Notice of Health Information Practices

Privacy and Confidentiality Notice

Each time you visit Pines or one of the Pines’ Service providers, a record of your visit is made. Typically, this record contains your symptoms, any test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • Basis for planning your care and treatment
  • Means of communication among the many health professionals who contribute to
    your care
  • Legal document describing the care you received
  • Means by which you or your insurance can verify that services billed were actually
  • A tool in educating health professionals
  • A source of data for research
  • A source of information for public health officials charged with improving the health
    of the nation.
  • A source of data for facility planning and marketing
  • A tool with which we can assess and continually work to improve the care we
    We render and the outcomes we achieve.
    Understanding what is in your record and how your health information is used helps you to:
  • Ensure its accuracy
  • Better understand who, what, when, where, and why others may access your health information
  • Make more informed decisions when authorizing (permitting) disclosure to others

Your Health Information Rights

Although your health record is the physical property of the healthcare provider or facility that compiled it, the information belongs to you. You
have the right to:

  • Request a restriction on certain uses and dis- closures of your information
  • Obtain a paper copy of the notice of information practices upon request
  • Inspect and obtain a copy of your record
  • Request amendments to your record
  • Obtain a list of disclosures of your health information
  • Revoke your authorization (permission) to use or disclose health information except to the extent that action has already been taken

Our Responsibilities

This organization is required to:

  • Maintain the privacy of your health information
  • Provide you with a notice as to our legal duties and privacy practices with respect to the information we collect and maintain about you.
  • Abide by the terms of this notice
  • Notify you if we are unable to agree to a requested restriction to the release of your information
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will notify you and the community and have such changes listed on the Pines website ( We will not use or release your health information without your authorization (permission), except as described in this notice. If you have questions and would like additional information, you may contact the CEO or the Chief Privacy Officer at 517-278-2129. If you believe your privacy rights have been violated, you can file a complaint with the Recipient Rights Officer (517-278-2129) or
with the Secretary of Health and Human Services (toll-free 877-696-6775). There will be no retaliation for filing a complaint.

Substance Use Confidentiality

Frequently, persons served by Pines have mental health issues as well as substance use issues. The confidentiality of information in the record that may contain information about alcohol and/or drug abuse maintained by Pines is protected by Federal Law and Regulations. Pines respects your confidentiality except under certain circumstances:

  1. The consumer consents in writing;
  2. The disclosure is allowed by a court order; or
  3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violation of the Federal Law and Regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal Regulations. Federal Law and Regulations do not protect any information about a crime committed by a consumer either at Pines or against any person who works for Pines or about any threat to commit such a crime. Federal Laws and Regulations do not protect any information about suspected child abuse or neglect from being reported
under State Law to appropriate State or Local authorities.

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