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Amigo Mobility Center, Inc. | |
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Apr 25, 2003 | |
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UNDERSTANDING THIS NOTICE |
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Amigo
Mobility Center (“AMC”) is required by law to maintain the privacy
of Protected Health Information (“PHI”). PHI is information
that may identify you and that relates to your past, present or future
physical or mental health, the provision of health care to you, or
the payment for the provision of health care to you. This Notice
of Privacy Practices ("Notice") describes how we may use and disclose
PHI for treatment, payment or health care operations activities or
as otherwise permitted or required by law. This Notice also
describes our legal duties and your rights with respect to your PHI.
We are required by law to provide you with this Notice. We are required
to follow the terms of our Notice currently in effect. We reserve
the right to change our practices and this Notice and to make the
new Notice effective for all the PHI we maintain, including information
created or received before the change. Should our privacy practices
change, we are not required to notify you, but we will post the new
Notice at our local branch offices. You may also request copies
of the new notice in person at our local branch offices or on our
web site at www.amigodfw.com. HOW WE MAY USE AND DISCLOSE YOUR
PHI: The following categories describe different ways that we use and
disclose your PHI. We have provided you with examples in certain categories.
Not every use or disclosure in a category will be listed. However,
all of the ways we are permitted to use and disclose your PHI should
fall within one of these categories. Treatment. We may use and disclose
your PHI to provide you with health care products or services or to
coordinate or manage your health care with other health care providers.
For example, we may use or disclose your PHI to provide you with a
customized wheelchair or to provide you with appointment reminders
or information about treatment alternatives or other health-related
benefits or services that may be of interest to you. We may
also disclose your PHI to therapists, physicians and other health
care providers who are involved in your care. Payment. We may use and
disclose your PHI for various payment-related functions. For
example, we may disclose your PHI to a third-party payer, such as
an insurance company, Medicare or Medicaid, for the purpose of getting
the payer’s prior authorization to provide our products or services
to you. We may also send a bill to you or a third-party payer.
The bill may include information that identifies you, as well as your
diagnosis and the products or services we provided to you. Health
Care Operations. We may use your health information for certain
operational, administrative and quality assurance activities.
For example, we may use information in your health record to monitor
the performance of the Rehab Technology Specialists who provide services
to you. This information will be used in an effort to continually
improve the quality and effectiveness of the health care and services
we provide. As Otherwise Allowed by Law. We are permitted to
use or disclose your PHI for the following purposes. However, we may
never have reason to make some of these uses or disclosures. · Business Associates. We allow business associate to provide
certain services on our behalf that involve the disclosure of your
PHI. However, our business associates will agree to take appropriate
steps to safeguard your information. · To Communicate with Individuals Involved in Your Care or Payment for
Your Care. We may disclose PHI to a family member, other relative,
close personal friend or any other person you identify. We will
endeavor to disclose only the PHI that is directly relevant to that
person's involvement in your care or payment related to your care. · Food and Drug Administration (“FDA”). We may disclose to the
FDA, or persons under the jurisdiction of the FDA, PHI relative to
adverse events with respect to products and product defects, or post-marketing
surveillance information to enable product recalls, repairs, or replacement. · Worker's Compensation. We may disclose your PHI to the extent authorized
by, and to the extent necessary to comply with, laws relating to worker's
compensation or other similar programs established by law. · Public Health. Consistent with applicable law, we may disclose
your PHI to public health agencies or legal authorities charged with
preventing or controlling disease, injury, or disability. · Law Enforcement. Consistent with applicable law, we may disclose
your PHI for law enforcement purposes if asked to do so by a law enforcement
official. · As Required
by Law. We may use or disclose your PHI when required to do so by
federal, state, or local law. · Health Oversight Activities. We may disclose your PHI to an oversight
agency for activities authorized by law. These oversight activities
might include audits, investigations, inspections, and credentialing,
as necessary for licensure and for the government to monitor the health
care system, government programs, and compliance with civil rights
laws. · Judicial and
Administrative Proceedings. We may disclose your PHI in response
to a court or administrative order. We may also disclose health information
about you in response to a subpoena, discovery request, or other lawful
process, but only if the requesting party represents that it has made
efforts to tell you about the request or to obtain an order protecting
the information requested. · Research. We may disclose your PHI to researchers when their research
has been approved by an institutional review board or privacy board
that has reviewed the research proposal and established protocols
to ensure the privacy of your information. · Notification. We may use or disclose your PHI to notify or assist
in notifying a family member, personal representative, or another
person responsible for your care, regarding your location and general
condition. · Fundraising.
