At High Tech Mobility, we value your right to privacy. The protection of your personal health information and is of primary concern to us. Below are the guidelines we use for protecting the information you provide us during a visit to our Internet site http://hightechmobility.net or when we communicate with you by phone. This notice was published and on October 8, 2004, it was last revised on February 16, 2005. The last revision was to correct two misspelled words, one incorrect referenced URL link that contained a typo and several errors in punctuation that were noted and then corrected.
NOTICE OF PRIVACY PRACTICES
As required by the privacy regulations pursuant to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA).
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to furnish medical equipment, obtain payment for equipment you receive, conduct health care operations, or for other purposes permitted or required by law. This Notice also describes your rights to access and control your protected information. "Protected health information" is information about you, including your name, address, insurance information, and other information that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.
High Tech Mobility is required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. If we do change this notice, the new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our Website www.hightechmobility.net or calling at 1-205-491-2109 and requesting that a revised copy be sent to you in the mail, or by e-mail or facsimile.
A. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information For Treatment, Payment, and Operations
We will use or disclose your protected health information as described in Section A. Your protected health information may be used and disclosed by our company, employees assisting you, and others outside of our office that are involved in serving your medical equipment needs and only for the purpose of providing medical equipment to you. Your protected health information may also be used and disclosed to pay your health care bills and in the operation of High Tech Mobility.
We are providing the following examples of the types of uses and disclosures of your protected health care information that High Tech Mobility may make.
Provision of Services: We will use and disclose your protected health information to provide and coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected information. For example, we would disclose your protected health information, as necessary, to a rehabilitation clinic that provides care to you. We will also disclose protected health information to other physicians or therapists who may be treating you when we have the necessary permission from you to disclose protected health information. For example, your protected health information may be provided to a physician or therapist to whom you have been referred to ensure that the physician or therapist has the necessary information to properly diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your medical equipment and other health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the equipment we furnish. Examples of the activities that your insurance may undertake include: making a determination of eligibility or coverage for insurance benefits, reviewing medical necessity of the equipment, and undertaking utilization review activities. We may also use your protected health information to bill you directly for services and equipment not covered by your insurance.
Health Care Operations: We may use or disclose, as needed, your protected health information in order to conduct business activities of High Tech Mobility. These activities include, but are not limited to, quality assessment activities, clinical research, licensing, marketing activities, cost-management and business planning activities, and as required by federal, state, or local law. We may use or disclose your protected health information, as necessary, to contact you regarding delivery or repair of your medical equipment. In addition, we may also call you by name in a group training or information session conducted to educate several users about their medical equipment.
We will share your protected health information with third party "business associates" that perform various activities (e.g., billing services or equipment repair services) for our company. Whenever an arrangement between our company and a business associate involves the use or disclosure of your protected health information, we will have a written contract with that business associate that contains terms to protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives, medical equipment, or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about our company and other products or services we offer that we believe may be beneficial to you. You may contact our Privacy Officer, listed within this Notice, to request that these materials not be sent to you.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke an authorization, at any time, in writing. However, please be aware that except to the extent that our company has already taken actions in reliance on the use or disclosure indicated in the authorization, those actions cannot be undone.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization, After Having Given You Opportunity to Object
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then by law, our company may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
Others Involved in Your Health Care: 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. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, about your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If an emergency situation occurs while we are serving you, our staff will attempt to obtain your consent as soon as reasonably practicable after treatment is delivered by the appropriate health care provider. If the physician or therapist is required by law to treat you and has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat, or assist in treating you.
Communication Barriers: We may use and disclose your protected health information if our staff or another health care provider in our presence attempts to obtain consent from you but is unable to do so due to substantial communication barriers - if our professional judgment indicates that you intend to consent to use or disclosure of your information under the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization, After Having Given You Opportunity to Object
We may use or disclose your protected health information in the following situations without your authorization. These situations include:
Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information, if we believe that you have been a victim of abuse, neglect or domestic violence, to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice's premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death.
Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers' Compensation: Your protected health information may be disclosed as authorized to comply with workers' compensation laws and other similar legally-established programs.
Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility. Disclosure for these purposes would be necessary for the correctional facility to provide health care services to you, for the safety of the correctional facility, and to protect the health and safety of you and other individuals.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
B. Your Rights Regarding Your Protected Health Information
The following statements advise you of your rights with respect to your protected health information and provide a description of how you may exercise these rights
You Have the Right to Inspect and Copy Your Protected Health Information: You may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that we use for assisting you.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, you may be able to have reviewed a decision by us to deny access to your information. Please contact our Privacy Officer if you have questions about access to your medical record.
You Have The Right To Request A Restriction Of Your Protected Health Information: You may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
By law, High Tech Mobility is not required to agree to a restriction that you may request. If we believe that medically, it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If we agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with our Privacy Officer. Contact information for our Privacy Officer is contained at the end of this Notice.
You Have The Right To Request To Receive Confidential Communications From Us By Alternative Means Or At An Alternative Location: We will accommodate reasonable requests to provide confidential communications to you by alternative means or at an alternative location. 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 reason for your request. Please make this request in writing to our Privacy Officer.
You May Have The Right To Have Your Protected Health Information Amended: You may request that we amend your protected health information stored in a designated record set for as long as we maintain this information. We may deny your request for an amendment if you request amendment of information that is accurate, not created by our organization, not part of the identifiable health information kept by our organization, or not part of identifiable health information that you would be permitted to inspect or copy. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement; however, if we do, we will provide you with a copy of any such rebuttal. A copy of this correspondence will be included with the designated record set. Please contact our Privacy Officer if you have questions about amending the medical record that we have maintained for you.
You Have The Right To Receive An Accounting Of Certain Disclosures High Tech Mobility Have Made, If Any, Of Your Protected Health Information: You may request an accounting of disclosures of your PHI. This right applies does not apply to disclosures: (1) disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices; (2) to you; (3) pursuant to an authorization; (4) to individuals involved in your care; or (5) for purposes of military or national security, as described above. This right excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You Have The Right To Obtain A Paper Copy Of This Notice From Us: Upon request, even if you have agreed to accept this Notice electronically, you have the right to receive a paper copy from us.
You may forward your complaints to us or to the Secretary of the Department of Health and Human Services if you believe that we have violated your privacy rights. You may file a complaint with us by notifying George White, the company Owner and our Privacy Officer and discuss your complaint. We will not retaliate against you for filing a complaint, in fact we encourage you to let us know. Please let us know so we can resolve problems like this to your satisfaction. That is important to us as we care about protecting privacy and your rights and want to work with you on things like this so they won't happen again to someone else in the future. We are always striving to improve our customer relations and the services we provide to those facing physical challenges in their everyday lives. We want to help.
You may contact our Privacy Officer at:
Physician and Patient Relations:
141 Church Avenue, Hueytown AL 35023
(205) 491-2109 (Office)
(205) 491-7772 (Fax)
Please acknowledge your receipt of this Notice of Privacy Practices by filling in the requested information below, signing it and returning by fax or mail to:
You may also confirm your receipt of this notice by e-mail to: firstname.lastname@example.org
Printed Name: __________________________________________________
Street Address: __________________________________________________
City:_____________________________________State: _______ Zip: _______