Consent for Use and/or Disclosure of Confidential Health Information (HIPAA)
At In-Home Companions we are very concerned about protecting your privacy. While HIPAA (Health Insurance Portability & Accountability Act) requires us to provide you with this disclosure, we want to reassure you that we will always protect & respect your confidential health information.
There are several circumstances in which we may have to use or disclose your health information:
- We may have to disclose your health information to another health care provider or a
hospital if it is necessary to refer you to them for the diagnosis, assessment, or
treatment of your health condition.
- We may have to disclose your health information and billing records to another party if
they are potentially responsible for the payment of your services. This would include
but is not limited to: a bank, insurance company, Michigan Department of Health and
Human Services, Michigan Medicaid, any Waiver Agency, P.A.C.E. or your power of
attorney for health and/or finances.
- We may release your health information to a third party for quality control or other
You have the right to request in writing that we do not disclose your health information to specific individuals, companies or organizations. You may revoke any of your authorizations at any time; however, your revocation must be in writing and must allow sufficient time for all parties involved to act upon such revocation.