HIPAA Privacy Notice
Posted on 01/15/26
About This Notice
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. We are required to abide by this notice.
Understanding Your Health Information
We collect information when you enroll in a health plan or use our healthcare services which by law we must maintain as private. This includes your date of birth, ID numbers, and other personal information. This information is private and protected by law. Only people with both the need and legal right may access your information.
How We Use & Disclose Your Information
Unless you give written permission, we only disclose your information for:
- Treatment – To coordinate your health care
- Payment – To properly bill and pay for your care
- Healthcare/Business Operations – In connection with our business operations
- As Required By Law – For law enforcement, court orders, communicable disease reporting, disaster relief, government agency reviews, or to prevent serious health/safety threats.
- Michigan’s Dental Patient Consent Law – We are required by Michigan Law to obtain your written consent prior to making certain disclosures of your dental health information.
- With Your Permission – All other uses not identified above will require your written permission, which you may revoke in writing at any time.
We may not and will not sell your information, for instance to drug companies that might use it to contact you.
Your Privacy Rights
- Right to Inspect and Copy – You can view or get copies of your records (copying fees may apply)
- Right to Amend – You can request changes to your records if you believe there’s a mistake
- Right to List of Disclosures – You can request a list of disclosures made after April 14, 2003 (excluding treatment, payment, operations, or authorized disclosures)
- Right to Request Restrictions – You can request we share information in a specific way or place (e.g., send to work address instead of home). You can ask us to limit how we use or share your information. We are not required to agree to your request, except: if you pay for a service or item out-of-pocket in full, you can ask us not to share information about that service or item with your health plan, and we must agree.
- Right to Request a Paper Copy – You can request a paper copy of this notice at any time, even if you agreed to receive it electronically.
How to Exercise Your Rights
To exercise any rights under this notice, contact us in writing or request an expanded notice, please contact:
OCDPH Privacy Officer, Dr. Gwen Unzicker
12251 James Street, Suite 400
Holland, MI 49424
(616) 396-5266 or (800) 764-4111
To file a complaint to the federal government if you feel your rights have been violated, please contact:
Office of Civil Rights, DHHS
200 Independence Ave, S.W.
Washington, D.C. 202-1
(866) 627-7748
ocrprivacy@hss.gov
You will not be penalized for filing a complaint.
Changes to This Notice
We reserve the right to revise this notice. Any revised notice will be effective for medical information we already have as well as future information. Changes will be published on our website.
Last revision 01/26