Ronald Chusid, D.O. 1762 E. Oak Ave. Muskegon , MI (231) 773-3258 Site
Medical Problems of Adults
3. Inspection and copies. You have the right to inspect and obtain a copy of the
PHI that may be used to make decisions about you, including patient medical records
and billing records. Under federal law you do not have the right to inspect or copy
the following records: psychotherapy notes, information compiled in reasonable anticipation
of, or use in, a civil, criminal, or administrative action or proceeding, and protected
health information that is not required to be accessible under the HIPAA Privacy
Rules or other applicable laws. You must submit your request in writing to our office
in order to obtain a copy of your PHI. We may charge a fee for the costs of copying,
mailing, labor and supplies associated with your request. We may deny your request
to inspect or copy PHI in certain limited circumstances. You may request a review
of our denial. Another health care professional chosen by us will conduct the review.
4. Amendment. You may ask us to amend your health information if you believe it is
incorrect or incomplete, and you may request an amendment for as long as the information
is kept by our practice. To request an amendment, your request must be made in writing
and submitted to our office. You must provide us with a reason that supports your
request for amendment. We may legally deny a request that is not in writing or does
not include a reason that supports the request, involves information that was not
created by us (unless the person that created the information is no longer available
to make the amendment), is not part of the medical information maintained by our
practice, is not part of the information which you would be permitted to inspect
and copy, or pertains to information that is accurate and complete.
5. Accounting of disclosures. You have the right to request an accounting of disclosures.
An accounting of disclosures is a list of certain non-routine disclosures our practice
has made of your PHI for purposes not related to treatment, payment, or operations.
Use of your PHI as part of routine patient care in our practice, including communication
with healthcare professionals, family members or friends involved in your care, and
use of information for billing purposes, is not required to be documented In order
to obtain an accounting of disclosures, you must submit your request in writing to
our office. All requests for an accounting of disclosures must state a time period,
which may not be longer than six years from the date of disclosure and may not include
dates before April 14, 2003. The first list you request within a twelve month period
is free of charge, but we may charge you for additional lists within the same twelve
month period. We will notify you of the costs involved with additional requests,
and you may withdraw your request before you incur any costs.
6. Right to a paper copy of this notice. You are entitled to receive a paper copy
of our Notice of Privacy Practices. You may ask us to give you a copy of this notice
at any time. To obtain a paper copy of this notice, contact Carol Chusid, R.N. Phone
7. Right to file a complaint. If you believe your privacy rights have been violated,
you may file a complaint with our practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with our practice, contact Carol
Chusid, R.N. Phone (231) 773-3258. All complaints must be submitted in writing. No
retaliatory action will be taken against you for making a complaint.
8. Right to provide an authorization for other uses and disclosures. Our practice
will obtain your written authorization for uses and disclosures that are not identified
by this notice or permitted by applicable law. Any authorization you provide to us
regarding the use and disclosure of your PHI may be revoked at any time in writing.
After you revoke your authorization, we will no longer use or disclose your PHI for
the reasons described in the authorization.
If you have any questions regarding this notice or our health information privacy
policies, please contact Carol Chusid, R.N. Phone (231) 773-3258