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ACTIVE MOBILITY INFO  
     
 

MOBILITY OF OHIO, INC. NOTICE OF PRIVACY PRACTICES
As Required by the Privacy Regulations Promulgated Pursuant to the
Health Insurance Portability and Accountability Act of 1196 (HIPPA
)

This notice describes how health information about you may be used and disclosed and how
you can get access to your protected health information. Please review this notice carefully.

 
     
     
  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 important information:

· How we may use and disclose your protected health information
· Our obligations concerning the use and disclosure of your protected health information.
· 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 WAYS

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 or deliveries.

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 disability
· Notifying a person regarding potential exposure to a communicable disease
· 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.

 
 

 

4. Law Enforcement. We may release protected health information if asked to do so by a law enforcement official:

· Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement
· Concerning a death we believe might have resulted from criminal conduct
· Regarding criminal conduct at our offices
· In response to a warrant, summons, court order, subpoena, or similar legal process
· To identify/locate a suspect, material witness, fugitive, or missing person
· In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Serious Threats to Health or Safety. We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

6. Military. We may disclose your protected health information if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

7. National Security. We may disclose your protected health information to authorized federal officials for intelligence and national security activities. We also may disclose your protected health information to federal officials to protect the President, other officials or foreign heads of state.

8. Inmates. We may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.

9. Workers' Compensation. We may disclose your protected health information for workers' compensation and similar programs.

 

D. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your protected health information that we maintain:

1. You have the right to inspect and copy your protected health information. You may ask to for access to information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request in certain circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by us.

2. You have the right to request a restriction of your protected health information. You may ask us to not use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. Additionally, you have the right to request that we not disclose your protected health information to family members and friends who may be involved in your care. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our company's use, disclosure, or both; and (c) to whom you want the limits to apply.

3. You have the right to request that we communicate with you in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. Specify to us the requested method of contact or the location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.

4. You have the right to ask us to amend your protected health information if you believe it is incorrect or incomplete. You may request an amendment for as long as the information is kept by or for our company. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the protected health information kept by or for the organization; (c) not part of the protected health information which you would be permitted to inspect and copy; or (d) not created by our company, unless the individual or entity that created the information is not available to amend the information.

5. You have the right to request an accounting of certain disclosures. An accounting of disclosures is a list of certain disclosures for purposes other than treatment, payment or healthcare operations as described in this Privacy Notice. Accounting is not required for disclosures made to you, authorized by you to family members or friends involved in your care, or disclosures made to carry out treatment, payment or health care operations. All requests for an accounting of disclosures must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but our company may charge you for additional lists within the same 12 month period. We will notify you of the costs involved with additional requests. You may withdraw your request before you incur any costs.

6. You have the right to provide an authorization for other uses and disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. This includes most marketing purposes for which we will obtain your consent. Exceptions will include if the product or service is directly treatment related, discussed face-to-face, or given as a promotional gift of nominal value. Any authorization you provide to us regarding the use and disclosure of your protected health information may be revoked at any time. After you revoke your authorization, we will no longer use or disclose your protected health information for the reasons described in the authorization. Please note, we are required to retain records of your care.

7. You have a right to a paper copy of this notice. You may ask for a copy of this Privacy Notice at any time.
8. You have a right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our company or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

E. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE
If you have any questions about this notice, or wish to make any requests to limit the use or disclosure of your protected health information, please contact our Privacy Officer:

 

Mary Kay Inguagiato
Active Mobility of Ohio, Inc.
5517 Schultz Drive, Sylvania, OH 43560
419-882-2727 1-800-544-7460

All requests to change or limit authorizations must be made in writing. Please contact the Privacy Officer to obtain the proper form.

This notice goes into effect April 14, 2003.

 
     
For more information about our products contact us at 1.800.544.7460
© 2004 Active Mobility, Inc. | Privacy Policy | HIPPA