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 and test results, diagnoses, treatment and a 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, as 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 or 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.

Practice Specifics: This practice utilizes a recall system for extended future appointments. Patients are sent postcard reminders to contact our office for a follow-up appointment. We also send fold-over cards sealed at the bottom with test results and/or appointment information. This practice also calls your home to confirm appointments. When you are not available by phone to discuss a medical issue, we will leave a message for you to return a call t our office.

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 reception area. You can also request a copy of our notice at any time. For more information about our privacy practices, please ask to speak with the Privacy Officer.

Individual Rights

In most cases, you have the right to look at or receive a copy of your health information that we use to make decisions about your care or treatment. Your request must be in writing. There is no charge for the first copy, but each additional copy is $45. You may request in writing access to your records, and we will be happy to schedule a time for you to review your health information with a provider or staff member. 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 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. This Practice maintains protected health information for ten years. After that time, the information is destroyed by a secure document shredding company.

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 emergency circumstances. 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 the Practice's Privacy Officer. You may also send a written complaint to the US Department of Health and Human Services. The Privacy Officer can provide you with the appropriate address.

Our Legal Duty

We are required by law to protect the privacy of your medical information, provide this notice about our information practices, and follow the information practices that are described in this notice and in our policy.

Urology Surgeons, P.C.
4070 Lake Drive SE, Suite 103
Grand Rapids, MI 49546-8294
Tel: 616.949.4340
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