Notice of Privacy Practices

Effective Date: April 14, 2003

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

At Mercy - Port Huron, we are required by law to maintain the privacy of individually identifiable patient health information (this information is "protected health information" and is referred to as "PHI"). We are also required to provide patients with a Notice of Privacy Practices regarding PHI. We are required to post this Notice in a prominent place within our facilities. We will only use or disclose your PHI as permitted or required by applicable state law. This Notice applies to your PHI in our possession including the medical records and billing records generated by us.

Mercy - Port Huron understands that your health information is highly personal, and we are committed to safeguarding your privacy. Please read this Notice of Privacy Practices thoroughly. It describes how Mercy - Port Huron will use and disclose your PHI.

This Notice applies to the delivery of health care by Mercy - Port Huron and its medical staff in the main hospital, outpatient departments and other facilities. This Notice also applies to the utilization review and quality assessment activities of Trinity Health and Mercy - Port Huron as a member of Trinity Health, a Catholic health care system with facilities in several states.

I. Permitted Use or Disclosure

A. Treatment: Mercy - Port Huron will use and disclose your PHI in the provision and coordination of heath care to carry out treatment functions.

Mercy - Port Huron will disclose all or any portion of your patient medical record information to your attending physician, consulting physician(s), nurses, technicians, medical students and other health care providers who have a legitimate need for such information in your care and continued treatment.
Mercy - Port Huron is a Catholic sponsored health care provider. Spiritual care providers who are members of our staff will be a part of Mercy - Port Huron's team of care providers who use your medical information to provide health care services to you when you are in Mercy - Port Huron's facilities. Trained volunteers who work under the supervision of the Spiritual Care Team may also visit you in the hospital.
Different departments will share medical information about you in order to coordinate specific services, such as lab work, x-rays and prescriptions.
Mercy - Port Huron also will disclose your medical information to people or entities outside Mercy - Port Huron who are involved in your medical care, such as family members and clergy.
Mercy - Port Huron will share certain information such as your name, address, employment, insurance carrier, emergency contact information and appointment scheduling information in an effort to coordinate your treatment with us and with other health care providers.
Mercy - Port Huron will use and disclose your PHI to inform you of, or recommend possible treatment options or alternatives that may be of interest to you.
Mercy - Port Huron will use and disclose PHI to contact you as a reminder that you have an appointment for treatment or medical care at Mercy - Port Huron.
If you are an inmate of a correctional institution or in the custody of a law enforcement officer, Mercy - Port Huron will disclose your PHI to the correctional institution or law enforcement official.

B. Payment: Mercy - Port Huron will disclose PHI about you for the purposes of determining coverage, eligibility, funding, billing, claims management, medical data processing, stop loss / reinsurance and reimbursement.

The medical information will be disclosed to an insurance company, third party payer, third party administrator, health plan or other health care provider (or their duly authorized representatives) involved in the payment of your medical bill and will include copies or excerpts of your medical records which are necessary for payment of your account. It will also include sharing the necessary information to obtain pre-approval for payment for treatment from your health plan.
Mercy - Port Huron will disclose PHI to collection agencies and other subcontractors engaged in obtaining payment for care.

C. Health Care Operations: Mercy - Port Huron will use and disclose your PHI during routine health care operations including quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing or credentialing activities, and for educational purposes.

For instance, Mercy - Port Huron will need to share your demographic information, diagnoses, treatment plan and health status for population based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, and contacting health care providers and patients with information about treatment alternatives, in order for us to operate our business in an efficient, safe and legal manner.

D. Other Uses and Disclosures: As part of treatment, payment and health care operations, we may also use your PHI for the following purposes:

Fundraising Activities: Mercy - Port Huron will use and may also disclose some of your PHI to a related foundation for certain fund raising activities. For example, we will use your demographic information (e.g., name, address and other contact information, age, gender, and insurance status) and the dates we provided service to you. Any communication sent to you will let you know how you may opt out of receiving similar communications in the future. We may disclose limited PHI to a company contracted to conduct fundraising for us. This company will use your PHI only for the purposes of fundraising for Mercy - Port Huron.
Medical Research: Mercy - Port Huron may disclose your PHI without your Authorization to medical researchers who request it for approved medical research projects; however, with very limited exceptions such disclosures must be cleared through a special approval process before any PHI is disclosed to the researchers. Researchers will be required to safeguard the PHI they receive.
Information and Health Promotion Activities: We will use and disclose some of your PHI for certain health promotion activities. For example, your name and address may be used to send you newsletters or general communications. We may also send you information based on your own health concerns. We may send you this information if we have determined that a product or service may help you. The communication will explain how the product or service relates to your well being and can improve your health.

