Privacy Legal Pages
A D MEDICAL SUPPLY, INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS
IMPORTANT TO US.
Summary of Our Privacy Practices
For purposes of this notice, “A D Medical Supply, Inc.” and the
pronouns “we,” “us” and “our” refer to all of the health care suppliers
operated or managed by A D Medical Supply, Inc. and/or its subsidiaries.
These entities have been designated as a single affiliated covered
entity for HIPAA Privacy Rule purposes. We may use and disclose your
medical information, without your permission, for treatment, payment,
and health care operations activities and, when required or authorized
by law, for public health and interest activities, law enforcement,
judicial and administrative proceedings, research, and certain other
public benefit functions.
We may disclose your medical
information to your family members, friends, and others you involve in
your health care or payment for health care, and to appropriate public
and private agencies in disaster relief situations.
We will not otherwise use or disclose your medical information without your written authorization.
You have the right to examine and receive a copy of your medical
information, to receive an accounting of certain disclosures we may make
of your medical information, and to request that we amend, further
restrict use and disclosure of, or communicate in confidence with you
about your medical information. Please review this entire notice for
details about the uses and disclosures we may make of your medical
information, about your rights and how to exercise them, and about
complaints regarding or additional information about our privacy
practices.
Our Legal Duty
We are required by state and federal law, including the Health
Insurance Portability and Accountability Act of 1996 ("HIPAA"), to
maintain the privacy of your medical information. We are also required
to inform you of our privacy practices, our legal duties, and your
rights in relation to the medical information that we maintain about
you. We will follow the practices that are described in this Notice
while it is effective. This Notice is effective as of April 14, 2003 and
will remain in effect unless we replace it. We reserve the right to
change our privacy practices and the terms of this Notice at any time,
provided such changes are permitted by applicable law. We reserve the
right to make the changes in our privacy practices and the new terms of
our Notice effective for all medical information that we maintain,
including medical information we created or received before we made the
changes. If we significantly change in our privacy practices, we will
change this Notice, and make the new notice available to our patients
and others upon request.
You may request a copy of our Notice
at any time. For more information about our privacy practices, or for
additional copies of this Notice, please contact us using the
information at the end of this Notice.
YOUR PROTECTED MEDICAL AND HEALTH INFORMATION
When you receive care from a healthcare provider, a record is made of that treatment. This record will typically contain information about your diagnosis, treatment, and future plan of treatment and is often collectively referred to as your medical record. This medical record includes your medical and health information and lays the foundation for determining your plan of care and treatment and allows for a successful means of communication between all healthcare professionals that contribute to your care. HIPAA protects information found in your medical record from improper use and disclosure. The information protected by HIPAA includes:
- Any information related to your past, present or future physical or mental health;
- The past, present or future payment for health services you have received;
- The specific care that you have received, are receiving or will receive;
- Any information that identifies you as the individual receiving the care; and
- Any information that someone could reasonably use to identify you as receiving the care.
This information is collectively referred to as your medical information throughout this Notice.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION—TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS
Treatment – We may use and disclose your medical information, without your permission, to treat you. As it pertains to A D Medical Supply, Inc. and its health care supplier subsidiaries and affiliates, treatment includes supplying you drugs, medications, supplies, durable medical equipment, and Medical Nutritional Therapy, as ordered by your physician. Treatment also includes coordination and consultation with your physician and other health care providers. As we provide these services to you, information obtained during this process will be recorded in your medical record. We will use this information, in coordination with your physician, to determine the best course of treatment for you.
Payment – We may use and disclose your medical information, without your permission, to obtain reimbursement for health care products and services that we provide to you, including submitting claims to health plans, other insurers, payers, or others. Payment activities include actions required for us to obtain reimbursement from your insurance carrier for the products and services ordered by your physician and provided to you by us. The activities include eligibility determinations, pre-certifications, billing and collection activities, obtaining documentation required by your insurer, and when applicable, disclosure of information to consumer reporting agencies.
Health Care Operations – We may use and disclose your medical information, without your permission, for health care operations. Health care operations may include:
- Review of your medical information by our professional healthcare staff to ensure compliance with all federal and state regulations;
- Utilization of your medical information to continually improve the quality and effectiveness of the services DCC provides to you; and
- Our business management and general administrative activities.
