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.
ActivStyle Holding Company and all affiliated entities (“ActivStyle”) are committed to protecting your privacy. Therefore, ActivStyle has developed policies and procedures to ensure that the information you provide to us – individually identifiable health information, including protected health information (“PHI”) is collected and maintained in a confidential manner, as required by law. ActivStyle Holding Company consists of several medical supply companies serving populations throughout the United States. ActivStyle companies currently include: ActivStyle, Inc.; Senior Care Services; Advocate Medical Services, Inc.; Home Wellness, Inc.; M.A.R.Y. Medical, Inc.; and Champlain Valley Brace and Limb, LLC.
ActivStyle is providing this Notice as required by the Privacy Regulations promulgated pursuant to the Health Insurance Portability and Accountability Act (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health Act (“HITECH”).
Our organization is dedicated to maintaining the privacy of your PHI. In conducting our business, we will create records regarding you and the treatment and services we provide you. To summarize, this Notice provides you with the following information:
|How we may use and disclose your PHI|
Your privacy rights in your PHI
Our obligation concerning the use and disclosure of your PHI
Treatment. Your PHI may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health and providing treatment. Your PHI may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. For example, information on the services you received may be provided to your physician in order to demonstrate ongoing utilization or to provide you other information about health related products to help manage your condition.
Payment. Your PHI may be used to seek payment from your health plan or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health care operations. Your PHI may be used as necessary to support the day-to-day activities and management ActivStyle. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Law enforcement. Your PHI may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.
Public health reporting. Your PHI may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
Serious Threats to Health or Safety. We may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
Military. We may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.
National Security. We may disclose your PHI 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 investigations.
Inmates. We may disclose your PHI 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) for 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 other individuals.
Workers’ Compensation. We may release your PHI for workers’ compensation and similar programs.
Certain types of uses and disclosures require an individual authorization from you, including uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and uses and sale of PHI. We will not make these uses and disclosures without your individual written authorization.
Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, however, that revocation will not be effective in instances where we have taken actions in reliance upon your authorization, and we are required to retain records of your care.
Confidential Communications. You have the right to request that we communicate with you about 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 at work. You may request a type of confidential communication by contacting an ActivStyle office. Written requests may also be sent to ActivStyle Privacy Officer, 1701 Broadway St NE, Minneapolis, MN, 55413 specifying the requested method of contact, or the location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we limit our disclosure of your PHI to individuals involved in your care or the payment for your care, such as family members and friends. With one exception, 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. We are obligated to agree to requests for restriction where the PHI pertains solely to a health care item or service for which you (or another person other than a health plan) had paid us in full (for example, you pay “out of pocket”). In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to ActivStyle Privacy Officer, 1701 Broadway St NE, Minneapolis, MN 55413. Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure, or both; and (c) to whom you want the limits to apply.
Requests to Inspect and Copy Protected Health Information. You have a right to inspect and copy your PHI. As permitted by federal regulation, we require that requests to inspect or copy protected PHI be submitted in writing. You may obtain a form to request access to your records by contacting ActivStyle Privacy Officer, 1701 Broadway St NE, Minneapolis, MN 55413.
Amendment. You may ask us to amend your PHI if you believe it is incorrect or incomplete. To request an amendment, your request must be made in writing and submitted to ActivStyle Privacy Officer, 1701 Broadway St NE, Minneapolis, MN 55413. You must provide us with a reason that supports 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 PHI kept by or for us; (c) not part of the PHI which you would be permitted to inspect or copy; or (d) not created by us, unless the individual or entity that created the information is not available to amend the information.
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 non-routine disclosures our organization has made of your PHI. In order to obtain an accounting of disclosures, you must submit a request in writing to ActivStyle Privacy Officer, 1701 Broadway St NE, Minneapolis, MN 55413. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 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.
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.
Complaints. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization, contact ActivStyle Privacy Officer, 1701 Broadway St NE, Minneapolis, MN 55413. All complaints must be submitted in writing. You will not be retaliated against for filing a complaint.
In General. We are required by law to maintain the privacy of PHI, and to provide individual with this notice of our legal duties and privacy practices.
Breach Notification. We are also required to notify affected individual following the breach of unsecured PHI.
Notice of Privacy Practices. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice and to make the new notice provisions effective for all PHI we maintain. The new notice will be available upon request, in our offices, and on our website.
If you have questions or would like additional information about this Notice of Privacy Practice you may contact ActivStyle Privacy Officer, at our primary telephone number: 1-800-651-6223.