Consultants in Sleep & Pulmonary Medicine, PLLC
29275 W. 10 Mile Rd. Farmington Hills, MI 48336
Ph: 248-350-2722 Fax: 248-350-0154
NOTICE OF PRIVACY PRACTICES
The policy of Consultants in Sleep & Pulmonary Medicine, PLLC (“CSPM”) is to protect the
confidentiality, integrity and security of the protected health information and personal
information of our patients and to prevent unauthorized access to, or the use or disclosure of
such information. This policy applies to information in electronic format and in paper format.
Individually identifiable health and personal information is any information obtained by CSPM
in connection with providing you with healthcare treatment, obtaining payment and related
health care operations. This information may contain your date of birth, social security
number, address and information regarding the condition(s) you are being treated for.
CSPM collects this personal information to learn about your medical history and medical
conditions, to render medical treatment to you for these conditions and to collect payment for
our services. We gather this information from patient information forms, health questionnaires
and other forms you will be asked to complete from time to time. In addition we will assemble
information based on our discussions and conversations with you, your personal
representatives and your family members. Your referring physician may forward necessary
medical information to us and your healthcare plan or insurance carrier may also provide
information to our office. This protected health information is maintained in our electronic
medical record software, sleep center data collection system (if applicable) and our practice
management billing software.
We will use the information provided by you to provide you with high quality medical care. As
part of our standard healthcare operations we may share your information electronically or in
written format with a hospital, laboratory, diagnostic service center, medical equipment
provider, your pharmacy and other healthcare providers involved your care. Your information
will be used with your contracted health plan for claims management and to obtain payment
for services rendered by CSPM and its physicians. As requested by your insurance company we
will exchange data with your carrier for activities such as eligibility, benefit and coverage
determinations, pre-certification for services, utilization review and case management. We will
contact you by phone or in writing to confirm or schedule appointments.
CSPM has made every effort in compliance with Federal Privacy and Security laws to protect
your protected health information in both electronic paper forms. In the unlikely event that a
breach occurs and your protected health information is accessed or compromised by an outside
party, you will be notified immediately if upon a risk analysis there is a chance the breach of
information could lead to harm to you in a financial or reputational manner. Your information
is accessed by CSPM staff and healthcare business associates on a “need to know basis” and
only the minimum necessary to accomplish the task at hand. With some limitations, you have
the right to inspect, amend, copy and receive an accounting of disclosures of your medical and
billing records.
Requests in writing from “Cash Only” patients to not release billing or medical information to
their insurance companies will honored unless disclosure is required by Federal Law.
CSPM will not sell or market your protected health information.
In the event CSPM engages in research programs that you may qualify for, you will be asked to
sign an authorization for use of your protected health information if you choose to participate
in a research study.
You may request copies of your medical records in the electronic form of your choice. You will
receive copies within 30 days and every effort will be made to accommodate your electronic
method of choice. Please note that CSPM does not permit use of any external storage device
such as thumb drives or memory sticks brought in by patients to be inserted into office
computers to obtain medical records.
Medical records containing protected health information may be released without your express
consent if Federal, State or other applicable law requires us to share the protected health
information in our records.
Should a breach of unsecured protected health information occur that could cause you financial
or reputational harm, you and the Department of Health and Human Services will be notified
within 60 days of the breach and will be advised of the method for mitigation.
If you have any questions or concerns you may contact the HIPAA Compliance Officer, Cheryl
Rich at 248-350-2722.
Revised September 2013