Uses and Disclosures Here are some examples of how we are allowed to disclose your private healthcare information for treatment, payment or practice operations.

1. Your healthcare provider or a staff member may disclose your health information, including all of your practice records, to another healthcare provider or a hospital if it is necessary to refer you to them for diagnosis, assessment or treatment of your health condition.
2. Our billing staff may disclose your examination and treatment records and your billing records to another party, such as an insurance carrier, an HMO, a PPO, or your employer to comply with worker’s compensation laws, if they are potentially responsible for the payment of your services.
3. Your healthcare provider and members of the practice staff may use your health information, examination and treatment records, and your billing records for quality control purposes or for other administrative purposes to efficiently and effectively run our practice.
4. Your healthcare provider and member of the practice staff may use your name, address, telephone number, and your clinical records to contact you to provide appointment reminders, information about treatment alternative, or other health related information that may be of interest to you. If you are not at home to receive an appointment reminder, a message will be left on your voice mail if you have checked yes on your demographic form.

Permitted uses and disclosures without your consent or authorization Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances:

1. We are required by law to release your health information as it relates to: a federal, state, county or law enforcement agency regarding reporting, investigating or prosecuting threatened or suspected child or elder abuse, or relinquishment of an infant 72 hours old or less.
2. We are required by law to release your health information to an agency or law enforcement agency investigating abuse, neglect, physical injury, violent crimes and death, an agency that investigates animal bites, and injuries due to the discharge of a firearm.
3. We may use or disclose your health information if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or to the public. We may also release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.
4. We are required by law to release your health information to your court-appointed guardian, an agent you appoint under a healthcare power of attorney, and the appropriate law enforcement official or correctional institution if you are in custody or incarcerated.
5. We are permitted to use or disclose your health information if we are providing healthcare services to you based on the orders of another healthcare provider.
6. We are permitted to use or disclose your health information if we provide healthcare services to you in an emergency.
7. We are permitted to use or disclose your health information if we are required by law to treat you and we are unable to obtain consent after attempting to do so.
8. We are permitted to use or disclose your health information if there are substantial barriers to communication with you, but in our professional judgment we believe that you intend for us to provide care to you.
9. We may disclose your health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. We may disclose your health information to the government or a health oversight agency for the following additional purposes: to control or prevent a communicable disease, injury, or disability, to report births and deaths, to report adverse events that occur after administering a vaccine, to report other adverse events, to report instances of food poisoning or product defect, to track products, to enable product recalls, or to conduct post-market surveillance as required by law. If necessary, we may disclose your health information to another healthcare provider who has or who will be providing care to you for purposes of controlling or preventing a communicable disease.

Other than the circumstances describe in the preceding examples, and in the section Uses and Disclosures of this document, any other use or disclosure of your health information will only be made with your written authorization. Marketing From time to time, our practice works with marketing organizations to make you aware of products or services that you may have an interest in purchasing. We may need to use your health information including your name, address, telephone number, and your clinical records for the purpose of marketing products or services to you. The authorization form you sign for this purpose contains the name of the organization and/or the products and services we are marketing. You have the right to refuse to give us authorization to contact you for marketing purposes. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care. You may inspect or copy the information that we use to market products and/or services to you at any time. Our practice and staff will receive direct or indirect remuneration from our marketing activities. Fundraising From time to time, our practice raises money for charitable causes. We may need to use your health information including your name, address, telephone number, and your clinical records to contact you to request your assistance with these fundraising efforts. The authorization form you sign for this purpose contains the name of the organization(s) for whom we are raising money. You have the right to refuse to give us authorization to contact you for fundraising purposes. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care. You may inspect or copy the information that we use to contact you about fundraising efforts at any time. Our practice and staff will receive direct or indirect remuneration from our fundraising activities. Your right to revoke your authorization You may revoke your authorization to us at any time; however, your revocation must be in writing and mailed to, or dropped off at, our office. There are two circumstances under which we will not be able to honor your revocation request:

1. If we already released your health information before we received your request to revoke your authorization.
2. If you were required to give your authorization at a condition of obtaining insurance, the insurance company may have the right to your health information if they decide to contest any of your claims.

