to aid in your treatment or the collection of payment. A disclosure of your PHI may also be made if we determine it is reasonably necessary or in your best interests for such purposes as allowing a person acting on your behalf to receive filled prescriptions, medical supplies, test results, etc.

Locating Responsible Parties
We may disclose your PHI to locate, identify or notify a family member, your personal representative, or other person responsible for your care. You may determine the extent or recipients of such disclosure, if we determine you are capable. Otherwise, we will disclose the minimum necessary PHI to locate a responsible party.

Disasters
We may use or disclose your PHI to any public or private entity authorized by law or by the charter to assist in disaster relief efforts.

Required by Law
We may use or disclose your PHI when required by law. For example, your PHI may be released when required by privacy laws, workers'; compensation or similar laws, public health laws, court or administrative orders, certain subpoenas, certain discovery requests, or other laws, regulations or legal processes. Under certain circumstances, we may make limited disclosures of PHI directly to law enforcement officials or correctional institutions if you are an inmate, lawful detainee, suspect, fugitive, material witness, missing person or a victim or suspected victim of abuse, neglect, domestic violence or other crimes. We may disclose your PHI to the extent reasonably necessary to avert a serious threat to your health or safety or the health or safety of others. We may disclose your PHI when necessary to assist law enforcement officials capture someone who has admitted to a crime against you or who has escaped from lawful custody.

Health Oversight
We may disclose your PHI to health oversight agencies for audits, investigations or other oversight activities but only to the extent permitted or required by law.

Deceased Persons
After your death, we may disclose your PHI to a coroner, medical examiner, funeral director or organ procurement organization to the extent required or permitted by law.

Research
Your PHI may be used or disclosed for research purposes only in those limited circumstances not requiring your written authorization, such as those which have been approved by an institutional review board that has established procedures for ensuring the privacy of your PHI

Military and National Security
We may disclose to military authorities the PHI of Armed Forces personnel under certain circumstances. When required by law, we may disclose your PHI for intelligence, counterintelligence and other national security activities.

Authorizations
We will use or disclose your PHI only as described in this Notice or as otherwise authorized in writing by you. We may request your authorization to use or disclose your PHI for any purpose but cannot require your authorization as a condition of your treatment. You may revoke any authorization in writing at any time but such revocation will not affect any prior authorized uses or disclosures.

YOUR INDIVIDUAL RIGHTS:

Access and Copies
In most cases you have the right to review or purchase copies of your PHI. Please contact our Privacy Officer in writing to request access to or copies of your PHI, or with inquiries regarding our copying fees.

Disclosure Accounting
You have the right to receive an accounting of the instances, if any, in which your PHI was disclosed for purposes other than Treatment, Payment, Health Care Operations, pursuant to a signed authorization from you, or certain other disclosures we are permitted to make without your authorization. For each twelve (12) month period, you may receive one free copy of an accounting for any period after April 13, 2003, and up to six (6) years in length. Subsequent requests will be subject to a reasonable, cost-based fee.

Additional Restrictions
You have the right to request that we place additional restrictions on our use or disclosure of your PHI, but we are not required to honor such a request. We will be bound by such restrictions only if we agree to do so in writing signed by our Privacy Officer.

Alternate Communications
You have the right to request that we communicate with you about your PHI by alternative means or in alternative locations. We will accommodate any reasonable request if it specifies in writing the alternative means or location, and provides a satisfactory explanation of how future payments will be handled.

Amendments to PHI
You have the right to request that we amend your PHI. Any such request must be in writing and contain a detailed explanation for the requested amendment. Under certain circumstances, we may deny your request but will provide you a written explanation of the denial. You have the right to send us a statement of disagreement to which we may prepare a rebuttal, a copy of which will be provided to you at no cost. Please contact our Privacy Officer with any further questions about amending your medical record.

COMPLAINTS:

If you believe we have violated your privacy rights you may file a complaint with us by notifying our privacy officer in writing or with the Secretary of the U.S. Department of Health and Human Services as permitted by law. We will not retaliate in any way if you choose to file a complaint.

Contact Us:

Privacy Officer
SURGICAL SPECIALISTS OF MICHIGAN, P.C.
21000 Twelve Mile Road, Suite 112
St. Clair Shores, MI 48081
Telephone: (586) 771-8900
Facsimile: (586) 771-8901