LifeClinic Community Resources

Our committment to your privacy:

This notice describes how health information about you, as a patient of this clinic, may be used and disclosed, and how to receive access to your health information. Please review it carefully. LifeClinic Community Resources is required by law to maintain the confidentiality of your health information, and to provide you with the following important information:

Your rights regarding your health information:

• You may request that LifeClinic communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that LifeClinic contact you at home, rather than work. LifeClinic will accommodate reasonable requests.
• You may 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 LifeClinic restrict our disclosure of your health information to only certain individuals involved in your care, such as family members and friends. LifeClinic 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.
• In accordance with the standards of implementation specifications of 45 C.F.R. § 164.524, you have the right to inspect or receive a copy of your patient medical records excluding any notes written by a patient advocate. You must sign a Consent for Release of Information to receive a copy of your medical records.
• You may ask LifeClinic to amend your health information if you believe it is incorrect or incomplete. Please submit your request, including the reason that supports the amendment, in writing to our Privacy Official.
• You are entitled to receive a copy of LifeClinic’s Notice of Privacy Practices. To obtain a copy, contact our Privacy Official.
• If you believe your privacy rights have been violated, you may file a complaint with LifeClinic or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. Please submit your complaint in writing to our Privacy Official.
• You may reach the Privacy Official by writing to LifeClinic Community Resources, P.O. Box 1804, Midland, MI 48641 or by calling 989-835-1500. 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

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. LifeClinic may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. LifeClinic may use or disclose protected health information about your treatment activities to another health care provider.

Health Care Operations: LifeClinic may use or disclose protected health information in the following circumstances as outlined by the U.S. Department of Health and Human Services:

• To improve the quality of care, which may include training programs for our staff.
• To cooperate with outside legal entities.
• To cooperate with public health authorities and health oversight agencies that are authorized by law to collect information.
• In response to a court or administrative order during lawsuits and similar proceedings.
• If required by a law enforcement official.
• When necessary to reduce or prevent a serious threat to the health and safety of yourself, another individual, or the public. LifeClinic will only make disclosures to a person or organization able to prevent the threat.
• If required by appropriate authorities within U.S. or foreign military forces of which you are a member (including veterans).
• If required by federal officials for intelligence and national security activities authorized by law.
• If required by correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
• If required by Workers Compensation and similar programs.

Additional uses: Any additional uses not listed above require LifeClinic Community Resources to obtain a separate written consent from you.