INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Health Insurance Portability &
Accountability Act of 1996 (“HIPAA”) is a
federal program that requires that all
medical records and other individually
identifiable health information used or
disclosed by us in any form, whether
electronically, on paper or orally, are kept
properly confidential. This Act gives you,
the patient, significant new rights to
understand and control how your health
information is used. “HIPAA” provides
penalties for covered entities that misuse
personal health information.
USES AND DISCLOSURES
information may be used by staff members or
disclosed to other health care professionals
for the purpose of evaluating your health,
diagnosing medical conditions, and providing
treatment. For example, results of tests and
procedures will be available in your medical
record to all health professionals who may
provide treatment or who may be consulted by
Your health information may be used to seek
payment from your health plan, from other
sources of coverage such as an automobile
insurer, or from credit card companies that
you may use to pay for services. For
example, your health plan may request and
receive information on dates of service, the
services provided, and the medical condition
health information may be used, as
necessary, to support the day-to-day
activities and management of Home Medical
Equipment, Supplies and Affiliates. For
example, information on the services you
received that may be used to support
budgeting and financial reporting, and
activities to evaluate and promote quality.
health information may be disclosed to our
business associates, such as subcontractors,
so they can perform the jobs we have asked
them to do. To protect your health
information, we require the business
associate to appropriately safeguard your
health information may be disclosed to law
enforcement agencies to support government
audits and inspections, to facilitate
law-enforcement investigations, and to
comply with government-mandated reporting.
health information may be disclosed to
comply with worker’s compensation laws and
other similar programs that provide benefits
for work-related injuries or illnesses.
USES AND DISCLOSURES REQUIRE YOUR
Disclosure of your health information or its
use for any purpose other than those listed
above requires your specific written
authorization. If you change your mind after
authorizing a use or disclosure of your
information, you may submit a written
revocation of the authorization. However,
your decision to revoke the authorization
will not affect or undo any use or
disclosure of information that occurred
before you notified us of your decision to
revoke your authorization.
certain rights under the federal privacy
standards. These include:
right to request restrictions on the use
and disclosure of your protected health
right to receive confidential
communications concerning your medical
condition and treatment.
right to inspect and copy your protected
right to amend or submit corrections to
your protected health information.
right to receive an accounting of how
and to whom your protected health
information has been disclosed.
right to receive a printed copy of this
required by law to maintain the privacy of
your protected health information and to
provide you with this notice of privacy
are required to abide by the privacy
policies and practices that are outlined in
permitted by law, we reserve the right to
amend or modify our privacy policies and
practices. These changes in our policies and
practices may be required by changes in
federal and state laws and regulations. Upon
request, we will provide you with the most
recently revised notice on any office visit.
The revised policies and practices will be
applied to all protected health information
INSPECT PROTECTED HEALTH INFORMATION
generally inspect or copy the protected
health information that we maintain. As
permitted by federal regulation, we require
that requests to inspect or copy protected
health information be submitted in writing.
You may obtain a form to request access to
your records by contacting Customer Service.
Your request will be reviewed and will
generally be approved unless there are legal
or medical reasons to deny the request.
would like to submit a comment or complaint
about our privacy practices, you can do so
by sending a letter outlining your concerns
to: Customer Service, Piper Medical,
Mobility & Accessibility, 1885 N.E. 149th
Street, Suite B, North Miami, FL 33181,
believe that your privacy rights have been
violated, you should call the matter to our
attention by sending a letter describing the
cause of your concern to the same address.
You will not be penalized or otherwise
retaliated against for filing a complaint.
also use the above address to contact us for
further information concerning our privacy
This notice is effective on and after April 14, 2003.