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CLARK HOME RESPIRATORY SUPPLY INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. Clark Home Respiratory Supply Inc. respects
your right to privacy of your identifiable health information and USES AND
DISCLOSURES OF HEALTH INFORMATION
Clark Home Respiratory Supply
Inc. can Treatment. Our organization may use
and disclose your identifiable health information to a physician or
other healthcare provider providing treatment to you. For example…we may use your
diagnosis provided by your physician to help select equipment that you
may need. Payment. Our organization
may use and disclose your identifiable health information in order to
bill and collect payment for the services and items you receive from
us. For
example…we may contact your health insurance carrier and
provide them with identifiable health information to ensure you qualify
for equipment. Healthcare
Operations.
Our organization may use and disclose your identifiable health information
to operate our business. Healthcare operations include software vendors,
staff training, quality assessment, organizational improvement activities,
accreditation, certification, licensing or credentialing activities,
cost-management and business planning activities for our organization.
For example…we may
use your identifiable health information for our organizational improvement
activities. Business Associates. Some of the
services provided by Clark Home Respiratory Supply are provided by business associates. When we contract for these services, we may
disclose your medical information to our business associates so that
they can perform the job we have hired them to do.
To protect your medical information, we require our business
associates to appropriately safeguard your information. Your Authorizations. You may give us written authorization to use
your identifiable health information or to disclosure it to anyone for
any purpose. If you give us
an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or
disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization,
we cannot use or disclose your health information for any reason except
those described in this Notice. Family/Caretaker/Friends. Our organization may release your identifiable
health information to a friend, caretaker or family member that is helping
you pay for your healthcare, or who assists in taking care of you but,
only if you have designated that individual to be involved in your care. We may use or disclose health information to
notify, or assist in the notification of (including identifying or locating)
a family member, your personal representative or another person responsible
for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure
of your health information, we will provide you with an opportunity
to object to such uses or disclosures. We will also use our professional
judgment and our experience with common practice to make reasonable
inferences of your best interest in allowing a person to pick up medical
supplies, filled prescriptions or other similar items that contain your Emergency. In the event of your incapacity or emergency circumstances,
we will disclose health information based on a determination using our
professional judgment disclosing only health information that is directly
relevant to the person’s involvement in your healthcare. Appointment Reminders. Our organization may use
and disclose your identifiable health information to contact you and
remind you of visits/deliveries, prescription refills, and Better Breathers
meetings Other
Health-Related Benefits and Services. Our organization may use and disclose
your identifiable health information to other organizations that will
provide healthcare related services to you while you are away from home
on vacation or other circumstances that may take you away from home
for an extended period of time. Our
organization may use and disclose your identifiable health information
to workers compensation or similar programs that provide benefits for
work related injuries and illness. Clark Home Respiratory Supply will not
use or disclose your identifiable health information for marketing communications
without written authorization. Health Oversight Activities. We
may disclose medical information to a health oversight agency for activities
authorized by law. These oversight
activities include, for example, audits, investigations, inspections,
and licensure. These activities
are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative order.
We may also disclose medical information about you in response
to a subpoena, discovery request, or other lawful process by someone
else involved in a dispute, but only if efforts have been made to tell
you about the request or to obtain an order protecting the information
requested. Coroners, Medical Examiners and Funeral
Directors. We may release medical information to a coroner
or medical examiner. We may
also disclose medical information to funeral directors consistent with
applicable law to carry out their duties. Food and Drug Administration. We
may disclose to the FDA medical information related to adverse events
with respect to food, supplements, products and product defects, or
post marketing surveillance information to enable product recalls, repairs,
or replacement. Inmates. If
you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release medical information about
you to the correctional institution or law enforcement official. Public Health Risks. We
may disclose medical information about you for public health activities.
These activities generally include the following: ·
to prevent or control disease, injury
or disability; ·
to report births and deaths; ·
to report reactions to medications
or problems with products; ·
to notify people of recalls of products
they may be using; ·
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;
Required By Law. Our organization
will use and disclose your identifiable health information when we are
required to do so by federal, state or local law. Abuse or Neglect. Our organization may disclose your identifiable
health information to appropriate authorities if we believe that you
are a possible victim of abuse, neglect, or domestic violence or the
possible victim of other crimes. We
may disclose your identifiable health information to the extent necessary
to avert a serious threat to your health or safety or the health and
safety of others. Military & National Security. Our organization may disclose your identifiable
health information to military authorities if you are a member of the
US or foreign military forces. We
may also disclose your identifiable health information to federal officials
for intelligence and national security activities authorized by law.
PATIENT RIGHTS
Access. You
have the right to look at or get copies of your health information,
with limited exceptions. You
may request that we provide copies in a format other tha Restrictions. You have the right to request a restriction
in our use or disclosure of your identifiable health information for
treatment, payment or health care operations. (You must make your request in writing to [Clark Home Respiratory Supply Inc.; Attn:
James Clark, CEO; 168 Jefferson Heights; Catskill, NY 12414]. We are not required to agree to your request;
however, if we do agree, we are bound by our agreement (except in an
emergency). Alternative Communication. You
have the right to request that we communicate with you about your identifiable
health information by alternative means or to alternative locations. (You must make your request in writing to [Clark Home Respiratory
Supply Inc.; Attn: James Clark,
CEO; 168 Jefferson Heights; Catskill, NY 12414]. Your
request must specify the alternative means or location, and provide
satisfactory explanation how payments will be handled under the alternative
means or location you request. Accounting of Disclosures. You have the right to request a list of
instances in which our organization or our business associates disclosed your identifiable health
information for any Amendment. You have the
right to request we amend your identifiable health information. (Your request must be made
in writing to
[Clark Home Respiratory Supply Inc.; Attn: James Clark, CEO; 168 Jefferson Heights; Catskill,
NY 12414], and it must
explain why the information should be amended.) We may deny your request under certain circumstances.
QUESTIONS & COMPLAINTSIf you believe
your privacy rights have been violated you may file a written complaint
with our organization or with the Secretary of the Department of Health
and Human Services. You or any
person involved in your care will not be retaliated against for a complaint. Written complaints should be sent to: Clark Home Respiratory
Supply Inc. and/or Department of Health and Human Services
168 Jefferson
Heights 200 Independence Ave. SW Room 509
HHH Building Catskill, NY 12414
Washington, DC 20201 If you have any questions about our
privacy practices, please contact us at 1-800-260-1190.
AMENDMENT
OF THIS NOTICE
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