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 calling the CRE Privacy Officer at 410-298-4555 or 1-800-777-6981 and 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 print this page from your web browser.

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.