Ronald Chusid, D.O. 1762 E. Oak Ave. Muskegon , MI (231) 773-3258 Site
Medical Problems of Adults
4. Law enforcement. We may release PHI if asked to do so by a law enforcement official:
• Regarding a crime victim in certain situations, if we are unable to obtain the
• Concerning a death we believe has resulted from criminal conduct,
• In the event that a crime occurs on the premises of our practice,
• In response to a warrant, summons, court order, subpoena or similar legal process,
• To identify/locate a suspect, material witness, fugitive or missing person,
• In an emergency, to report a crime (including the location or victim(s) of the
crime, or the description, identity or location of the perpetrator).
5. Serious threats to health or safety. Our practice may use and disclose your PHI
when necessary to reduce or prevent a serious threat to your health and safety or
the health and safety of another individual or the public. Under these circumstances,
we will only make disclosures to a person or organization able to help prevent the
6. Military. Our practice may disclose your PHI if you are a member of U.S. or foreign
military forces (including veterans) and if required by the appropriate authorities.
7. National security. Our practice may disclose your PHI to federal officials for
intelligence and national security activities required by law.
8. Inmates. Our practice may disclose your PHI to correctional institutions or law
enforcement officials if you are an inmate or under the custody of a law enforcement
official. Disclosure for these purposes would be necessary: (a) for the institution
to provide health care services to you, (b) for the safety and security of the institution,
and/or (c) to protect your health and safety or the health and safety of other individuals.
9. Workers’ compensation. Our practice may release your PHI as authorized to comply
with workers’ compensation laws and other similar legally-established programs.
E. Your rights regarding your PHI:
You have the following rights regarding the protected health information (PHI) that
we maintain about you:
1. Confidential communications. You have the right to request that our practice communicate
with you about your health and related issues in a particular manner or at a certain
location. For instance, you may ask that we contact you at home, rather than work.
In order to request a type of confidential communication, you must make a written
request to our office specifying the requested method of contact, or the location
where you wish to be contacted. Our practice will accommodate reasonable requests.
You do not need to give a reason for your request.
2. Requesting restrictions. You have the right to request a restriction in our use
or disclosure of your PHI beyond those otherwise required under HIPAA privacy rules.
Additionally, you have the right to request that we restrict our disclosure of your
PHI to only certain individuals involved in your care or the payment for your care,
such as family members and friends. We are not required by law 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 order
to request a restriction in our use or disclosure of your PHI, you must make your
request in writing to our office. Your request must describe in a clear and concise
• The information you wish restricted,
• Whether you are requesting to limit our practice’s use, disclosure or both,