Notice of Privacy Practices

Your information. Your rights. Our responsibilities.

This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

Your Rights

This section explains your rights and some of our responsibilities to help you:

Get an electronic or paper copy of your health record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.


Ask us to correct your health record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.


Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
  • We will say “yes” unless a law requires us to share that information


Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.


Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.


File a complaint if you feel your rights are violated

  • You can file a complaint if you feel we have violated your rights by contacting the Center’s privacy officer, Michelle Caryl. Her contacts are listed below.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share.

If you have a clear preference for how we share your information in the situations described below, talk to us.  Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest.  When needed, we may also share your information to lessen a serious and imminent threat to health or safety.


In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

Treat you

  • We can use your health information and share it with other professionals who are treating you. With your consent, your health information will be entered into an electronic health record system established by Jackson Community Medical Record, LLC (JCMR), and may be shared with other providers who use the system and treat you for treatment, payment or health care operations, and as described in the provider’s Notice of Privacy Practices.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary. We may share your health information with third-party business associates who perform services on our behalf, including JCMR, consultants, accountants, auditors, attorneys, and information technology vendors.  These associates will also be required to protect your health information.

Example:  We use health information about you to manage your treatment and services.

Bill for your services

  • We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.


How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research.  We have to meet many conditions in the law before we can share your information for these purposes.  For more information see:


Help with public health and safety issues

  • We can share health information about you for certain situations such as:
  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety


Do research

  • We can use or share your information for health research.


Comply with the law

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Example:  We will share your health information to comply with mandatory state reporting requirements.  These include reporting of births, deaths, injuries caused by a deadly weapon, victims of abuse or neglect, certain diseases and afflictions, the dispensing of certain controlled substances, and drug diversion and fraudulent prescription activity.


Respond to organ and tissue donation requests

  • We can share health information about you with organ procurement organizations.


Work with a medical examiner or funeral director

  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.


Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.


Appointment reminders and treatment alternatives

  • We can use or share health information about you to provide you appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.



  • We can share health information about you to a correctional institution or law enforcement official if you are an inmate of a correctional institution or under the custody of a law enforcement official.


 Health oversight activities

  • We can share your health information to a health oversight agency for oversight activities authorized by law. These oversight activities include, for example, audits investigations, inspections, licensure or disciplinary actions, or other activities necessary for the appropriate oversight of the health care system, government benefit programs, and compliance with civil rights laws.


Serious threats to health or safety

  • We can use or share your health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety and the use or disclosure is to a person reasonably able to prevent or lessen the threat, or necessary for law enforcement authorities to identify or apprehend an individual.



  • We will share proof of immunizations with a school to comply with relevant law requiring the school to have proof of immunization prior to admitting a student. We will obtain the oral or written consent of a minor’s parent or guardian or the individual, if the individual is an adult or emancipated minor prior to making the disclosure.


We can also use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • For special government functions such as military, national security, and presidential protective services


More stringent state and federal laws

  • In some cases, certain Michigan or federal laws are more stringent than HIPAA. Michigan or federal laws are more stringent when the individual’s health information is more protected from disclosure than under HIPAA, or when the individual is entitled to greater access to health information than under HIPAA.

  Certain Michigan laws and/or federal laws and regulations governing the confidentiality of mental health, substance abuse and HIV/AIDS conditions are more stringent than HIPAA.  We will abide by these more stringent state and federal laws.


Organized health care arrangement

  • We participate in an organized health care arrangement with physicians, allied health professionals, and other health care practitioners and entities that provide health care services to patients at our health care facility and service delivery sites. This notice will be followed by all participants in the organized health care arrangement, including all health care facilities and service delivery sites run by us, or workforce (including all employees, students, volunteers and other workforce members), and all physicians, allied health professionals, and other health care practitioners who are not our agents or employees but who provide services and treatment to patients at our facilities.  Participants in the organized health care arrangement may use and share your health information for treatment, payment and health care purposes related to the organized health care arrangement.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.

For more information see:


Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you.  The new notice will be available upon request, in our office, and on our web site.

This Notice of Privacy Practices applies to all sites of the Center for Family Health.

Center for Family Health
505 N. Jackson St.
Jackson, MI 49201

Michelle Caryl, Privacy Officer

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