HOME
THERAPY EQUIPMENT, INC.
NOTICE
OF PRIVACY PRACTICES
This
notice is effective as of
April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY.
The Health Insurance Portability and Accountability
Act (HIPAA) requires Home Therapy Equipment, Inc. to protect the privacy of
medical information about you and that identifies you. We
are also required by law to provide you with this Notice of Privacy Practices
to describe how we may use or disclose your protected health information. This
notice also explains your rights regarding this protected health information.
We may make changes to this Notice at any time. You can obtain a revised copy
of this Notice by contacting our office: [Privacy
Officer: Home Therapy Equipment, Inc. 4 Enterprise Ave Clifton Park, NY 12065
Att: Jill E Martin phone # 518-664-6654]
I. Uses
and Disclosures of Protected Health Information
Home therapy Equipment, Inc. uses protected health
information on a daily basis to provide treatment, obtain payment, to carry out
healthcare operations, and for other uses within our organization. The
following are examples of how your information may be used:.
Treatme
nt:
Your protected health information may be used to
provide you with the appropriate durable medical equipment as ordered
by your physician. For example, we cwould use your diagnosis provided by
your physician to help select a wheelchair that would best meet your needs for
mobility.
Payment
:
We may use or disclose your protected health
information to obtain payment for healthcare that has been provided. For
example, we may contact your health insurance carrier and provide them with
your protected health information to ensure that you qualify for the equipment.
This
information may also be disclosed when we seek payment for services
provided.
Healthc
are
Operations:
We may use or disclose your protected health
information to provide effective business operations. For example, this
information may be used to for quality improvement, staff
training, or to review
employee performance. We may also use it to call you to see if you need any
further supplies such as respiratory medications.
Individ
uals
Iinvolved
Iin Yyour Ccare:
We may disclose protected health information to a
family member or other individuals you have designated to be involved in your
care. For example, it may be used to let your caretakerthe person know the
type of equipment we need to deliver to you.
Disclosure
as required by
lawLawsuits and Similar
Proceedings:
We may disclose protected health information in response to a court or
administrative order. if we are ordered to by the court.
For
example, if
we may be required to respond to a are served with
a
subpoena that requires us to
disclose your protected
information to the
court.
Disclosure for
Law
Eenforcement:
We may disclose your protected health information to
assist law
enforcement of the law. For example, if a crime has been
committed, or to help find a missing person.
Disclosure for
Ppublic Hhealth Aactivities:
Public health activities may require us to disclose
your protected health information for the investigation of diseases or injury,
or for monitoring drugs or devices regulated by the Food and Drug
Administration. For example, if you are exposed to a communicable disease, we
would be required to release your protected health information to the State
Health Department.
Disclosures to
Social
Services or Protective Service Agencies:
We may disclose your protected health information if
we reasonably believe that you may be a victim of abuse, neglect or domestic
violence.
Disclosure to
Ggovernment Aagencies:
We may disclose protected health information to
governmental agencies authorized by law to conduct health oversight activities
including audits and investigations. For example, Medicare may come to our offices to conductdo
an audit and they will want to see our customer complaint
log.
Disclosure to
Business
Associates:
We may disclose protected health information to our bBusiness aAssociates. An
example of a business associate is our software vendor. They supply us with a
computer program that allows us to carry out our daily operations. All of our
business associates will be
required to sign contracts that explaining how they can use
your protected health information. The business associates will also and be required to safeguard the privacy of your protected healththis information.
Worker’s Compensation
National Security
Military
We
may disclose your protected health information if you are a member of US or foreign military
forces (including veterans) and if required by the appropriate military
authorities.
Uses and Disclosures Not Mentioned in This Notice: Authorization:
Other uUses and/or disclosures of your protected health
information that are not
mentioned in this Notice will be made only with your written
authorization. You can revoke this authorization at any time.
II. Your
Rights Regarding Your Protected Health Information
You have certain rights regarding your protected
health information. The following is a list of those rights:
Confidential Communications
You have the right to request that
our organization communicate
with you about your health and related issues in a particular manner or at a
certain location. For
instance, you may ask that we contact you at home instead of at work. In order
to request a type
of confidential communication, please make a request in writing
to: [Home
Therapy Equipment, Inc. 4 Enterprise Ave Clifton Park, NY 12065 Att: Jill
Martin, Privacy Officer],
specifying the requested method of communication. You need not give a reason
for this request. Our office will accommodate all reasonable requests.
