HIPAA PATIENT PRIVACY RULE

Under the Federal HIPAA privacy rule, we are required to give you our notice of Privacy Practices and make a good faith effort, before providing services, to your Acknowledgement of Receipt of this Notice.

“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.”

Safe Place Bedding LLC is committed to preserving the privacy of your personal health information. In fact, we are required by law to protect the privacy of your medical information and to provide you with this notice describing how your medical information is used and disclosed for your treatment, to obtain payment for treatment, administrative purposes and to evaluate the quality of care that you receive.

Uses and Disclosures: We use and disclose elements of your Protected Health Information (PHI) in the following ways:

• Treatment: including, but not limited to, inpatient, outpatient or psychiatric care.
• Your treating physician(s).
• Payment: including, but not limited to, asking you about your health care plan(s), or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts, either ourselves or through a collection agency or attorney.
• Health care operations: including, but not limited to, financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
• Disclosures when release is authorized by law, including, but not limited to, judicial settings and to health oversight regulatory agencies, law enforcement and correctional institutions.
• Uses or disclosures for specialized government functions including, but not limited to, the protection of the President or high-ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign services.
• If emergency situations or other serious health / safety situations.
• If you are a member of the armed forces, we may release medical information about you and your dependents as requested by military command authorities.
• Disclosures of de-identified information.
• Disclosures relating to workers’ compensation claims.
• To medical examiners, coroners or funeral directors to aid in identifying you or to help them in performing their duties.
• To organizations that handle organ and tissue donations.
• To public health authorities or federal organizations in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
• Disclosures to “business associates” who perform health care operations for us and who commit to respect the privacy of your health information.
• We may be required or permitted by certain laws to use and disclose your medical information for other purposes without your consent or authorization.
• We will notify you by e-mail or US Mail of any breaches of your PHI.
• You have the following rights concerning your protected health information (PHI):

Restrictions: To request restricted access to all or part of your PHI. To do this, contact the organization’s HIPAA Privacy and Security Officer. We are not required to grant your request, and you do not have the right to restrict disclosures required by law. If we do agree, we must honor the restrictions you request.

Confidential Communications: To receive correspondence of confidential information by alternate means or location such as phoning you at work rather than at home or mailing your health information to a different address. To do this, contact the organization’s HIPAA Privacy and Security Officer. We will take reasonable actions to accommodate your request.

Access: To inspect or receive copies of your PHI. To do this, contact the organization’s HIPAA Privacy and Security Officer. In certain circumstances you may not have the right to access your records if the organization reasonably believes (or has reason to believe) that such access would cause harm.

Examples include, but are not limited to, certain psychotherapy notes, information compiled in reasonable anticipation of or for use in civil, criminal or administrative actions or proceedings, or information obtained from someone other than a healthcare provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.

Amendments / Corrections: To request changes be made to your PHI. To do this, contact the organization’s HIPAA Privacy and Security Officer. We are not required to grant your request if we did not create the record, or if the record is accurate and complete. If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you may complain. If we agree to the request, we will make the correction within 60 days and will send the corrected information to persons we know who got the wrong information, and others you specify.

Accounting: To receive an accounting of the disclosures by us of your PHI. To do this, contact the organization’s HIPAA Privacy and Security Officer. Accounting does not include disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law, we can have a 30-day extension of time if we notify you of the extension in writing. We are not required to give you a list of disclosures that occurred before April 14, 2003.

This Notice: To get updates or reissue of this notice, at your request.

Complaints: To complain to us or the U.S. Department of Health & Human Services if you feel your privacy rights have been violated. To register a complaint with us, contact: 614-602-5196.

The law forbids us from taking retaliatory action against you if you complain.

Our Duties: We are required by law to maintain the privacy of your protected health information (PHI). We must abide by the terms of this notice or any update of this notice.

As a patient of Safe Place Bedding LLC, you have important rights relating to inspecting and copying your medical information that we maintain, amending or correcting the information, obtaining an accounting of disclosures of your medical information, requesting that we communicate with you confidentially, requesting that we restrict certain uses and disclosures of your health information, and complaining if you think your rights have been violated.