WillowBrook Rehabilitation Services

State and Other Federal Laws: Willowbrook will comply with all applicable state and federal laws.
Other Uses of Medical Information Require an Authorization. Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us an authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by the written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provide to you.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have many rights with regard to you medical information. If you wish to exercise any of these rights, you must submit your request in writing, unless otherwise noted, to:
Willowbrook Rehabilitation Services, 7200 Challis Road, Brighton, MI 48116, Attention Privacy Officer
Your Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. We may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request.
Your Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to add a statement. You must provide a reason that supports your request for an amendment.
Your Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures”. This is a list of certain disclosures we made of medical information about you. Your request must state a time period. We may limit the time period to 6 years and to disclosures made on or after April 14, 2003. The first list you request within a 12-month period is free. For additional lists, we may charge you for the costs of providing the list.
Your Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you. We are not required by law to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Your Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will not ask you the reason for your request. You may make this request in writing or verbally.
Right to Paper Copy of this Notice: You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with Willowbrook. You may also file a complaint directly with the Secretary of the Department of Health and Human Services. You will not be penalized in any way for filing a complaint. \
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice at Willowbrook and make copies available upon request.