NOTICE OF PRIVACY PRACTICES
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.
The terms of this Notice of Privacy Practices applies to Progressive Medical, Inc. and subsidiaries. We are required by law to maintain the privacy of protected personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your protecting your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at www.progressive-medical.com or a copy may be obtained by mailing a request to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization.
Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that consent or authorization in writing unless we have taken any action in reliance on the consent or authorization.
Uses and Disclosures for Treatment.
We will make uses and disclosures of your personal health information as necessary for coordination and management of your health care and related services. This includes the coordination or management of your health care with a third party, i.e. we could disclose your protected health information, as necessary, to another organization to assist in providing medical products or care to you. We may use or disclose information, as necessary, to contact you to obtain information on your use of provided medical equipment and/or supplies, and your progress while using. We would also disclose your protected health information to a nurse case manager or claims adjuster handling your claim.
Uses and Disclosures for Payment.
We will make uses and disclosures of your personal health information as necessary for payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding services provided to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations.
We will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations, which include but are not limited to, quality assessment activities, clinical improvement, professional peer review and training, licensing, business management and conducting or arranging other business activities.
Family and Friends Involved In Your Care.
With your approval, we may from time to time disclose your personal health information to designated family, friends and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval.
Business Associates.
Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, vendors, legal services, etc. At times, it may be necessary for us to provide certain of your personal health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Reminders and Services.
We may contact you to provide reminders on upcoming service or product reminders. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You may request such confidential communication in writing and may send your request to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
Other Uses and Disclosures.
We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization.
· We may release your personal health information for any purpose required by law;
· We may release your personal health information for public health activities, such as required reporting of disease, injury, and birth and death and for required public health investigations;
· We may release your personal health information as required by law if we suspect child abuse or neglect; we may also release your personal health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
· We may release your personal health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
· We may release your personal health information to your employer when we have provided health care to you at the request of your employer; in most cases you will receive notice that information is disclosed to your employer;
· We may release your personal health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
· We may release your personal health information if required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release;
· We may release your personal health information to law enforcement officials as required by law to report wounds and injuries and crimes;
· We may release your personal health information to coroners and/or funeral directors consistent with law;
· We may release your personal health information if necessary to arrange an organ or tissue donation from you or a transplant for you;
· We may release your personal health information for certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy;
· We may release your personal health information in limited instances if we suspect a serious threat to health or safety;
· We may release your personal health information if you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities; and
· We may release your personal health information to workers' compensation agencies if necessary for your workers' compensation benefit determination.
You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge you $.50/pg +$10 search fee if you request a copy of the information. We will also charge for postage if you request a mailed copy and will charge for preparing a summary of the requested information if you request such summary. You can view printable request for this information by accessing forms at www.progressive-medical.com or a copy may be obtained by mailing a request to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
Amendments to Your Personal Health Information.
You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative and must state the reasons for the amendment/correction request. If we make an amendment or correction you request, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You can view printable request for this information by accessing forms at www.progressive-medical.com or a copy may be obtained by mailing a request to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
Accounting for Disclosures of Your Personal Health Information.
You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. You can view printable request for this information by accessing forms at www.progressive-medical.com or a copy may be obtained by mailing a request to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.The first accounting in any 12-month period is free; you will be charged a fee of $.50/pg +$10 search fee for each subsequent accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Your Personal Health Information.
You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. You can view printable request for this information by accessing forms at www.progressive-medical.com or a copy may be obtained by mailing a request to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when
appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction to sending such termination notice to Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
Complaints.
If you believe your privacy rights have been violated, you can file a complaint with Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
Acknowledgment of Receipt of Notice.
Please sign and return acknowledgment that you received this Notice of Practice Practices.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may contact Attention: Compliance Officer, 250 Progressive Way, Westerville, OH 43082.
As a patient, you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.
EFFECTIVE DATE: This Notice of Privacy Practices is effective April 14, 2003.