E. More Stringent State and Federal Laws: The State laws of Michigan are more stringent than the Health Insurance Portability Accountability Act (HIPAA) in several areas. State law is more stringent when the individual is entitled to greater access or records more protected from disclosure than under HIPAA. Certain federal laws also are more stringent than HIPAA. Mercy - Port Huron will continue to abide by these more stringent state and federal laws. The federal laws include applicable internet privacy laws, such as the Children's Online Privacy Protection Act and the federal laws and regulations governing the confidentiality of health information regarding substance abuse treatment.

For example, patients have greater rights of access to behavioral health information under Michigan law than under HIPAA. Minors in Michigan have greater rights to confidentiality and protection of certain information (reproductive health, behavioral health and substance abuse) than under HIPAA. Michigan law also requires a letter of authority or a notice signed by a judge for a personal representative to access PHI of a deceased individual.

II. Permitted Use or Disclosure with an Opportunity for You to Agree or Object

A. Family/Friends: We will disclose PHI about you to a friend or family member who is involved in your medical care. We will also give information to someone who helps you pay for your care. In addition, we will disclose PHI about you to an agency assisting in a disaster relief effort so that your family can be notified about your condition, status and location. You have a right to request that your PHI not be shared with some or all of your family or friends.

B. Hospital Directory: We will include certain limited information about you in our Directory while you are a hospital patient at Mercy - Port Huron. This information will include your name, location in the hospital, your general condition (e.g., fair, stable, critical, etc.) and your religious affiliation. This is so your family and friends can visit you in the hospital and know how you are doing. The directory information, except for your religious affiliation, will also be disclosed to people who ask for you by name. In the case of deceased patients, we will share this information with others once the family has been notified.

You have the right to request that your name not be included in the Hospital Directory. If you request to opt out of the Hospital Directory, we cannot inform any visitors of your presence, location, or general condition.

C. Spiritual Care: Directory information may be given to a clergy member in your religious affiliation, such as a priest or rabbi, even if they don't ask for you by name. You have a right to request that your name not be given to any member of the outside clergy.

D. Promotional Communications: Mercy - Port Huron does not share or sell your PHI to companies that market health care products or services directly to consumers for use by those companies to contact you, such as drug companies. We do maintain a database of individuals for promotional communications, disease management, health promotion, and fundraising purposes. You may be included in this database. Mercy - Port Huron sends information to the individuals in this database about the programs and services we offer. If you wish to be deleted from this database, please contact the Fund Development Department at 810/985-1675.

E. Media Conditions Reports: Mercy - Port Huron may release information for an update to the media if the media requests information about you using your full name and after we have given you an opportunity to agree or object. The following information may then be disclosed: your condition described in general terms that do not communicate specific medical information, such as "good", "fair", "serious", or "critical."

III. Use or Disclosure Requiring Your Authorization

A. Marketing: Unless you have signed an authorization, we are not permitted to provide your PHI to any other person or company for marketing of any products or services other than Mercy - Port Huron's products or services.

B. Research: Mercy - Port Huron will use or disclose your PHI as part of research that includes providing you with treatment. For example, if you agree to participate in a research study that includes treatment, we may require that you sign an authorization to allow the researchers to use or disclose your PHI for this research.

C. Other Uses: Any uses or disclosures that are not for treatment, payment or operations and that are not permitted or required for public policy purposes or by law will be made only with your written authorization. You have the right to revoke an authorization at any time.

IV. Use or Disclosure Permitted by Public Policy or Law without your Authorization

A. Law Enforcement Purposes: We will disclose your PHI for law enforcement purposes as required by law, such as responding to a court order or subpoena, identifying a criminal suspect or a missing person, or providing information about a crime victim or criminal conduct.