We may contact you as part of a fundraising effort. · To Avert a Serious Threat to Health or Safety. Consistent with
applicable law, we may use and disclose your PHI when necessary to
prevent a serious threat to your health and safety or the health and
safety of the public or another person. · Military and Veterans. If you are a member of the armed forces, we
may release PHI about you as required by military command authorities.
We may also release PHI about foreign military personnel to the appropriate
foreign military authority. · National Security, Intelligence Activities, and Protective Services
for the President and Others. We may release PHI about you to federal
officials for intelligence, counterintelligence, protection to the
President, and other national security activities authorized by law. · Victims of Abuse or Neglect. We may disclose PHI about you to a government
authority if we reasonably believe you are a victim of abuse or neglect.
We will only disclose this type of information to the extent required
by law, if you agree to the disclosure, or if the disclosure is allowed
by law and we believe it is necessary to prevent serious harm to you
or someone else. Other Uses and Disclosures of Your PHI. We will
obtain your written authorization before making a use or disclosure
of your PHI that does not fall into one of the categories listed above.
You may revoke your authorization in writing at any time. Upon receipt
of the written revocation, we will stop using or disclosing your PHI,
except to the extent that we have already taken action in reliance
on the authorization. YOUR HEALTH INFORMATION RIGHTS: Right to Inspect
and Copy. In most cases, you have the right to inspect and copy
the PHI that we maintain about you. To inspect or copy your PHI, you
must send a written request to your local AMC office. We may charge
you a fee for the costs of copying (25 cents per page), mailing and
supplies that are necessary to fulfill your request. We may deny your
request to inspect and copy in certain limited circumstances. Right
to Amend. If you feel that PHI we maintain about you is incomplete
or incorrect, you may request that we amend it. To request an amendment,
you must send a written request to your local AMC office. You must
include a reason that supports your request. In certain cases, we
may deny your request for amendment. Right to an Accounting of Disclosures.
You have the right to receive an accounting of the disclosures we
have made of your PHI after April 14, 2003 for most purposes other
than treatment, payment, or health care operations. The right to receive
an accounting is subject to certain exceptions, restrictions, and
limitations. To request an accounting, you must submit a request in
writing to your local AMC office. Your request must specify
the time period. The time period may not be longer than six years
and may not include dates before April 14, 2003. The first accounting
you request within a 12-month period will be free. For additional
accountings, we may charge you for the costs of providing the accounting. Right
to Request Restrictions. You have the right to request a restriction
on our uses and disclosures of your PHI for treatment, payment, or
health care operations. You also have the right to request restrictions
on our disclosures to persons, such as family members, involved in
your care or the payment for your care. However, we are not
required to agree to these requests. To request restrictions,
you must make your request in writing to the local AMC office. In
your request, you must tell us (1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both; and (3)
to whom you want the limits to apply, for example, disclosures to
your spouse. Right to Request Communications by Alternative Means or
at Alternative Locations. You have the right to request that we communicate
with you about medical matters in a certain way or at a certain location.
For example, you can ask that we contact you only at work or by mail.
To request communications by alternative means or at alternative locations,
you must make your request in writing to the local AMC office.
We will accommodate all reasonable requests. Your request must specify
how or where you wish to be contacted. Right to a Paper Copy of This
Notice. You have the right to a paper copy of this notice. You may
ask us to give you a copy of this notice at any time. Even if you
have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice. To obtain a paper copy of this
notice please contact the local AMC office. You may also obtain
an electronic copy of this notice at our website, www.amigodfw.com. FOR
MORE INFORMATION OR TO REPORT A PROBLEM: If you have questions or would
like additional information about AMC's privacy practices, you may
contact our Officer at (800) 886-8237. If you believe your privacy
rights have been violated, you can file a written complaint with the
Privacy Officer or with the Secretary of Health and Human Services.
Send written correspondence to the Privacy Officer c/o Amigo Mobility
Center, Inc., 2100 Highway 360, Suite 1802, Grand Prairie, Texas 75050.
There will be no retaliation for filing a complaint. |
