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HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION
BACKGROUND
The HIPAA Privacy Rule gives an individuals a
fundamental new right to be informed of the privacy
practices of their health plans and of most of their
health care providers, as well as to be informed of
their privacy rights with respect to their personal
health information. Health plans
and covered health care providers are required to
develop and distribute a notice that provides a
clear explanation of these rights and practices.
The notice is intended to focus individuals
on privacy issues and concerns, and to prompt them
to have discussions with their health plans and
health care providers and exercise their rights.
HOW WE MAY USE AND
DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We use and disclose protected health information for
a variety of reasons. We have a
limited right to use and/or disclose your health
information for purposes of providing your
suppliers, payment, or for the operations of your
company. For other uses, you
must give us your written authorization to release
your health information unless the law permits or
requires us to make the use or disclosure without
your authorization. Should it
become necessary to release your health information
to an outside party, we will require the party to
have a signed agreement with us that the party will
extend the same degree of privacy protection to your
information as we do.
The following describes the different ways we may
use or disclosure your health information without
your consent or authorization.
1.
USE AND DISCLOSURES
RELATED TO TREATMENT:
We
may disclose your health information to those who
are involved in providing medical and nursing care
services and treatments to you.
We may also disclose your health information to
outside entities performing other services related
to your treatment; such as diagnostic laboratories,
home health/hospice agencies, family members, etc.
2.
USE AND DISCLOSURES
RELATED TO PAYMENT:
We
may use or disclose your health information to bill
and collect payment for services we provided to you.
For example, we may contact your insurance
facility, health plan, or another third party to
obtain payment for services we provided to you.
3.
USE AND DISCLOSURES
RELATED TO COMPANY OPERATIONS:
We
may use or disclose your health information to
perform certain functions within our company should
these uses or disclosures become necessary to
operate our company and to ensure that you and
others we provide services to continue to receive
quality services. For example,
we may use your health information to evaluate the
effectiveness of the services you are receiving.
We may disclose your health information to
our staff for auditing, care planning, and learning
purposes. We may also combine
your health information with information from other
health care providers to study how our company is
performing in comparison to like companies or what
we can do to improve the care and services we
provide to you.
4.
USE AND DISCLOSURES
RELATED TO TREATMENT ALTERNATIVES, HEALTH-RELATED
BENEFITS AND SERVICES:
We
may use or disclose your health information for
purposes of contacting you to inform you of testing
alternatives or health-related benefits and services
that may be of interest to you.
For example, a newly released medication, treatment,
or testing system that has a direct relationship to.
USES AND
DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
You have the right to revoke an authorization at any
time to stop future uses or disclosures of your
information except to the extent that we had already
undertaken an action in reliance upon your
authorization. Your revocation
request must be provided to us in writing.
The name and address of the person to contact
is located on the last page of this document.
Examples of uses or
disclosures that would require your written
authorization include, but are not limited to, the
following:
1.
A request to
provide your health information to an attorney for
use in a civil litigation claim.
2.
A request to
provide certain information to an insurance or
pharmaceutical facility for the purposes of
providing you with information relative to insurance
benefits, new medications, or new monitoring systems
that may be interest to you.
3.
A request to
provide certain information to another individual or
company.
USES OR
DISCLOSURES OF INFORMATION BASED UPON YOUR VERBAL
AGREEMENT
We may disclose a limited amount of your health
information if we provide you with an advance oral
or written notice and you do not subject to such
release or such release is not otherwise prohibited
by law. However, if there is an
emergency situation and you are unable to object,
disclosure may be made if it is consistent with any
prior expressed wishes and disclosure is determined
to be in your best interest.
When a disclosure is made on emergency situations,
we will only disclose health information relevant to
the person’s involvement in your care.
For example, if you are sent to the emergency
room, we may only inform the person that you are
diabetic. You will be informed
and given an opportunity to object to further
disclosures of such information as soon as you are
able to do so.
We may disclose your health information to
the person who help pay for your supplies.
You may object to the release of this
information. Your objection may
be made orally or in writing.
The name, address, and telephone number of the
person to whom you may make your objection is listed
on the last page of this document.
USES AND
DISCLOSURES OF INFORMATION THAT DO NOT REQUIRE YOUR
CONSENT OR AUTHORIZATION
State and federal laws and regulations require or
permit us to use or disclose your health information
without your consent or authorization.
Examples of uses or disclosures that would require
your written authorization include, but are limited
to, the following:
1.
WHEN REQUIRED BY
LAW:
We
may disclose your health information when a federal,
state or local law requires that we report
information injury from a health care product, or in
response to a court order or subpoena.
2.
FOR PUBLIC HEALTH
ACTIVITIES FOR THE PURPOSE OF PREVENTING OR
CONTROLLING DISEASE:
We
may disclose your health information when a federal,
state or local requires that we report information
injury from a health care product, or in response to
a court order or subpoena.
3.
FOR HEALTH
OVERSIGHT ACTIVITIES:
We
may disclose your health information to a health
oversight agency such as a protection and advocacy
agency, the state agency responsible for inspecting
our company or to other agencies responsible for
monitoring the health care system for such purposes
as reporting or investigating of unusual incidents
or to ensure that we are in compliance with
applicable state and federal laws and regulations
and civil rights issues.
4.
TO CORONERS OR
MEDICAL EXAMINERS:
We
may disclose your health information to a coroner or
medical examiner for the purpose of identifying a
deceased individual or to determine the cause of
death.
5.