B. Required by Law: We will disclose PHI about you when required by federal, state, or local law to make reports or other disclosures. We also will make disclosures for judicial and administrative proceedings such as lawsuits or other disputes in response to a court order or subpoena. We will disclose your medical information to government agencies concerning victims of abuse, neglect or domestic violence. We will report drug diversion and information related to fraudulent prescription activity to law enforcement and regulatory agencies. Specialized government functions will warrant the use and disclosure of PHI. These government functions will include military and veteran's activities, national security and intelligence activities, and protective services for the President and others. We will make certain disclosures that are required in order to comply with workers' compensation or similar programs.

C. Coroners, Medical Examiners, Funeral Directors: We will disclose your PHI to a coroner or medical examiner. For example, this will be necessary to identify a deceased person or to determine a cause of death. We will also disclose your medical information to funeral directors as necessary to carry out their duties.

D. Organ Procurement: We will disclose PHI to an organ procurement agency for organ, eye or tissue donation purposes.

E. Health or Safety: We will use and disclose PHI to avert a serious threat to health and safety of a person or the public. We will use and disclose PHI to Public Health Agencies for immunizations, communicable diseases, etc. We will use and disclose PHI for activities related to the quality, safety or effectiveness of products or activities regulated by the Food and Drug Administration (FDA), including collecting and reporting adverse events, tracking and facilitating product recalls, and monitoring product safety. Any patient receiving a medical device subject to FDA tracking requirements may refuse to disclose, or refuse permission to disclose, his/her name, address, telephone number and social security number, or other identifying information for the purpose of tracking.

V. Your Health Information Rights

Your records are the physical property of Mercy – Port Huron, but you have the following rights concerning your PHI:

A. Right to Inspect and Copy: You have the right to access your PHI and to inspect and copy your PHI as long as we maintain it except for: psychotherapy notes, information that will be used in a civil, criminal or administrative action or proceeding, and where prohibited or protected by law. We will deny your request for access to your PHI without giving you an opportunity to review that decision if:

You don't have the right to inspect the information; or it is otherwise prohibited or protected by law;
You are an inmate at a correctional institution and obtaining a copy of the information would risk the health, safety, security, custody or rehabilitation of you or other inmates;
The disclose of the information would threaten the safety of any officer, employee or other person at the correctional institution or who is responsible for transporting you;
You are involved in a clinical research project and Mercy - Port Huron created or obtained the PHI during that research. Your access to the information will be temporarily suspended for as long as the research is in progress;
We obtained the information that you seek access to from someone other than a health care provider under a promise of confidentiality and your access request is likely to reveal the source of the information; or
Under other limited circumstances. In these instances, however, we will allow the review of our decision by a health care professional that Mercy - Port Huron has chosen. This person will not have been involved in the original decision to deny your request.
You agree to pay a reasonable copying charge. You must make your requests to access and copy your PHI in writing. We will respond to your request within 30 days of its receipt. If we cannot, we will notify you in writing to explain the delay and the date by which we will act on your request. In any event, we will act on your request within 60 days of its receipt.

Right to Amend: You have the right to request an amendment to your PHI for as long as we maintain it. However, we will deny your request for amendment if:

We did not create the information;
The information is not part of the designated record set;
The information would not be available for your inspection (due to its condition or nature); or
The information is accurate and complete.

If we deny your request for changes in your PHI, we will notify you in writing with the reason for the denial. We will also inform you of your right to submit a written statement disagreeing with the denial. You may ask us to include your request for amendment and the denial any time we disclose the information that you wanted changed. We may prepare a rebuttal to your statement of disagreement and will provide you with a copy of that rebuttal.

You must make your request for amendment of your PHI in writing to Mercy - Port Huron, including your reason to support the requested amendment. We will respond to your request within 60 days of its receipt. If we cannot, we will notify you in writing to explain the delay and the date by which we will act on your request. In any event, we will act on your request within 90 days of its receipt.

B. Right to an Accounting: You have a right to receive an accounting of the disclosures of your PHI that we made, except for the following disclosures:

To carry out treatment, payment or health care operations;
To you or authorized by you in writing;
To persons involved in your care;
For national security or intelligence purposes;
To correctional institutions or law enforcement officials; or
That occurred prior to April 14, 2003.

For each disclosure, you will receive: the date of the disclosure, the name of the receiving organization and address if known, a brief description of the PHI disclosed and a brief statement of the purpose of the disclosure or a copy of the written request for the information, if there was one.

