Each time you visit the Mind & Mood Clinic, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is often referred to as your health or medical record.

We are required by law to maintain the privacy of your medical information, and to notify you of our legal duties and privacy practices regarding your medical information. This Notice of Privacy Practices provides detailed information about how we may use and disclose your medical information with or without authorization and information about your specific rights with respect to your medical information. Mind & Mood Clinic abides by the practices of this Notice, unless more stringent laws or regulations apply.

Disclosures of your medical information that we may make without your authorization:

• Treatment:
  We may disclose and/or share your healthcare information with other health care professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and/or other persons you choose to involve in your care, only if you agree that we may do so.
• Payment:
  We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include insurance organizations or other businesses that may become involved in the process of billing and collecting unpaid balances.
• Healthcare Operations:
  We may use your medical information to support the business activities of the Clinic and to ensure the provision of high quality healthcare services. That includes quality improvement activities, staff training and performance review, licensure and accreditation, data aggregation and audits by regulatory agencies, outside health or management reviewers, and individuals performing similar activities. We may share your protected health information with third parties who perform services such as transcription or billing. In those cases, we will have written agreements with the third parties that they will not use or disclose your information for any other purposes, except as required by law.
• Required by Law:
  We may use or disclose your health information when we are required to do so by law. We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement. The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.
• Public Health Responsibilities:
  We will disclose your health care information to report problems with products, reactions to medications, product recalls, disease/infection exposure and to prevent and control disease, injury and/or disability.
• Emergencies:
  We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death.
  If at all possible, we will provide you with an opportunity to object to this use or disclosure. Otherwise, we will use our professional judgment to disclose only the information directly relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, x-rays or other similar forms of health information and/or supplies unless you have advised us otherwise.
• Abuse or Neglect:
  We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or that of others. Any disclosures of this nature will be consistent with state and federal law.
• Appointment Reminders:
  We may use or disclose your health information to provide you with appointment reminders, including, but not limited to voicemail messages, postcards or letters.
• Coroners, Funeral Directors, and Organ Donation:
  Your medical information may be disclosed to a coroner or medical examiner for identification purposes, determining the cause of death or other legally required duties. Your medical information may also be released to a funeral director in order to permit him/her to perform their duties.
  
  Your information may be disclosed if we reasonably anticipate your death, and may also be used and disclosed for cadaver organ, eye or tissue donation purposes.
• Research and Marketing:
  We will not disclose your health information to researchers and not use it for marketing purposes unless we have your written authorization to do so.

Other uses and disclosures of your medical information will be made only with your written authorization. You may revoke your authorization at any time.

• Your Rights:
  The following information describes your rights with respect to your medical information that we maintain.
• Right to Request Restrictions:
  You have the right to ask us to place restrictions on the way we use or disclose your medical information for treatment, payment, or healthcare operations. We are not required to agree to the restriction, but if we do, we will comply with your request whenever feasible and will notify you when it no longer is. You should contact the registration staff for further details and a form to fill out.
• Confidential Communications:
  We will accommodate reasonable requests to communicate with you about your medical information by different methods or alternative locations if you make your request in writing and give it to the registration staff. For example, if you are covered on a health plan but are not the subscriber, and would like your medical information sent to a different address than the subscriber, we can usually do that for you.
• Access to Your Medical Information:
  You have the right to receive a copy of your medical information that we maintain, with some limited exceptions. You may request access to those records in writing and provide us with information about the specific information you need so that we can fulfill your request. We reserve the right to charge a reasonable fee for the cost of producing and mailing the copies. Amendment of Your Medical Information: You have the right to ask us to change any of your medical information. You need to request this amendment in writing and submit it to the Medical Record Department. In certain situations we may have to deny your request, such as when the medical information in your records was created by another provider. Any denials will be in writing. You have the right to appeal our denial by filing a written statement of disagreement.
• Accounting of Certain Disclosures:
  You have a right to a listing of the disclosures we make of your medical information, except for those disclosures made for treatment, payment, or healthcare operations, or those disclosures made pursuant to your authorization. The type of disclosures typically contained in a listing would be disclosures made for mandatory public health purposes, law enforcement, legal proceedings, or for other required reporting such as birth and death certificates.
• Questions and Complaints:
  To exercise any of the above rights, or if you are concerned that any of your privacy rights have been violated, please contact our Privacy Officer at 248-851-8281. You also have the right to complain to the Secretary of Health and Human Services at:
  Office for Civil Rights
  U.S. Department of Health and Human Services
  200 Independence Avenue, S.W.
  Room 515F, HHH Bldg.
  Washington, D.C. 20201
  You will not be retaliated against for filing a complaint.
• Changes to Privacy Practices:
  Mind & Mood Clinic reserves the right to change its privacy practices and its Notice of Privacy Practices at any time. The new notice will be effective for any medical information we create or maintain as of the date of the change. You may view a copy of our most current Notice of Privacy Practices on our website, at m-m-clinic.com or request a copy from the registration staff. You have the right to a paper copy of this Notice any time, upon request. You may contact the registration staff to get a current paper copy.