FOR RESEARCH
PURPOSES:
We
may disclose your health information for research
purposes only when a privacy board has approved the
research project.
6.
TO AVERT A SERIOUS
THEAT TO HEALTH OR SAFETY:
We
may disclose your health information to avoid a
serious threat to your health or safety or to the
health or safety of others. When
such disclosure is necessary, information will only
be released to those law enforcement agencies or
individuals who have the ability or authority to
prevent or lessen the threat of harm,
7.
FOR SPECIFIC
GOVERNMENT FUNCTIONS:
We
may disclose your health information of military
personnel and veterans, when requested by military
command authorities, to authorized federal
authorities for the purposes of intelligence,
counterintelligence, and other national security
activities, or to correctional institutions.
YOUR RIGHT
REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights concerning the use or
disclosure of your health information that we create
or that we may maintain on our premises:
1.
TO REQUEST
RESTRICTIONS ON USES AND DISCLOSURES OF YOUR HEALTH
INFORMATION:
You have the right to request that we limit how we
use your health information for treatment, payment
or health care operations. You
have the right to request a limit on the health
information we disclose about you to someone who is
involved in your care or the payment for your care
of services.
Should you wish a restriction placed on the use and
disclosure of your health information, you must
submit such request in writing.
The name, address, and telephone number of the
person to whom the request is to be submitted is
listed on the last page of this document.
Please note that we are not required to your
restriction request.
2.
THE RIGHT TO
INSPECT AND COPY YOUR MEDICAL AND BILLING RECORDS:
You have the right to inspect and copy your health
information, such as medical and billing records
that we use to make decisions about your services.
You must submit a written request to us.
If you request a copy of your medical
information, we may charge you a reasonable fee for
the paper, labor, mailing, and/or retrieval costs
involved in filing your requests.
We will provide you with information
concerning the cost of copying your health
information prior to performing such service.
The name, address, and telephone number of
the person to whom you may file your request is
listed on the last page of this document.
We will respond within thirty (30) days of
receipt of such requests.
3.
THE RIGHT TO AMEND
OR CORRECT YOUR INFORMATION:
You have the right to request that your health
information be amended or corrected if you have
reason to believe that certain information is
incomplete or incorrect. You
have the right to make such requests of us for as
long as we maintain/retain your health information.
Your requests must be submitted to us in
writing. We will respond within
sixty (60) days of receiving the written request.
If we approve your request, we will make such
amendments/corrections and notify those with a need
to know of such amendments/corrections.
We may deny your request if:
a.
Your request is not
submitted in writing
b.
Your written
request does not contain a reason to support your
request
c.
The information was
not created by us, unless the person or entity that
created the information is no longer available to
make the amendment
d.
It is not a part of
the health information kept by or for our company
e.
It is not part of
the information which you would be permitted to
inspect and copy
f.
The information is
already accurate and complete
4.
THE RIGHT TO
REQUEST CONFIDENTIAL COMMUNICATIONS:
You have the right to request that we communicate
with you about your health matters in a certain way
or at a certain location. For
example, you may request that we not send any health
information about you to a family member’s address.
We will agree to your request as long as it
is reasonably easy for us to do so.
You are not required to reveal nor will we
ask the reason for your request.
To
request confidential communications you must:
a.
Notify us in
writing
b.
Indicate what
information you wish to limit
c.
Indicate whether or
not you wish to limit or restrict our use or
disclosure information
d.
Identify to whom
the restrictions apply
e.
The name, address,
and telephone number of the person to whom you may
file your request is listed on the last page of this
document.
5.
THE RIGHT TO
REQUEST AN ACCOUNTING OF DISCLOSURES OF HEALTH
INFORMATION:
You have the right to request that we provide you
with a listing of when, to whom, for what purpose,
and what content of your health information we have
released over a specified period of time.
This accounting will not include any
information we have made for the purposes of
treatment, payment, or company operations or
information released to you, your family,
disclosures made for the national security purposes,
or any releases pursuant to your authorization.
Your request must be submitted to us in writing and
must indicate the time period for which you wish the
information. Your request may
not include releases for more than six (6) years
prior to the date of your request and may not
include releases prior to
April 14, 2003
. Your request must indicate
what form you wish to receive this information.
We will respond to your request within sixty
(60) days of the receipt of your written request.
Should additional time be needed to reply,
you will be notified of such extension.
However, in no case will such extension
exceed thirty (30) days. The
first accounting you request during a twelve (12)
month period will be free. There
may be a reasonable fee for additional requests
during the twelve (12) month period.
We will notify you of the cost involved and
you may choose to withdraw or modify your request at
that time before any costs are incurred.
The name, address, and telephone number of
the person to whom you may file your request is
listed on the last page of this document.
6.
THE RIGHT TO
RECEIVE A PAPER COPY OF THIS NOTICE:
You have the right to receive a paper copy of this
notice. You may request a paper
copy of this notice at anytime.
The name, address, and telephone number of the
person to whom you may obtain a paper coy of this
notice is listed below.
HOW TO FILE A
COMPLAINT
If you believe we have
violated your privacy rights, violated our privacy
policies and procedures, or you disagree with a
decision we made concerning access to your health
information, you have the right to file a complaint
with us or the Secretary of the Department of Health
and Human Services. Complaints
may be filed without fear of retaliation in any
form.
Please refer your complaint or
any written requests to:
Diabetic
Supplies, Inc.
2140 Riverside Drive, Suite 4
Columbus
,
OH
43221
Phone:
1-800-248-8814
Fax: 1-877-288-2520
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