NOTICE OF PRIVACY PRACTICES (Attachment 11.1A)
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.
We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change those terms and any changes made will be effective for all medical information we maintain. A copy of the revised notice will be available at our office, from our Privacy Coordinator by calling (913) 721-3737 or by writing to Advanced Medical DME, 2040 Hutton Road, Kansas City, Kansas 66109, Attention: Privacy Coordinator. You may also address questions regarding our privacy practices, your privacy rights, or requests for additional information regarding your privacy to this person.
We may use and disclose your medical information for specific reasons:
Treatment: We will provide your doctor or other health care providers, involved in your care, with the type of equipment we provide and information related to your condition and how your use of our equipment affects that condition.
Appointment/Service Reminders: We may contact you before the initial equipment instruct to remind you of your appointment or to talk to you about preparing for the set up. We may also contact you periodically to follow up on your use of the equipment in order to answer your questions and to discuss your compliance with the prescribed therapy with your ordering physician.
Payment: We will bill your insurance company, you directly, or another person that may be responsible for payment of your account. We may contact your health plan provider to see if they will pay for the equipment and services your doctor has ordered. Many insurance plans require proof of medical necessity which will be obtained from your physician.
Health Care Operations: We will use or disclose your protected health information to support our business activities authorized by law, such as audits, investigations, inspections, quality control; disciplinary actions; or civil, administrative, or criminal proceedings or actions. We may also select your billing information for review by our internal or external Compliance Department or by external auditors.
Business Associates : We contract with individuals and entities (business associates) to perform various functions on our behalf or to provide certain types of services. To perform these functions (to provide the services), business associates will receive, create, maintain, use or disclose your protected health information, we require business associates to agree in writing to safeguard your information.
Disclosures without Authorization
Disclosures Required by Law: We may be required by federal, state, or local law to disclose your medical information.
Public Health Activities: We may disclose your medical information to a public agency (such as the Food and Drug Administration - FDA) if you experience an adverse effect from any of the drugs, supplies or equipment we use.
Victims of Abuse, Neglect, or Domestic Violence: We may be required to disclose your medical information if we feel that you have been abused or neglected.
Health Oversight Activities: We may be required to disclose your medical information to Medicare or related agency if they select your case for a medical review.
Judicial and Administrative Proceedings: We may have to disclose your medical information if we receive a subpoena from a judge or administrative tribunal.
Law Enforcement: We may have to disclose your medical information in conjunction with a criminal investigation by a federal, state, or law enforcement agency.
Serious Threats to Health or Safety: We may be required to disclose your medical information if, in our opinion, doing so will help avert a serious threat to the public.
Military Personnel: We may disclose your medical information to the appropriate command authorities.
Worker's Compensation: We may disclose your medical information to comply with laws regarding worker's compensation.
Your rights with respect to your protected health information are as follows:
Right to Request a Restriction: You have the right to request we restrict the protected health information we use to disclose about you. We are not required to agree to any restriction that you may request. If we do agree to the restriction, we will comply with the restriction unless the information is needed to provide emergency treatment to you and as required by law. Your request must: 1) be in writing, 2) describe the information that you want restricted, 3) state if the restriction is to limit our use or disclosure, and 4) state of whom the restriction applies.
Confidential Communications: You may ask that we communicate with you in a particular way, or at a certain location, to maintain your confidentiality. Your request must be in writing. We will accommodate a request for confidential communications that is reasonable and that state that the disclosure of all or part of your protected health information could endanger you.
Inspect and Copy: You may request access to inspect and copy your medical information maintained in designated record set. Your request must be in writing. We will act and process your request in a timely manner. We may deny your request to inspect or to receive a copy of your protected health information in certain limited circumstances. If you are denied access we will send you a written denial. If this happens, you may request that the denial be reviewed. To request a review you must contact us at the address provided in the privacy notice. A fee may be charged for this service.
Amendment: You may ask us to amend your health information if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. Your request may be denied if we believe that the information is complete and accurate, if the information is not part of the medical information that you would be permitted to inspect or copy, or if we did not create the information.
Accounting of Disclosures: You may request a list of disclosures that we have made of your medical information of the previous six (6) years. You may not request an accounting of dates of services prior to April 14, 2003. Your first request within a 12-month period is free, but we may charge for additional lists within the same 12-month period.
Paper COPY of This Notice: You are entitled to receive a paper copy of our Notice of Privacy Practices by using the contact information provided on the first page.
File a Complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with us using the contact information on the first page. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for complaining.
Provide an Authorization for other uses and Disclosures: We will request your written authorization for uses and disclosures of your medical information that are not identified in this notice or permitted by law. You may revoke your authorization at any time in writing.
Effective Date: August 7, 2006