You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. You may revoke such authorization at any time. However, your revocation will not affect any use or disclosure previously permitted by your authorization. Unless you give us a written authorization, we will not use or disclose your medical information for any purpose other than those permitted by law and as described in this Notice.
OTHER PERMITTED USES AND DISCLOSURES
We may use and disclose your medical information without your
authorization for purposes other than treatment, payment or health care
operations in certain circumstances.
Family, Friends and Others Involved in Your Care or Payment for Care
We may disclose to a member of your family, other relative, or a close
personal friend, or any other person identified by you, your medical
information directly relevant to such person's involvement with your
care or payment related to your health care.
Public Health and Benefit Activities
We may use and disclose your medical information to third parties, without your authorization, if it is:
- Required by law;
- For certain public health activities and purposes;
- To a legally-authorized government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect or domestic violence;
- For law enforcement purposes and in response to court orders or subpoenas; or
- To agencies authorized by law to conduct health oversight activities, including audits, investigations, licensing and similar activities
YOUR RIGHTS AS OUR PATIENT
You have the following rights in relation to your medical information:
Restriction - you may request, in writing, that we restrict our use or disclosure
of your medical information. We are not required to agree to the
requested restrictions. If we do agree, we will abide by our agreement,
except in emergencies or as required or authorized by law. If you would
like us to restrict our use or disclosure of your medical information,
you should submit your request to the contact office listed on this
Notice.
Amendments
- you have the right to request that we amend your medical record. Your
request must be in writing and it must explain why the information
should be amended. You should submit your request to the contact office
listed on this Notice. We may deny your request only for certain
reasons. If we deny your request, we will provide you with a written
explanation. If we accept your request, we will make your amendment part
of your medical information and will use reasonable efforts to inform
others of the amendment who we know may have relied upon the unamended
information to your detriment, as well as persons who you want to
receive the amendment.
Electronic Notice
- if you obtained a copy of this Notice on our website or by electronic
mail (email), you are entitled to receive a copy of this Notice in
written form. Please contact us using the contact information at the end
of this Notice to obtain a copy of this Notice in written form.
Access- You have the right to inspect and obtain a copy of your medical
record, subject to certain limitations. You must make a written request
to obtain copies of your medical information. You should submit your
request to the contact office at the end of this Notice.
We may
charge you reasonable, cost-based fees for a copy of your medical
information, for mailing the copy to you, and for preparing any summary
or explanation of your medical information you request. Contact us using
the information at the end of this notice for information about our
fees.
Accounting of Disclosures
- you have the right to obtain an accounting of disclosures of your
medical record for purposes other than treatment, payment, health care
operations, as authorized by you, and for certain other activities. You
should submit your request to the contact office at the end of this
Notice. We will provide you with information about each accountable
disclosure that we made during the period for which you request the
accounting, except we are not obligated to account for a disclosure that
occurred more than 6 years before the date of your request and never
for a disclosure that occurred before. If you request this accounting
more than once in a 12-month period, we may charge you a reasonable,
cost-based fee for responding to your additional requests. Contact us
using the information at the end of this Notice for information about
our fees.
Confidential Communications - you have the right to request that we communicate with you about your
medical information in confidence by alternative means or to
alternative locations that you specify. You should submit your request
to the contact office at the end of this Notice.
We will
accommodate your request if it is reasonable, specifies the alternative
means or location for confidential communication, and explains how
payment for our services will be handled under the alternative means or
alternative location you request for confidential communication of your
medical information. We will not ask you to explain the reason for your
request.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions, would like additional information or, if you
suspect misuse of your protected health information and believe that
your rights have been violated, you may, without fear of retaliation,
contact:
A D Medical Supply, Inc.
1525 W. Homer Street, Suite 101
Chicago, IL 60642
Attn: Cory D. Skwor
General Manager/Owner
Phone: 1-888-785-7370
Email: info@admedicalinc.com
You may also file a complaint with:
Office for Civil Rights
U.S. Department of Health & Human Services 200 Independence Avenue SW
HHH Building, Room 509F
Washington D.C. 20201
(800) 368-1019