We are committed to preserving the privacy and confidentiality of your health information whether created by us or maintained on our premises. We are required by certain state and federal regulations to implement policies and procedures to safeguard the privacy of your health information. Copies of our privacy policies and procedures are maintained in the business office. We are required by state and federal regulations to abide by the privacy practices described in this notice including any future revisions that we may make to the notice as may become necessary or as authorized by law.
Individually identifiable information about your past, present, or future health or condition, the provisions of health care to you, or payment for the health care treatment or services you receive is considered protected health information (PHI). As such, we are required to provide you with this Privacy Notice that contains information regarding our privacy practices that explains how, when and why we may use or disclose your PHI and your rights and our obligations regarding any such uses or disclosures. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure of such information.
We reserve the right to change this notice at any time and 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 about you. Should we revise/change this Privacy Notice, we will post a copy of the new/revised Privacy Notice in our offices. You also may request and obtain a copy of any new/revised Privacy Notice from our Privacy Practices Manager. Should you have questions concerning our privacy practices you may contact our Privacy Practices Manager at the address on the last page of this notice.
We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your health information for purposes of providing your supplies, payment, or for the operations of our company. For other uses, you must give us your written authorization to release your PHI unless the law permits or requires us to make the use or disclosure without your authorization. Should it become necessary to release your PHI to an outside party, we will require the party to have a signed agreement with us that the party will extend the same degree of privacy protection to your information as we do.
The privacy law permits us to make some uses or disclosures of your PHI without your consent or authorization. The following describes each of the different ways we may use or disclose your PHI. Where appropriate, we have included examples of the different types of uses or disclosures. These include:
We may disclose your PHI to those who are involved in providing medical and nursing care services and treatments to you. We may also disclose your PHI to outside entities performing other services relating to your treatment; such as diagnostic laboratories, home health/hospice agencies, family members, etc.
We may use or disclose your PHI to bill and collect payment for services we provided to you. For example, we may contact your insurance facility, health plan, or another third party to obtain payment for services we provided to you.
We may use or disclose your PHI to perform certain functions within our company should these uses or disclosures become necessary to operate our company and to ensure that you and others we provide services to continue to receive quality services. For example, we may use your health information to evaluate the effectiveness of the services you are receiving. We may disclose your PHI to our staff for auditing, care planning, and learning purposes. We may also combine your health information with information from other health care providers to study how our company is performing in comparison to like companies or what we can do to improve the care and services we provide to you. When information is combined, we remove all information that would identify you so others may use the information in developing research on the delivery of health care services without learning your identity.
We may use or disclose your PHI for purposes of contacting you to inform you of testing alternatives or health-related benefits and services that may be of interest to you. For example, a newly released medication, treatment, or testing system that has a direct relationship to you.
For uses and disclosures of your PHI beyond treatment, payment and operations purposes, we are required to have your written authorization, except as permitted by law. You have the right to revoke an authorization at any time to stop future uses or disclosures of your information except to the extent that we have already undertaken an action in reliance upon your authorization. Your revocation request must be provided to us in writing. The name and address of the person to contact is located on the last page of this document.
Examples of uses or disclosures that would require your written authorization include, but are not limited to, the following:
In the following situations, we may disclose a limited amount of your PHI if we provide you with an advance oral or written notice and you do not object to such release or such release is not otherwise prohibited by law. However, if there is an emergency situation and you are unable to object (because you were not present or you were incapacitated, etc.), disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest. When a disclosure is made based on these or emergency situations, we will only disclose health information relevant to the personâ€™s involvement in your care. For example, if you are sent to the emergency room, we may only inform the person that you are diabetic. You will be informed and given an opportunity to object to further disclosures of such information as soon as you are able to do so.
We may disclose your PHI to your family members and friends who help pay for your supplies. You may object to the release of this information. Your objection may be made orally or in writing. The name, address, and telephone number of the person to whom you may make your objection is listed on the last page of this document. (See also Section VI, paragraph 1.)
State and federal laws and regulations either require or permit us to use or disclose your PHI without your consent or authorization. The uses or disclosures that we may make without your consent or authorization include the following:
We may disclose your PHI when a federal, state or local law requires that we report information injury from a health care product, or in response to a court order or subpoena.
We may disclose your PHI when we are required to collect information about diseases or injuries (e.g., product recalls).
