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For Patients & Family

Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated
Get an electronic or paper copy of your medical 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.
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.
Ask us to correct your medical 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.
File a complaint if you feel your rights are violated
  • You can complain if you feel we have violated your rights by contacting us using the information on page 1.
  • 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 
www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.
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.

You have some choices in the way that we use and share information as we

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds

 

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
  • Include your information in a hospital directory


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. We may also share your information when needed 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

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests
  • Work with a medical examiner or funeral director
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions

We typically use or share your health information in the following ways.

Treat you
  • We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.
In these cases we never share your information unless you give us written permission
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.
Run our organization
  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

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

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: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

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
Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services
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.
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.

Patients can access their Mary Free Bed medical records via the EPIC MyChart Portal. Contact 1-616-840-8000 or 1-800-528-8989 (TTY:711) for assistance in setting up the portal.

Special Considerations: Uses and Disclosures of Substance Use Disorder (SUD) Records

Our Responsibilities for SUD Records

We are required to:

  • Maintain the confidentiality of SUD records in accordance with HIPAA and 42 CFR Part 2.
  • Comply with stricter protections when they apply.
  • Notify you of your privacy rights and our legal duties relating to SUD information.
  • Include all required privacy protections in this Notice of Privacy Practices.

 

If we receive SUD records from another provider-such as during coordination of care, referrals, or medical history review-we must continue to safeguard those records under the same heightened federal protections

Additional Protections for SUD Records
  • SUD records are subject to enhanced privacy protections. In many situations, we may not use or disclose SUD information-even for purposes normally allowed under HIPAA such as treatment, payment, or healthcare operations-unless you provide written consent or another specific exception applies under federal law.
Legal Proceedings
  • SUD records cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order meeting strict requirements under federal law. This prohibition applies even if we did not create the SUD records but received them from another provider.
Re-disclosure of Information
  • If we disclose your SUD information pursuant to your written consent, the recipient may be prohibited from re-disclosing the information unless you consent again or federal law permits it. We will inform you when information we share may be subject to redisclosure limitations under Part 2.
Your Rights Concerning Substance Use Disorder Records
  • Right to Receive Notice of SUD Privacy Protections: You have the right to receive clear information about how your SUD records are protected, how they may be used or disclosed, and what your rights are under federal confidentiality laws
  • Right to Restrict Disclosures: You may request that we restrict the use or disclosure of your SUD records. While we are not always required to agree to requested restrictions, we will follow all legally required limitations on disclosure.
  • Right to Opt Out of Fundraising Communications: If we intend to use SUD information for fundraising communications, you will have the right to opt out before receiving such communications. We will provide a clear and conspicuous option to decline future fundraising contacts involving any SUD-related information.