NOTICE OF PRIVACY PRACTICE
THIS 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.
We are committed to protecting the privacy of your medical information. We are required by law to maintain the confidentiality of information that identifies you and the care you receive. This Notice describes your rights and our legal duties regarding your Protected Health Information ("PHI"). Protected Health Information means any information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this Notice, we call that protected information, "medical information". If you have any questions about this notice, please contact Tracy Creger with Connect Benefit at 855-624-7283.
HOW THIS PROVIDER MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION
1. Treatment We will use your medical information to provide you with prescribed Durable Medical Equipment. For example, we may disclose your medical information to doctors, nurses, technicians, medical students or to other care professionals for additional treatment or clarification of prescriptions. We also may disclose your medical information to people outside our organization who may be involved in your care such as your family members.
2. Payment We may use and disclose your medical information to receive payment for our services from you, an insurance company or a third party. For example, we may need to give your health plan information about equipment we provide so your health plan will pay us or reimburse you for the equipment. We may also tell your health plan about equipment you are going to receive to obtain prior approval or determine whether your plan will cover the equipment.
3. For Health Care Operations We may use and disclose your medical information to operate this facility. For example, we may use this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. We may also share your medical information with our business associates, such as a billing service, that perform administrative services for us. We have a written contract with each business associate that contains terms requiring them to protect the confidentiality of your medical information.
4. With Your Authorization We may disclose your medical information for purposes not described in this Notice or otherwise permitted by law only with your written authorization. You may revoke an authorization at any time, in writing, but only as to future uses or disclosures, and only where we have not already acted in reliance on your authorization. Revocations should be delivered to Luke Sterling as described at the bottom of this notice.
5. Notification and Communication with Family We may disclose your medical information to notify or assist in notifying a family member, or another person who is involved in your care unless you ask us not to. In the event of a disaster, we may disclose information to a relief organization, such as the Red Cross, so that they may coordinate these notification efforts. We may also disclose information to someone who pays for your care. If you are unable to agree or object to these disclosures, our health professionals will use their best judgment in communication with your family and others.
6. Required by Law We may use and disclose your medical information when required to do so by law, but only to the extent and under the circumstances provided in that law.
7. Lawsuits and Disputes If you are involved in a lawsuit or a dispute, we may disclose your medical information 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 the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
8. Law Enforcement Your medical information may be disclosed to law enforcement authorities to identify or locate suspects, fugitives or witnesses, or victims of crime (with your consent in some circumstances) and to report possible deaths caused by criminal activities or to report crimes on the premises.
9. Workers' Compensation Your medical information may be used or disclosed as required by law related to workers' compensation.
10. Specialized Government Functions We may disclose your medical information for military or national security purposes, national intelligence, protection of the President, or to correctional institutions or law enforcement officers that have you in their lawful custody.
11. Military If you are a member of the armed forces, we may release protected health information about you as required by military command authorities.
12. Public Health and Safety Your medical information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities prevent or control disease, injury, or disability; to report child abuse or neglect; to report problems with products; to notify you of recalls of products you may be using; or to notify the appropriate governmental authority if we believe a patient has been the victim abuse, neglect, or domestic violence, if the victim agrees to our reporting or if are required to do so by law. Your medical information may be disclosed to appropriate persons to prevent or lessen a serious and imminent threat to you or to the health and safety of a particular person or the general public.
13. Health Oversight Activities We may disclose protected health information to a health oversight agency for activities necessary for the government to monitor the health care system, government programs, and compliance with applicable laws. These oversight activities include, for example, audits, investigations, inspections, medical device reporting and licensure.
14. Coroners/Funeral Directors We may disclose your medical information to coroners in connection with their investigations of death or to funeral directors to enable them to carry out their lawful duties.
15. Change of Ownership In the event that this facility is sold or merged with another organization, your medical information will become the property of the new owner who will have access to it, although you will maintain the right to request that copies of your medical information be transferred to another physician or medical practice.
YOUR MEDICAL INFORMATION RIGHTS
You have the right:
To receive a paper copy of this Notice of Privacy Practice.
To request restrictions on certain uses and disclosures of your medical information by written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request and will notify you of our decision. If we agree to a restriction, we may disregard it if the information is needed to provide you emergency treatment.
To request that you receive medical information in a specific way or at a specific location. For example, you may ask that we send information to your work address. We will comply with all reasonable requests submitted.
To review and obtain a copy of medical information, with limited exceptions defined by law. A reasonable fee may be charged for making copies. Under Oklahoma law, a fee of $1.00 will be charged for the first page and $0.50 for each additional page. We may also charge for postage if the copies are to be mailed. If we deny your request for copies, you will be informed of your rights to appeal our decision.
To receive an accounting of disclosures made of your medical information by this provider unless the disclosures were for purposes of treatment, payment, health care operations, certain government functions, or pursuant to your written authorization.
Contact:
If you would like to have a more detailed explanation of these rights, or if you would like to exercise one or more of these rights, contact Tracy Creger at 855-624-7283.
Changes to this Notice:
We reserve the right to change or amend this Notice of Privacy Practice at any time in the future. After an amendment is made, the revised Notice of Privacy Practice will apply to all protected health information that we maintain. A copy of any revised Notice of Privacy Practices will be made available to you at each appointment.
Complaints:
Complaints about this Notice of Privacy Practices or how this provider handles your medical information should be directed to the attention of:
Tracy Creger, Connect Benefit, LLC
5930 E 31st St
Ste 300
Tulsa, OK 74135
You will not be penalized for filing a complaint.