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NOTICE
OF PRIVACY PRACTICES
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.
The Health Insurance Portability & Accountability Act of 1996
(HIPAA) is a federal program that requires that all medical records
and other individually identifiable health information used or
disclosed by us in any form, whether electronically, on paper,
or orally, are kept properly confidential. This Act gives you,
the patient, significant new rights to understand and control
how your health information is used. HIP AA provides penalties
for covered entities that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how
we are required to maintain the privacy of your health information
and how we may use and disclose your health information.
Key Issues,
We may use and disclose your health information for providing
durable medical equipment (DME), to obtain payment for DME, for
administrative purposes, and to evaluate the quality of service
that we provide. Continuity of care is part of treatment and your
records may be shared with other providers to whom you are referred.
We may use or disclose identifiable health information about you
without your authorization in several situations, but beyond those
situations, we will ask for your written authorization before
using or disclosing any identifiable health information about
you. See details below for examples of information uses.
Your rights: In most cases, you have the right to look at or get
a copy of health information about you. You also have the right
to receive a list of certain types of disclosures of your information
that we made. If you believe that information in your record is
incorrect, you have the right to request that we correct the existing
information.
Our legal duty: We are required by law to protect the privacy
of your information, provide this notice about our information
practices, follow the information practices that are described
in this notice, and seek your acknowledgement of receipt of this
notice. We reserve the right to change the terms of our Notice
of Privacy Practices. We will post and you may request a written
copy of the revised Notice of Privacy Practices. For more information
about our privacy practices, contact the person listed below.
Complaints: If you are concerned that we have violated your privacy
rights, or you disagree with a decision we made about access to
your records, you may contact the person listed below. You also
may send a written complaint to the U.S. Department of Health
and Human Services. The address is listed below. We will not retaliate
against you for filing a complaint.
Payment: Your protected health information will be used, as needed,
in activities related to obtaining payment for durable medical
equipment. For example, obtaining approval for your communication
device may require that your relevant protected health information
be disclosed to your health insurance company or governmental
plan to obtain approval for the equipment.
Healthcare Operations: We may use or disclose, as-needed, your
protected health information in order to support out business
activities. For example, when we review employee performance,
we may need to look at what an employee has documented in your
medical record.
Business Associates: We may share your protected health information
with a third party "business associate" that performs
various activities (e.g. billing, outside sales). Whenever an
arrangement between a business associate and us involves the use
or disclosure of your protected health information, we will have
a written contract that contains terms that will protect the privacy
of your protected health information.
Marketing: We may use or disclose certain health information in
the course of providing you with information about equipment alternatives,
health-related services, or fund-raising activities. You may contact
us to request that these materials not be sent to you.
Opportunity to Object
We may use and disclose your protected health information in the
following instances. You have the opportunity to object. If you
are not present or able to object, then your provider may, using
professional judgment, determine whether the disclosure is in
your best interest .
..•
Others Involved in Your Healthcare: Unless you object, we may
disclose to a member of your family, a relative, a close friend
or any other person you identify, your protected health information
that directly relates to that person's involvement in your health
care.
Communication Barriers: We may use and disclose your protected
health information if we have attempted to obtain acknowledgement
from you of our Notice of Privacy Practices but have been unable
to do so due to substantial communication barriers and we determine,
using professional judgment, that you would agree.
Without Opportunity to Object
We may use or disclose your protected health information in the
following situations without your authorization or opportunity
to object.
Public Health: For public health purposes to a public health authority
or to a person who is at risk of contracting or spreading your
disease.
Health Oversight: To a health oversight agency for activities
authorized by law, such as audits, investigations, and inspections.
Abuse, or Neglect: To an appropriate authority to report child
abuse or neglect, if we believe that you have been a victim of
abuse, neglect, or domestic violence.
Food and Drug Administration: In the course of legal proceedings.
Law Enforcement: For law enforcement purposes, such as pertaining
to victims of a crime or to prevent a crime.
Research: To researchers when their research has been approved
by an Institutional Review Board or Privacy Board.
Soldiers, Inmates, and National Security: To military supervisors
of Armed Forces personnel or to custodians of inmates, as necessary.
Preserving national security may also necessitate disclosure of
protected health information.
Workers' Compensation: To comply with workers' compensation laws.
Compliance: To the Department of Health and Human Services to
investigate our compliance.
In general, we may use or disclose your protected health information
as required by law and limited to the relevant requirements of
the law.
Your Rights
You have the right to:
Inspect and copy your protected health information: However, we
may refuse to provide access to certain psychotherapy notes or
information for a civil or criminal proceeding.
Request a restriction of your protected health information: You
may ask us not to use or disclose certain parts of your protected
health information for treatment, payment or healthcare operations.
You may also request that information not be disclosed to family
members or friends who may be involved in your care. Your request
must state the specific restriction requested and to whom you
want the restriction to apply. We are not required to agree to
a restriction that you may request, but if we do agree, then we
must act accordingly.
Request to receive confidential communications from us by alternative
means or at an alternative location: We will accommodate reasonable
requests. We may also condition this accommodation by asking you
for information as to how payment will be handled or specification
of an alternative address or other method of contact. We will
not request an explanation from you as to the basis for the request.
Ask us to amend your protected health information: You may request
an amendment of protected health information about you. If we
deny your request for amendment, you have the right to file a
statement of disagreement with us, and your medical record will
note the disputed information.
Receive an accounting of certain disclosures we may have made:
This right applies to disclosures for purposes other than treatment,
payment or healthcare operations. It excludes disclosures we may
have made to you, for a facility director, to family members or
friends involved in your care, or for notification purposes. You
have the right to receive specific information regarding these
disclosures. The right to receive this information is subject
to certain exceptions, restrictions and limitations .
Please
contact us for more information:
Joseph B. Myers, Myers Home Medical, Inc.
938 Cassat Avenue, Jacksonville, FL 32205, 904-695-0570
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For more information about HIP AA, or to file a complaint:
U.S. Department of Health and Human Services Office of Civil Rights
200 Independence Ave., SW Washington, DC 20201 877/696-6775
p:/sales/dis/ins/forms/HIPA A Notice. doc 11/13/06
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