We may disclose your PHI to a health oversight agency such as a protection and advocacy agency, the state agency responsible for inspecting our company or to other agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents or to ensure that we are in compliance with applicable state and federal laws and regulations and civil rights issues.
We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death.
We may disclose your PHI for research purposes only when a privacy board has approved the research project. However, we may use or disclose your PHI to individuals preparing to conduct an approved research project in order to assist such individuals in identifying persons to be included in the research project. Researchers identifying persons to be included in the research project will be required to conduct all activities onsite. If it becomes necessary to use or disclose information about you that could be used to identify you by name, we will obtain your written authorization before permitting the researcher to use your information. Researchers will be required to sign a Confidentiality and Non-Disclosure Agreement form before being permitted access to health information for research purposes.
We may disclose your PHI to avoid a serious threat to your health or safety or to the health or safety of others. When such disclosure is necessary, information will only be released to those law enforcement agencies or individuals who have the ability or authority to prevent or lessen the threat of harm.
We may disclose PHI of military personnel and veterans, when requested by military command authorities, to authorized federal authorities for the purposes of intelligence, counterintelligence, and other national security activities (such as protection of the President), or to correctional institutions.
You have the following rights concerning the use or disclosure of your PHI that we create or that we may maintain on our premises:
You have the right to request that we limit how we use or disclose your PHI for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care or services. For example, you could request that we not disclose to family members or friends information about services you received. Should you wish a restriction placed on the use and disclosure of your PHI, you must submit such request in writing. The name, address, and telephone number of the person to whom the request is to be submitted is listed on the last page of this document. We are not required to agree to your restriction request. However, should we agree, we will comply with your request not to release such information unless the information is needed to provide emergency care or treatment to you.
You have the right to inspect and copy your health information, such as your medical and billing records that we use to make decisions about your services. In order to inspect and/or copy your health information, you must submit a written request to us. If you request a copy of your medical information, we may charge you a reasonable fee for the paper, labor, mailing, and/or retrieval costs involved in filing your requests. We will provide you with information concerning the cost of copying your health information prior to performing such service. The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document. We will respond within thirty (30) days of receipt of such requests.
You have the right to request that your health information be amended or corrected if you have reason to believe that certain information is incomplete or incorrect. You have the right to make such requests of us for as long as we maintain/retain your health information. Your requests must be submitted to us in writing. We will respond within sixty (60) days of receiving the written request. If we approve your request, we will make such amendments/corrections and notify those with a need to know of such amendments/corrections.
We may deny your request if:
If your request is denied, we will provide you with a written notification of the reason(s) of such denial and your rights to have the request, the denial, and any written response you may have relative to the information and denial process appended to your health information. The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document.
You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may request that we not send any health information about you to a family memberâ€™s address. We will agree to your request as long as it is reasonably easy for us to do so. You are not required to reveal nor will we ask the reason for your request. To request confidential communications you must:
The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document.
You have the right to request that we provide you with a listing of when, to whom, for what purpose, and what content of your PHI we have released over a specified period of time. This accounting will not include any information we have made for the purposes of treatment, payment, or company operations or information released to you, your family, disclosures made for national security purposes, or any releases pursuant to your authorization.
Your request must be submitted to us in writing and must indicate the time period for which you wish the information (e.g., May 1, 2003 through August 31, 2005). Your request may not include releases for more than six (6) years prior to the date of your request and may not include releases prior to April 14, 2003. Your request must indicate in what form (e.g., printed copy or email) you wish to receive this information. We will respond to your request with sixty (60) days of the receipt of your written request. Should additional time be needed to reply, you will be notified of such extension. However, in no case will such extension exceed thirty (30) days. The first accounting you request during a twelve (12) month period will be free. There may be a reasonable fee for additional requests during the twelve (12) month period. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document.
You have the right to receive a paper copy of this notice. If you have agreed to receive this Notice electronically, you are still entitled to a paper copy. To obtain a paper copy of the current Notice, please make your request in writing to the Privacy Practices Manager at the address below.
If you believe we have violated your privacy rights, violated our privacy policies and procedures, or you disagree with a decision we made concerning access to your PHI, etc., you have the right to file a complaint with us or the Secretary of the Department of Health and Human Services. Complaints may be filed without fear of retaliation in any form.
Please refer your complaint to:
Privacy Practices Manager
American Diabetes Services Inc.
951 Broken Sound Pkwy NW, Suite 250
Boca Raton, FL 33487-3506
(561) 416-3096 (phone)
(561) 416-1162 (fax)