Notice of
PRIVACY PRACTICES
Notice of
HEALTH INFORMATION PRACTICES
Forest Hills Pediatric Associates
This notice describes how information about
you may be used and disclosed, and how
you can get access to this information.
PLEASE REVIEW IT CAREFULLY
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| How We Safeguard
Your Privacy
We know that keeping your personal information private is important to
you. That's why Forest Hills Pediatric Associates wants you to know how
we protect the information that you share with us.
We have built our practice on a foundation of integrity, honesty, and
trust. These values are reflected in our commitment to protect your privacy.
Understanding
Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare provider,
a record of your visit is made. Typically, this record contains your symptoms,
examination, test results, diagnoses, treatment, and plan for future care
or treatment. We use this information, often referred to as your health
or medical record, as a basis for planning your care and treatment, a
means to obtain payment for treatment, for administrative purposes, and
to evaluate the quality of care that you receive.
In any other situation, we will ask for your written authorization before
using or disclosing any identifiable health information about you. If
you choose to sign an authorization to disclose information, you can later
revoke that authorization to stop any future uses and disclosures. Understanding
what is in your record and how your health information is used helps you
to ensure its accuracy, better understand who, what, when, where, and
why others may access your health information and make more informed decisions
when authorizing disclosure to others.
We at Forest Hills Pediatrics, use an automated telephone system for all appointment reminder calls.
The automated system uses the name of the patient, phone number, provider, date and time of your appointment.
The automated call will leave this information on your voice mail system, answering machine or with who
ever answers your telephone. If you have concerns regarding this service or would prefer that we don't call
using our automated system, please let us know.
We will, at times, leave messages on your
answering machine for you to call us back regarding testing results or
appointment changes. (We do not leave the actual test information on your
voice mail.) Several insurance companies that we participate with require
us to transmit claims and referrals through the internet. Also, all of
our patients' immunization records are recorded with the state through
their immunization registry (MCIR).
We may change our policies at any time. Before we make a significant change
in our policies, we will change our notice and post the new notice in
the waiting area and in each examination room. You can also request a
copy of our notice at any time.
Individual
Rights
In most cases, you have the right to look at or get a copy of your information
that we use to make decisions about you. You also have the right to receive
a list of instances where we have disclosed health information about you
for reasons other than treatment, payment, or related administrative purposes.
If you believe that the information in your record is incorrect or if
important information is missing, you have the right to request that we
correct the existing information or add the missing information.
You may request in writing that we not use or disclose your information
for treatment, payment and administrative purposes except when specifically
authorized by you, when required by law, or in an emergent circumstance.
We will consider your request but are not legally required to accept it.
Complaints
If you are concerned that we have violated your privacy rights or you
disagree with a decision we made about access to your records, you may
contact our office manager. You also may send a written complaint to the
U.S. Department of Health and Human Services. The manager can provide
you with the appropriate address upon request.
Our Legal Duty
We are required by law to protect the privacy of your information, provide
this notice about our information practices, and follow the information
practices that are described and in our policy.
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Forest Hills Pediatrics
Richard E. Wood, M.D.
Susan H. Wakefield, M.D.
Michael S. Meindertsma, M.D.
Joan M. Downs, M.D.
Claire D. Olgren, M.D.
William L. Bush, M.D.
Barbara L. Periard, M.D.
Kathleen A. Howard, M.D.
Marcy S. Larson, M.D.
Steph M. Krauchunas, P.A.C.
877 Forest Hill S.E.
Grand Rapids, Michigan 49546
Phone: 616-949-4465
Fax: 616-949-6191 |