You have
the
right
ofTo Rreceive a Paper Ccopy
of Tthis
Nnotice:
Upon request you canYou are entitled to receive
a paper copy of this
Notice of Privacy Practices
upon request. You may ask us for a copy at any time. To obtain a paper copy of this Notice, contact:
[Home
Therapy Equipment, Inc. 4 Enterprise Ave Clifton Park, NY 12065 Att: Jill
Martin, Privacy Officer. Phone # 518-664-6654]
The
right
tTo Rrequest Rrestrictions on the
Uuse and/or Ddisclosure:
You have the right to request that we restrict the use and/or the
disclosure of your protected health information. We will review this request,
however we are not obligated to agree with the requested restrictions. However, if we do agree, we are
bound by our agreement except when otherwise required by law, in the event of
an emergency, or when disclosure of this information is required to treat you.
In order to request a restriction in the use and/or disclosure of your protected
health information, you must make a request in writing to: [Home Therapy Equipment,
Inc. 4 Enterprise Ave. Clifton Park, NY 12065 Att: Jill Martin, Privacy Officer]. Your request must
describe in a clear and concise fashion: (a) the information you wish to be restricted,
(b) whether you are requesting a limit on use, disclosure, or both, and (c) to whom you want the limits to
apply.
The right tTo Iinspect and Ccopy Yyour Pprotected Hhealth Iinformation:
You have the right to inspect and copy your
protected health information. If you choose to do so, we will need the request
to be in writing. Please send this request to the attention of ourthe Privacy Officer: [Home
Therapy Equipment, Inc. 4 Enterprise Ave. Clifton Park, NY 12065 Att: Jill
Martin].
Our organization may charge a reasonable fee associated with complying with your request.
The right
tTo Aamend Pprotected Hhealth Iinformation:
If you feel that your protected health information
is incorrect or incomplete, you have the right to request that it be amended
(corrected). This request needs to be made in writing to the Privacy Officer, [Home Therapy Equipment,
Inc. 4 Enterprise Ave. Clifton Park, NY 12065 Att: Jill Martin]. You must provide us
with a reason that supports your request for amendment. We have the right
to deny your request and we will explain theese reason(s) for denial in writing. If you disagree with
this denial, you may file a statement of disagreement.
The right to
request communications occur at an alternative location:
For example, you may chose to have information
mailed to an address other than your home address.
The
right
tTo Rreceive an Aaccounting of Ddisclosures:
You
have the right to request an “accounting of disclosures”. This is a list of certain disclosures
our organization has made of your protected health information. This right applies allto disclosures for
other
than those used for
treatment,
payment or healthcare operations. This request must be made in writing to: [Home Therapy Equipment,
Inc. 4 Enterprise Ave. Clifton Park, NY 12065 Att: Jill Martin]. The information you will receive will include disclosures that have
occurred after April 14, 2003. Pleas submit your request in writing to our Privacy
Officer. The
first list you request in a given 12-month period is free. Our organization may
charge you for additional lists you request within that same 12-month period.
Our organization will notify you of the costs involved, and you may withdraw
your request before costs are incurred.
COMPLAINTS ABOUT OUR PRIVACY PRACTICES
You may file a written complaint with to Home Therapy Equipment, Inc. or the Departmentt of Health and Human
Services
or to Home Therapy Equipment, Inc. if you
feel that your privacy has been violated. You or any person involved in your
care will not be retaliated against for filing a complaint. The address to file
a complaint with the dept of health and Human Servicesour organization is: [Home
Therapy Equipment, Inc. 4 Enterprise Ave. Clifton Park, NY 12065]
Dept of Health
and Human Services/ Office of Civil Rights
200
Independence Ave SW Room 509 HHH Building
Washington
DC 20201
Phone#
800-368-1019
The address to file a complaint
with the Department of Health and Human Services is:
Department of Health and Human Services / Office of Civil
Rights
200
Independence Ave SW Room 509 HHH Building
Washington
DC 20201
Phone:
800-368-1019
Company
Contact Person for Further Information, or to Submit a Complaint:
If you should have any questions regarding this notice or to file a
complaint, please contact our Pprivacy Officer: Jill Martin at:
Home Therapy Equipment, Inc. 4 Enterprise Ave. Clifton Park, NY 12065. Phone:
518-664-6654.