NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH 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 is provided to you
as a requirement of the Health Insurance Portability
and Accountability Act (HIPAA). It describes how we
may use or disclose your protected health information,
with whom that information may be shared, and the safeguards
we have in place to protect it. This notice also describes
your rights to access and amend your protected health
information. You have the right to approve or refuse
the release of specific information outside of our company
except when the release is required or authorized by
law or regulation. You will be asked to provide a signed
acknowledgment of receipt of this notice. Our intent
is to make you aware of the possible uses and disclosures
of your protected health information and your privacy
rights. The delivery of your healthcare services will
in no way be conditioned upon your signed acknowledgment.
If you decline to provide a signed acknowledgment, we
will continue to provide your treatment and will use
and disclose your protected health information for treatment,
payment, and healthcare operations as necessary.
Our Duties to You Regarding Protected Health Information
“Protected health information” is individually
identifiable health information. This information includes
demographics, for example, age, address, e-mail address,
and information related to your past, present, or future
physical or mental health or condition and related healthcare
services, including diagnoses, equipment utilized, etc.
Chesapeake Rehab Equipment is required by law to do
the following:
§ Make sure that your protected health information
is kept private,
§ Give you this notice of our legal duties and
privacy practices related to the use and disclosure
of your protected health information,
§ Follow the terms of the notice currently in
effect,
We reserve the right to change this notice. Its effective
date is at the top of the first page. We reserve the
right to make the revised or changed notice effective
for health information we already have about you as
well as any information we receive in the future. You
may obtain a Notice of Privacy Practices by accessing
the Chesapeake Rehab Equipment website at www.chesrehab.com,
calling the CRE Privacy Officer at 410-298-4555 or 1-800-777-6981and
requesting a copy be mailed to you, or asking for a
copy at your next appointment from any CRE employee.
How We May Use or Disclose Your Protected Health Information
Following are examples of permitted uses and disclosures
of your protected health information. These examples
are not exhaustive.
Required Uses and Disclosures: We may disclose your
protected health information in the following contexts,
including, but not limited to:
§ The Secretary of the Department of Health and
Human Services for investigations or determinations
of our compliance with laws on the protection of your
health information.
§ A public health authority who is permitted by
law to collect or receive the information. Such a disclosure
may be necessary to prevent or control disease, injury,
or disability; report suspected abuse or neglect; report
reactions to or problems with products; or to notify
a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or
condition.
§ A health oversight agency for activities authorized
by law, such as audits, investigations, and inspections.
These health oversight agencies might include government
agencies that oversee the healthcare system, government
benefit programs, other government regulatory programs,
and civil rights agencies.
§ The Food and Drug Administration or their designee
to report adverse events, product defects, track products,
enable product recalls, make repairs and replacements,
and conduct post-marketing surveillance as required.
§ In response to a court order or administrative
tribunal (if such a disclosure is expressly authorized)
during any judicial or administrative proceeding, and
in certain conditions in response to a subpoena, discovery
request, or other lawful process.
§ To law enforcement in response to legal proceedings.
§ To your parent(s) and/or guardian(s) if you
are a minor and your state law permits or requires disclosure
of protected health information to persons in or acting
in a parental, guardian, or similar legal status.
Treatment: We will use and disclose your protected
health information to provide you with the medical equipment
that your doctor has prescribed for you. The information
you provide us will/may be shared with other organizations
directly related to providing the equipment you need.
This information may be faxed, written, emailed, or
relayed verbally. The organizations that we may share
information with include, but are not limited to:
§ Your physician and any consulting physicians
to determine what equipment you need based on your treatment
plan, anticipated future needs, and past medical history,
§ Your home health agency and staff directly related
to your care to determine if there are any homecare
related issues related to the equipment you will receive,
including other equipment you have, physical issues,
and structural issues in your residence,
§ Your PT and/or OT staff to assist with determining
your mobility needs through evaluation,
§ The facility where you reside (hospital, nursing
home, group home, assisted living facility, etc.) to
assure equipment provided is adequate for your needs
in your home,
§ Manufacturers related to specific information
to properly fit your equipment and/or to be notified
of equipment recalls,
Payment: Your protected health information will be
used, as needed, to obtain payment for equipment and
services provided to you. This may include certain activities
Chesapeake Rehab Equipment might undertake to determine
eligibility or coverage for benefits, to determine medical
necessity for equipment or services, filing claims to
insurers and/or their clearinghouses, and utilizing
collection agencies and/or attorneys for purposes of
collecting outstanding monies due.