If you wish to revoke your authorization, please write to us at: drjanellemackowiak@gmail.com Your right to limit uses or disclosures If there are healthcare providers, hospitals, employers, insurers, or other individuals or organizations to whom you do not want us to disclose your health information, please let us know, in writing, what individual or organizations to whom you do not want us to disclose your healthcare information. We are not required to agree to your restrictions. However, if we agree with your restrictions, the restrictions are binding on us. If we do not agree to your restrictions, you may drop your request or you are free to seek care from another healthcare provider. Your right to receive confidential communication regarding your health information We normally provide information about your health information to you in person at the time you receive services from us. We may also mail you information regarding your health or the status of your account. We will do our best to accommodate any reasonable request if you would like to receive information about your health or the services that we provide at a place other than your home, or if you would like information in a different form. To help us respond to your needs, please make any request in writing. Your right to inspect and copy your health information You have the right to inspect and/or copy your healthcare information for seven years from the date that the record was created or as long as the information remains in our files. We require your request to inspect and/or copy your health information to be in writing. We may deny your request to inspect and copy your health record if the information involved is naturopathic or psycho-therapy notes, or information compiled in anticipation of, or use in, a civil, criminal or administrative action or proceeding. We may also deny your request if your health information was obtained from someone other than a healthcare provider under a promise of confidentiality and your accessing the health information would reveal the source of the health information. We may also deny a request by you or your legal representative to inspect and copy your health information if doing so may endanger the life or physical safety of you or another person. If we deny your request, in its entirety or in part, we will inform you in writing of the basis of the denial, and how and under what circumstances you may have your denial reviewed, and how you may complain. Your right to amend your health information You have the right to request that we amend your health information for seven years from the date that the record was created or as long as the information remains in our files. We require your request to amend your records to be in writing and for you to give us a reason to support the change you are requesting us to make. We may deny your request if we determine that your health information a) was not created by us, b) is not part of the record set, c) is protected from access by law, or d) we believe your health information is accurate and complete. Your right to receive an accounting of the disclosures we have made of your records You have the right to request that we give you an accounting of the disclosures we have made of your health information for the last six years before the date of your request. The accounting will include all disclosures except:

• Those disclosures required for your treatment, to obtain payment for your services, or to run our practice.
• Those disclosures made to you.
• Those disclosures necessary to maintain a directory of individuals in our facility or to individuals involved in your care. • Those disclosures for national security or intelligence purposes.
• Those disclosures made to correctional officers or law enforcement officers.
• Those disclosures that were made prior to the effective date of the HIPAA privacy law.

We will provide you the first accounting within any 12-month period without charge. There is a fee for any additional request during the next 12 months. When you make your request, we will tell you the amount of the fee and you will have the opportunity to withdraw or modify your request. The list of disclosures will include the following information about the disclosures: a) the date the disclosure was made, b) the name and address of the person or entity to whom it was made, c) a brief description of what was disclosed, and d) and brief statement of the purpose of the disclosure. We will attempt to provide the list to you within 60 days after receipt of your request. If we are unable to do so within that time frame, we will notify you. Our duties We are required by law to maintain the privacy of your health information. We are also required to provide you with this notice of our legal duties and our privacy practices with respect to your health information. We must abide by the terms of this notice while it is in effect. However, we reserve the right to change the terms of our privacy notices. If we make a change to the terms of our privacy agreement, we will notify you in writing when you come in for treatment or by mail. If we make a change in our privacy terms, the change will apply for all of your health information in our files. Re-Disclosure Information that we use or disclose may be subject to re-disclosure by the person to whom we provide the information and may no longer be protected by the federal privacy rules. Your Right to Complain You may complain to us or to the Secretary for Health and Human Services if you feel that we have violated your privacy rights. We respect your right to file a complaint and will not take any action against you if you file a complaint. While you may make an oral complaint at any time, written comments should be addressed to us at:drjanellemackowiak@gmail.com or sent to: 370 State St, Oxford, MI 48371 To complain to the United States Department of Health and Human Services, contact: The Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue SW Washington, D.C., 20201   Our Privacy Pledge We have and always will respect your privacy. Other than the uses and disclosures we described above, we will not sell or provide any of your health information to any outside organizations. We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all health information that we maintain, including that created or received by us prior to the effective date of the new notice. The effective date of this notice is set forth on the bottom of each page of this notice. A copy of our current Notice of Privacy practices will be available to all patients upon request. Contact Us If you would like further information about our privacy policies and practices, please contact: drjanellemackowiak@gmail.com