Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This is your Notice of Privacy Practices that describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

DHD#10 Privacy Commitment

District Health Department #10 takes confidentiality and privacy of your health information very seriously. District Health Department #10 is required, by federal law, to maintain the privacy of protected health information and to provide you with this notice of our legal duties and our privacy practices with respect to your protected health information. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing, DHD#10 will only disclose your information for the purposes of treatment, payment, health care operations, or when required by law to do so.

Your Rights

  1. Get a copy of your paper or electronic 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.
    • DHD#10 will provide a copy or a summary of your health information, usually within 30 days of your request. DHD#10 may charge a reasonable, cost-based fee.
  2. Correct your paper or electronic medical record
    • You can ask DHD#10 to correct health information about you that you think is incorrect or incomplete.
    • DHD#10 may say “no” to your request, but will explain why in writing within 60 days.
  3. Request confidential communication
    • You can ask DHD#10 to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
    • DHD#10 will say “yes” to all reasonable requests.
  4. Ask us to limit the information we share
    • You can ask DHD#10 not to use or share certain health information for treatment, payment, or our operations. DHD#10 is not required to agree to your request, and 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 DHD#10 not to share that information for the purpose of payment or our operations with your health insurer.
    • DHD#10 will say “yes” unless a law requires us to share that information.
  5. Get a list of those with whom we’ve shared your information
    • You can ask for a list (accounting) of the times DHD#10 has shared your health information for six years prior to the date you ask, who it was shared it with, and why.
    • DHD#10 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). DHD#10 will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
  6. 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. DHD#10 will provide you with a paper copy promptly.
  7. 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.
    • DHD#10 will make sure the person has this authority and can act for you before we take any action.
  8. File a complaint if you believe your privacy rights have been violated
    • You can complain if you feel DHD#10 has violated your rights by contacting the Human Resources at (231) 876-3815.
    • 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, or by calling 1-877-696-6775, or visiting
    • DHD#10 will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell DHD#10 your choices about what we share. If you have a clear preference for how we share your information in the situations described below, please notify DHD#10. 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
  • Provide mental health care

If you are not able to tell DHD#10 your preference, for example if you are unconscious, DHD#10 may share your information if it is in your best interest. DHD#10 may also share your information when needed to lessen a serious and imminent threat to health or safety.
DHD#10 will never share your information for most sharing of psychotherapy notes unless you give us written permission.

How DHD#10 may use and share your information

  1. Treat you
    DHD#10 can use your health information and share it with other professionals to provide, coordinate, or manage your health care and related services such as Maternal Support Services or Family Planning Services.
    Example: A nurse may obtain medical information from you to determine the proper case and services to provide. DHD#10 may contact you with reminder cards of appointments and/or other services which may benefit your family.
  2. Run our organization
    DHD#10 can use and share your health information to run health care operations, improve your care, and contact you when necessary.
    Example: DHD#10 may use information to review the quality of care you receive.
  3. Bill for services
    DHD#10 can use and share your health information to bill and get payment from health plans or other public or private entities.
    Example: If you have Medicaid, DHD#10 will need to disclose your health information to the Medicaid Program in order to be reimbursed for our services.
  4. Help with public health and safety issues
    DHD#10 can share health information about you for certain situations such a preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
  5. Do research
    DHD#10 can use or share your information for health research.
  6. Comply with the law
    DHD#10 will share information about you if state or federal laws require it, including with the Department of Health and Human Services to see that we’re complying with federal privacy law.
  7. Address workers’ compensation, law enforcement, and other government requests
    DHD#10 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, and for special government functions such as military, national security, and presidential protective services.
  8. Respond to lawsuits and legal actions
    DHD#10 can share health information about you in response to a court or administrative order, or in response to a subpoena.

How else can DHD#10 use or share your health information?

DHD#10 is 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. DHD#10 has to meet many conditions in the law before we can share your information for these purposes. For more information see:

Our Responsibilities

  • DHD#10 is required by law to maintain the privacy and security of your protected health information.
  • DHD#10 will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • DHD#10 must follow the duties and privacy practices described in this notice and give you a copy of it.
  • DHD#10 will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. This notice was published and became effective on February 1, 2014.

For more information:

Quick Links

DHD#10 Notice of Privacy Policy Brochure