THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT PATIENTS MAY BE USED, DISCLOSED AND HOW PATIENTS CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS INFORMATION CAREFULLY
This notice describes in accordance with the HIPAA Privacy regulations, how Heavenly Wheels may use and disclose your protected health information to carry out treatment, payment or healthcare operations, and for other specific purposes that are permitted by law. The Notice also describes your rights and the duties that Heavenly Wheels shall follow with respect to the protected health care information about you. When it comes to your healthcare information, Heavenly Wheels will store it in our computer system and or office according to HIPAA standards. This will include your name, address, phone number and other identifying information such as the drugs you are taking, your medical conditions, your allergies and any other information that could possibly affect your health. Heavenly Wheels will use this information to provide services, supplies and equipment to you.
Treatment, Payment and Healthcare Operations
Heavenly Wheels will use your healthcare information to dispense prescription medical equipment / supplies. We may also disclose your information to other healthcare providers for the purpose of your treatment. It may also be used to receive payment for products and services rendered to you. We may need to contact your third party payor, insurer or pharmaceutical benefits manager (PBM) to determine whether your program will pay for medical equipment / supplies. We will bill you and/or a third party payor, Medicare, Medicaid for the cost of prescription medical equipment / supplies dispensed to you. The information on or accompanying the bill may include your identification as well as the medical equipment / supplies we are providing. We will use your healthcare information to carry out healthcare operations like utilizing your healthcare records to monitor the quality of company performance and to train company personnel.
Uses and Disclosures that are Either Permitted or Required by the Regulation:
Using their judgment as healthcare professionals, our staff may disclose your protected health information to a family member, other relative, close personal friend or any person you identify as being involved in your healthcare. We form contracts known as Business Associates to perform services for us. They may sort insurance or other third party payor claims for submission to the actual payor. We may disclose protected information to our Business Associates so they can perform the job Heavenly Wheels needs them to do and then bill your third party payor for the services rendered. Our Business Associates will safeguard the protected health information. Heavenly Wheels may also contact you to alert you on reminders or any other pertinent information about health related benefits/services that may help you.
Other required or Permitted Disclosures
Heavenly Wheels may disclose your healthcare information to the following entities and/or under given circumstances to the following:
> To public health or legal authorities charged with preventing or controlling disease, injury or disability.
> To law enforcement agencies as required by law or in response to a valid subpoena or other legal process.
> To health oversight agencies (medical licensing boards e.g.) for activities authorized by law such as audits, investigations and inspections necessary for Heavenly Wheels licensure and for the government to monitor the healthcare system, etc.
> In response to a court order, administrative order, subpoena, discovery request, or other lawful process by another person involved in a dispute involving a patient but only if efforts have been made to tell the patient about the request or to obtain an order protecting the requested healthcare information.
> As authorized by and as necessary to comply with laws relating to workman's compensation or similar programs established by law.
> Whenever required to do so by law.
> To researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of the patient's information.
> To a medical examiner for example in the identity of a deceased person to determine cause of death or a funeral director with applicable law to carry out their duties.
> To contact the patient for the purpose of fundraising.
> To notify a family member, personal representative for the patient's care, location or condition.
> To a correctional institution or its agents if a patient is or becomes an inmate, when necessary for the patient's health and safety and that of the public or another person.
> As required by military command authorities when patient is a member of the armed forces and to appropriate military authority about foreign military personnel.
> To authorized federal officials for intelligence, national security authorized by law, to provide protection to the president, other authorized persons or to conduct special investigations
> Or to a government authority (social service or protective services agency) if Heavenly Wheels believes the patient is a victim of abuse, neglect or domestic violence but only to the extent of the law, if the patient agrees to the disclosure or if the disclosure is allowed by law and Heavenly Wheels believes it necessary to prevent serious harm to the patient or someone else so long as it is not used against the patient.
Authorized Use and Disclosure:
Heavenly Wheels will obtain your written Authorization prior to using or disclosing protected health information about you for purposes other than those aforementioned in this notice or otherwise permitted or required by law. You may revoke an Authorization in writing at any time. Direct all written revocations, concerns and restrictions you may have to the Privacy Office at:
Heavenly Wheels, Inc. 5855 Jimmy Carter Blvd., Suite 210, Norcross, GA 30071
Upon receipt of written revocation Heavenly Wheels shall stop using or disclosing protected health information about you, except to the extent that we have already taken action in reliance on the Authorization.
The Patient's Rights
You have the right to request that we restrict how your protected health information is used or disclosed in carrying out treatment, payment or healthcare operations. You have the right to request that our communications to you regarding your health care information be made by alternative means or at alternative locations. These all must also be made in writing to the Privacy Office at Heavenly Wheels. We are not required to agree to the requested restrictions. At any time you have the right to inspect or obtain a copy of your protected health information; the right to access and copy this information contained in the designated record set for as long as we maintain your protected health information. To receive a copy of such records, send a written request to the Privacy Office at:
Heavenly Wheels, Inc. 5855 Jimmy Carter Blvd., Suite 210, Norcross, GA 30071
We may charge you a fee for the costs of copying, mailing or other supplies that are necessary for us to grant your request. We may also deny your request to inspect and copy in limited circumstances. If you are denied access to your protected health information in most cases you may request that the denial be reviewed. Healthcare Information Amendments: If you feel that the information we maintain about you is incomplete or incorrect you may request that we amend it, for as long as we maintain the protected health information. Make all requests for amendment in writing to Heavenly Wheels Privacy Office. Forms for such amendments are available at our office and store. You must include a reason that supports your request. In certain cases, Heavenly Wheels may deny the request. If the request for amendment is denied you have the right to file a statement of disagreement with our decision and we may give a rebuttal to your statement.
For most purposes other than treatment, payment or healthcare operations, you have the right to receive an Accounting of the disclosures we made on or after April 14, 2003 of your protected health information. The Accounting will exclude disclosures we have made directly to you, to friends or family members involved in your care and disclosures for purposes you specifically authorized in writing. All requests for Accounting must be made in writing to the Privacy Office at Heavenly Wheels. The time period for the requested accounting must be specified and it may not be longer than 6 years. The first accounting you request within a 12 month period will be provided free of charge but you may be charged for the cost of providing additional accountings within that period. We will notify you of the cost involved and you may choose to withdraw or modify the request at that time.
You have the right to receive a paper copy of this notice from us upon request
Heavenly Wheels takes its responsibility for maintaining your protected health information in confidence very seriously. This information may identify you and may relate to your pasts, present or future physical, mental or condition and related health care services. It also includes basic demographic information. We are required by law to maintain the privacy of protected health information and to provide you with a Notice of Privacy Practices including our legal duties with respect to protected health information. Heavenly Wheels reserves the right to change the terms of our Notice of Privacy Practice and to make the new Notice provisions effective for all protected health information that we maintain. Should Heavenly Wheels make changes to this Notice, copies of the revised Notice will be made available on request in our office and store. A copy will be posted in all of our stores and will be available on our web site at www.heavenlywheels.com and www.heavenlywheelsstore.com. For more information or to report a problem about Heavenly Wheels privacy practices, you may contact our Privacy Office at 404-284-4905 or direct all inquiries in writing to:
Heavenly Wheels, Inc. 5855 Jimmy Carter Blvd., Suite 215, Norcross, GA 30071
If you believe that your privacy rights have in any way been violated, you can file a written complaint with Heavenly Wheels Privacy Office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
This Notice of Privacy Practice is effective as of April 14, 2003.