Healthcare Operations: We may use or disclose, as needed,
your protected health information to support the daily
activities related to healthcare. These activities include,
but are not limited to, quality assessment activities,
investigations, oversight or staff performance reviews,
training of staff, licensing, and accreditation to assure
that minimum standards of practice are followed. We
may use or disclose your protected health information
as necessary to contact you regarding appointments.
We will share your protected health information with
third party “business associates” who perform
various activities (for example, auditing, transcription
services, contracted evaluation services, information
technology services) for Chesapeake Rehab Equipment.
The business associates will also be required to protect
your health information.
We may use or disclose your protected health information
as necessary to provide you with information about treatment
alternatives or other equipment related benefits and
services that might interest you. For example, your
name and address may be used to send you information
about Chesapeake Rehab Equipment services or products
that we believe may benefit you.
Uses and Disclosures of Protected Health Information
Requiring Your Permission
In some circumstances, you have the opportunity to
agree or object to the use or disclosure of all or part
of your protected health information. Following are
examples in which your agreement or objection is required:
Individuals 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 healthcare.
We may also give information to someone who helps pay
for your care.
Your Rights Regarding Your Health Information
Right to Inspect and Copy: You may inspect and obtain
a copy of your protected health information 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 Chesapeake Rehab
Equipment uses for making decisions about you. This
right does not include inspection and copying of the
following records: 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.
Right to Request Restrictions: You may ask us not to
use or disclose any part of your protected health information
for treatment, payment, or healthcare operations. Your
request must be made in writing to the Chesapeake Rehab
Equipment Privacy Officer. In your request, you must
tell us (1.) what information you want restricted, (2.)
whether you want to restrict our use, disclosure, or
both, (3.) to whom you want the restriction to apply
(for example, disclosure to your spouse), and (4.) an
expiration date. If Chesapeake Rehab Equipment believes
that the restriction is not in the best interest of
either party, or we cannot reasonably accommodate the
request, Chesapeake Rehab Equipment is not required
to agree. If the restriction is mutually agreed upon,
we will not use or disclose your protected health information
in violation of that restriction except when legally
required to do so or in an emergency situation. You
may revoke a previously agreed upon restriction at any
time in writing.
Right to Request Confidential Communications: You may
request that we communicate with you using alternative
means or at an alternative location. We will not require
a reason for the request and will accommodate reasonable
requests whenever possible.
Right to Request Amendment: If you believe that the
information we have about you is incorrect or incomplete,
you may request an amendment to your protected health
information as long as we maintain this information.
While we will accept requests for amendment, we are
not required to agree to the amendment.
Right to an Accounting of Disclosures: You may request
that we provide you with an accounting of the disclosure
we have made of your protected health information. This
right applies to disclosure made for purposes other
than treatment, payment, or healthcare operations as
described in this Notice of Privacy Practices. The disclosure
must have been made after April 14, 2003, and no more
than 6 years from the date of request. This right excludes
disclosures made to you, to family members or friends
involved in your care, or for notifications. The right
to receive this information is subject to additional
exceptions, restrictions, and limitations as described
earlier in this notice.
Right to Obtain a Copy of this Notice: You may obtain
a paper copy of this notice from Chesapeake Rehab Equipment
by request or view it electronically on the Chesapeake
Rehab Equipment website at www.chesrehab.com.
Complaints
If you believe these privacy rights have been violated,
you may file a written complaint with the Chesapeake
Rehab Equipment Privacy Officer or the Department of
Health and Human Services. No retaliation will occur
against you for filing a complaint.
Contact Information
You may contact the Chesapeake Rehab Equipment Privacy
Officer, Melissa Kaufman, for additional information
about the complaint process by calling 410-298-4555
or 800-777-6981 or by email at mkaufman@chesrehab.com.
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