Notice of Privacy Practices as Required by the Privacy
Regulations Promulgated
Pursuant to the Health Insurance Portability and Accountability
Act of 1996
(HIPPA)
• Our Commitment to Your Privacy
Our organization is dedicated to maintaining the privacy of your
identifiable health information. In conducting our business, we
will create records regarding you and the treatment and services
we provide to you. We are required by law to maintain the
confidentiality of health information that identifies you. We
also are required by law to provide you with this notice of our
legal duties and privacy practices concerning your identifiable
health information. By law, we must follow the terms of the
notice of privacy practices that we have in effect at the time.
To summarize, this notice provides you with the following
important information:
How we may use and disclose your identifiable health
information.
Your privacy rights in your identifiable health information.
Our obligations concerning the use and disclosure of your
identifiable health information.
The terms of this notice apply to all records containing your
identifiable health information that are created or retained by
our practice. We reserve the right to revise or amend our notice
of privacy practices. Any revision or amendment to this notice
will be effective for all of your records our practice has
created or maintained in the past, and for any of your records
we may create or maintain in the future. Our organization will
post a copy of our current notice in our offices in a prominent
location, and you may request a copy of our most current notice
during any home visit.
If you have any questions about this notice, please contact The
Administrator of ADAVNCED MOBILITY SOLUTIONS, INC. at
863-665-7666.
• We May Use and Disclose Your Health Information in the
Following Ways:
The following categories describe the different ways in which we
may use and disclose your identifiable health information.
A. Treatment. Our organization may use your identifiable health
information to treat you. After we receive an order/prescription
to deliver equipment to deliver equipment/supplies to you we may
inform you that laboratory testing may need to be performed to
establish a proper diagnosis appropriate for the
services/equipment rendered if testing information was not
available at the time services were requested, if testing
information is available through an independent laboratory or a
hospital it may need to be forwarded to us to establish
qualifying results and diagnosis. Many of the people who work
for our organization may use or disclose your identifiable
health information in order to treat you or to assist others in
your treatment. Additionally, we may disclose you identifiable
health information to others that may assist in your care, such
as your physician , therapists, spouse, children, or parents.
B. Payment. Our organization may use and disclose your
identifiable health information in order to bill and collect
payment for the services and items you may receive from us. For
example, we may contact your health insurer to certify that you
are eligible for benefits (and for what range of benefits). And
we may provide your insurer with details regarding your
treatment to determine if your insurer will cover, or pay for
your treatment. We also may use and disclose your identifiable
health information to obtain payment from third parties that may
be responsible for such costs, such as family members. Also, we
may use your identifiable health information to bill you
directly for services and items.
C. Health Care Operations. Our organization may use and disclose
your identifiable health information to operate our business. As
examples of the ways in which we may use and disclose your
information for our operations, our organization may use your
health information to evaluate the quality of care you received
from us, or to conduct cost-management and business planning
activities for our practice.
D. Appointment Reminders. Our organization may use and disclose
your identifiable health information to contact you and remind
you of visits/deliveries.
E. Release of Information to Family/Friends. Our organization
may release your identifiable health information to a friend or
family member that is helping you pay for your health care, or
who assists in taking care of you.
F. Disclosure 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.
• Use and disclosure of Your Identifiable Health Information in
Certain Special circumstances
The following categories describe unique scenarios in which we
may use or disclose your identifiable health information
A. Public Health Risks. Our organization may disclose your
identifiable health information to public health authorities
that are authorized by law to collect information for the
purpose of:
Maintain vital records, such as births and deaths.
Reporting abuse or neglect.
Preventing or controlling disease, injury, or disability.
Notifying a person regarding potential exposure to a
communicable disease.
Notifying a person regarding a potential risk for spreading or
contracting a disease or condition.
Reporting reactions to drugs or problems with products or
devices.
Notifying appropriate government agency(ies) and authority(ies)
regarding the potential abuse or neglect of an adult patient
(including domestic violence); however, we will only disclose
this information if the patient agrees or we are required or
authorized by law to disclose this information.
Notifying your employer under limited circumstances related
primarily to a workplace injury or illness or medical
surveillance.
B. Health Oversight Activities. Our organization may disclose
your identifiable health information to a health oversight
agency for activities authorized by law. Oversight activities
can include, for example, investigations, inspections, audits,
surveys, licensure and disciplinary actions; civil,
administrative, and criminal procedures or action; or other
activities necessary for the government to monitor government
programs, compliance with civil rights laws and the health care
system in general.
C. Lawsuits and Similar Proceedings. Our organization may use
and disclose your identifiable health information in response to
a court or administrative, if you are involved in a lawsuit or
similar proceeding. We also may disclose your identifiable
health information in response to a discovery requires,
subpoena, or other lawful process by another party involved in
the dispute, but only if we have made an effort to inform you of
the request or to obtain an order protecting the information the
party has requested.
D. Law Enforcement. We may release identifiable health
information if asked to do so by law enforcement official.
Regarding a crime victim in certain situations, if we are unable
to obtain the person’s agreement.
Concerning a death we believe might have resulted from criminal
conduct.
Regarding criminal conduct at our offices.
In response to a warrant, summons court order, subpoena or
similar legal process.
To identify/locate a suspect, material witnesses, fugitive or
missing person.
In an emergency, to report a crime (including the location or
victim of the crime, or the description, identity or location of
the perpetrator).