You must make your request for an accounting of disclosures of your PHI in writing to Mercy - Port Huron. You must include the time period of the accounting, which may not be longer than 6 years. We will respond to your request within 60 days from its receipt. If we cannot, we will notify you in writing to explain the delay and the date by which we will act on your request. In any event, we will act on your request within 90 days of its receipt.

In any given 12-month period, we will provide you with an accounting of the disclosures of your PHI at no charge. Any additional requests for an accounting within that time period will be subject to a reasonable fee for preparing the accounting.

C. Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI to carry out treatment, payment or health care operations or to prohibit such disclosure. We will consider your request but are not required to agree to the requested restrictions.

You also have the right to limit the release of PHI to family, friends, or in the hospital directory. For example, you may ask that your name not be used in the waiting room or that information about your expected discharge date not be shared with your family.

D. Right to Confidential Communications: You have the right to receive confidential communications of your PHI by alternative means or at alternative locations. For example, you may request that we only contact you at work or by mail.

E. Right to Receive a Copy of this Notice: You have the right to receive a paper copy of this Notice of Privacy Practices, upon request.

VI. Complaints

If you believe your privacy rights have been violated, you may file a complaint with Mercy - Port Huron or with the Secretary of the Department of Health and Human Services. To file a complaint with Mercy - Port Huron, please contact the Privacy Officer at 810/985-1601. All complaints must be submitted in writing directly to the Privacy Officer. Mercy - Port Huron assures you that there will be no retaliation for filing a complaint.

VII. Sharing and joint use of your Health Information

In the course of providing care to you and in furtherance of our mission to improve the health of the community, we will share your PHI with other organizations as described below that have agreed to abide by the terms described below:

A. Medical Staff: The medical staff and Mercy - Port Huron participate together in an organized health care arrangement to deliver health care to you at Mercy - Port Huron. Both Mercy - Port Huron and its medical staff have agreed to abide by the terms of this Notice with respect to PHI created or received as part of delivery of health care services to you in Mercy - Port Huron. Physicians and allied health care providers are members of Mercy - Port Huron's medical staff and will have access to and use your PHI for treatment, payment and health care operations purposes related to your care within Mercy - Port Huron. We will disclose your PHI to the medical staff for payment, treatment and health care operations.

B. Business Associates: Mercy - Port Huron will use and disclose your PHI to business associates contracted to perform business functions on its behalf including Trinity Health, its parent who performs certain business functions for Mercy - Port Huron. Whenever an arrangement between Mercy - Port Huron and another company involves the use or disclosure of your PHI, that business associate will be required to keep your information confidential.

C. Membership in Trinity Health: Mercy - Port Huron, other members of Trinity Health, and Trinity Health participate together in an organized health care arrangement for utilization review and quality assessment activities. We have agreed to abide by the terms of this Notice with respect to PHI created or received as part of utilization review and quality assessment activities of Trinity Health and its members. Members of Trinity Health will abide by the terms of their own Notice of Privacy Practices in using your PHI for treatment, payment or healthcare operations. As a part of Trinity Health, a national Catholic health care system, Mercy - Port Huron and other hospitals, nursing homes, and health care providers in Trinity Health share your PHI for utilization review and quality assessment activities of Trinity Health, the parent company, and its members. Members of Trinity Health also use your PHI for your treatment, payment to Mercy - Port Huron and/or for the health care operations permitted by HIPAA with respect to our mutual patients.

D. Affiliations: Mercy - Port Huron is affiliated with the following health care organizations:

Partners at Heart
Tri-Hospital Emergency Medical Services
Tri-Hospital MRI

Mercy - Port Huron will share your PHI with these organizations for purposes of your treatment, payment and health care operations by these organizations.

VIII. Additional Information

For further information regarding the issues covered by this Notice of Privacy Practices, please contact:

Privacy Officer
Mercy – Port Huron
2601 Electric Avenue
Port Huron, MI 48060
Telephone: 810/985-1601

XI. Changes to this Notice

We will abide by the terms of the Notice currently in effect. We reserve the right to change the terms of our Notice and to make the new Notice provisions effective for all PHI that we maintain. We will provide you with the revised Notice at your first visit following the revision of the Notice.