|A. OUR COMMITMENT TO YOUR PRIVACY
Active Mobility of Ohio, Inc. is dedicated to maintaining
the privacy of your protected health information. In conducting
business with you, we create records regarding you and the
treatment and services we provide to you. We are required by
law to maintain the confidentiality of health information that
identifies you. We also are required to provide you with this
notice of our legal duties and privacy practices concerning
your protected health information. By law, we must follow the
terms of the notice of privacy practices that we have in effect
at the time.
To summarize, this notice provides you with the following
· How we may use and disclose your protected health
· Our obligations concerning the use and disclosure of your protected
· Your privacy rights to your protected health information
The terms of this notice apply to all records containing your
protected health information that are created or retained by
Active Mobility. We reserve the right to revise or amend our
notice of privacy practices. Any revisions to this notice will
be effective for all your records we created or maintained
in the past, and for any records we may create or maintain
in the future. We will post a copy of our current notice in
our office, and you may request a copy of our most current
notice at any time.
B. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING
The following categories describe the different ways in which
we may use and disclose your protected health information:
1. Treatment. We may use your protected health information
to treat you. For example, we may ask you to undergo a consultation
with a physical therapist and we may use the results to help
us best fit you to the equipment most suitable for you. Our
employees may use or disclose your protected health information
in order to treat you or to assist others in your treatment.
Additionally, we may disclose your protected health information
to others who may assist in your care, such as your physician,
therapists, spouse, children or parents.
2. Payment. We may use and disclose your protected health
information in order to bill and collect payment for the services
and items you may receive from us. For example, we may contact
your health insurer to certify that you are eligible for benefits,
and we may provide your insurer with details regarding your
treatment to determine whether your insurer will cover, or
pay for, your treatment. We also may use and disclose your protected
health information to obtain payment from third parties who
may be responsible for such costs, such as family members.
In addition, we may use other companies (finance companies
and collection agencies) or charitable funding organizations
(The Ability Center, MS Society, etc.) to obtain payment on
your behalf. Also, we may use your protected health information
to bill you directly for services and items.
3. Health Care Operations. We may use and disclose your protected
health information to operate our business. As examples of
the ways in which we may use and disclose your information
for our operations, we may use your health information to evaluate
the quality of service you received from us to conduct cost-management
and business planning activities for our company.
4. Appointment Reminders. We may use and disclose your protected
health information to contact you and remind you of visits
5. Health-Related Benefits and Services. We may use and disclose
your protected health information to inform you of health-related
benefits or services that may be interest to you.
6. Release of Information to Family/Friends. We may release
your protected health information to a friend or family member
who is helping you pay for your health care or who assists
in taking care of you.
7. Disclosures Required by Law. We will use and disclose your
protected health information when we are required to do so
by federal, state, or local law.
C. SPECIAL CIRCUMSTANCES WHICH DO NOT REQUIRE AUTHORIZATION
TO USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe unique situations in which
we may use or disclose you protected information:
1. Public Health Risks. We may disclose
your protected health information to public health authorities
who are authorized
by law to collect information for the purpose of:
· Preventing or controlling disease, injury, or
· Notifying a person regarding potential exposure to a communicable
· Notifying a person regarding a potential risk for spreading
or contracting a disease or condition
· Reporting reactions to drugs or problems with products or devices
· Notifying individuals if a product or device they may be using
has been recalled
· Notifying appropriate government agencies and authorities regarding
the potential abuse or neglect of an adult patient
(including domestic violence); however, we will only disclose this
information if the patient agrees or we are required or authorized by law
to disclose this information
· Notifying your employer under limited circumstances related
primarily to workplace injury or medical surveillance.
2. Health Oversight Activities. We may disclose your protected
health information to a health oversight agency for activities
authorized by law. Oversight agencies seeking this information
include government agencies that oversee the health care system,
government benefit programs, other government regulatory programs
and civil right laws.
3. Legal Proceedings. We may use and disclose your protected
health information in response to a court or administrative
order if you are involved in a lawsuit or legal proceeding.
We also may disclose your protected health information in response
to a discovery request, subpoena, or other lawful process by
another party involved in the dispute, but only if we have
made an effort to inform you of the request or to obtain an
order protecting the information the party has requested.