E. Serious Threats to Health and Safety. Our organization may
use and disclose your identifiable health information when
necessary to reduce or prevent a serious threat to you health
and safety or the health and safety of another individual or the
public. Under these circumstances, we will only make disclosure
to a person or organization able to help prevent the threat.
F. Military. Our organization may disclose your identifiable
health information if you are a member of US or foreign military
forces (including veterans) and if required by the appropriate
military command authorities.
G. Nation Security. Our organization may disclose your
identifiable health information to federal officials for
intelligence and national security activities authorized by law.
We also may disclose your identifiable health information to
federal officials in order to protect the President, other
officials or foreign heads of state, or to conduct
investigation.
H. Inmates. Our organization may disclose your identifiable
health information to correctional institutions or law
enforcement officials if you are an inmate or under the custody
of a law enforcement official, Disclosure for these purposes
would be necessary: (a) or the institution to provide health
care services to you, (b) for the safety and security of the
institution, and/or (c) to protect your health and safety or the
health and safety of similar programs.
I. Worker’s Compensation. Our organization may release your
identifiable health information for worker’s compensation and
similar programs.
• Your Rights Regarding Your Identifiable Health Information
A. Confidential communications. Your have the right to request
that our organization communicate with you about you and your
health and related issues in a particular manner or at a certain
location. For instance, you may ask that we contact YOU AT HOME,
RATHER THAN WORK. In order to request a type of confidential
communication, you must make a written request to the
administrator or office to contact for further information
specifying the requested method of contact, or the location
where you wish to be contacted. Our organization will
accommodate reasonable requests. You do not need to give a
reason for your request.
B. Requesting 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.
Additionally, you have the right to request that we limit our
disclosure of your identifiable health information to
individuals involved in your care or the payment for your care,
such as a family member or friends. We are not required to agree
to your request; however if we do agree we are bound by our
agreement except when otherwise required by law, in emergencies,
or when the information is necessary to treat you. In order to
request a restriction in our use or disclosure of your
identifiable health information you must make your request in
writing to the Administrator of ADVANCED MOBILITY SOLUTIONS,
INC.. Your request must describe in a clear and concise fashion:
(a) the information you wish restricted; (b) whether you are
requesting to limit our practices use, disclosure or both; and
(c) to whom you want the limits to apply.
C. Inspection and Copies. You have the right to inspect and
obtain a copy of the identifiable health information that may be
used to make decisions about you, including patient medical
records and billing records, but not including psychotherapy
notes. You must submit your request in writing to the
administrator of ADVANCED MOBILITY SOLUTIONS, INC. in order to
inspect and/or obtain a copy of your identifiable health
information. Our organization may charge a fee for the costs of
copying, mailing, labor and supplies associated with your
request. Our practice may deny your request to inspect and/or
copy in certain limited circumstance; however, you may request a
review of our denial. Reviews will be conducted by another
licensed health care professional chosen be us.
D. Amendment. You may ask us to amend your health information if
you believe it is incorrect or incomplete, and you may request
an amendment for as long as the information is kept by or for
our organization. To request an amendment, your request must be
made in writing and submitted to the administrator of ADVANCED
MOBILITY SOLUTIONS, INC. at 863-665-7666. You must provide us
with a reason that supports your request for amendment. Our
organization will deny your request if you fail to submit your
request (and the reason supporting your request) in writing.
Also, we may deny your request if you ask us to amend
information that is (a) accurate and complete; (b) not part of
the identifiable health information kept by or for the
organization; (c) not part of the identifiable health
information which you would be permitted to inspect and copy; or
(d) not created by our organization, unless the individual or
entity that created the information is not available to amend
the information.
E. Accounting of Disclosures. All of our patients have the right
to request an “accounting of disclosures”. An “accounting of
disclosures” is a list of certain disclosures our organization
is made of your identifiable health information. In order to
obtain an accounting of disclosures, you must submit your
request in writing to the administrator of ADVANCED MOBILITY
SOLUTIONS, INC. at 863-665-76666. All requests for an
“accounting of disclosures” must state a time period that may
not be longer than six years and may not include dates of
service before April 14, 2003. The first list you request within
a 12-month period is free of charge, but our practice may charge
you for additional lists within a 12-month period. Our
organization will notify you of the costs involved with
additional requests, and you may withdraw your request before
you incur any costs.
F. Right to a Paper Copy of This Notice. You are entitled to
receive a paper copy of our notice of privacy practices. You may
ask us to give you a copy of this notice at any time. To obtain
a paper copy of this notice, contact the administrator of
ADVANCED MOBILITY SOLUTIONS, INC. at 863-665-7666. You will not
be penalized for filing a complaint. All complaints must be
submitted in writing.
G. Right To File a Complaint. If you believe your privacy rights
have been violated, you may file a complaint with our
organization or with the Secretary of the Department of Health
and Human Services. To file a complaint with our organization,
contact the Administrator of ADVANCED MOBILITY SOLUTIONS, INC.
at 863-665-7666. You will not be penalized for filing a
complaint. All complaints must be submitted in writing.
H. Right to provide an authorization for other uses and
disclosures. Our organization will obtain your written
authorization for uses and disclosures that are not identified
by these notices or permitted by applicable law. Any
authorization you provide to us regarding the use and disclosure
of your identifiable health information may be revoked at any
time in writing. After you revoke your authorization, we will no
longer use or disclose your identifiable health information for
the reasons described in the authorization. Please not, we are
required to retain records of your care.
