MDS Medical Device Specialty Inc.
NOTICE OF PRIVACY PRACTICES
Effective: March 1, 2015
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 understand that your medical and health information is personal. Protecting your health information is important. We follow strict federal and state laws that require us to maintain the confidentiality of your health information.
How We Use Your Health Information
When you receive medical devices from MDS Medical Device Specialty Inc. (“MDS”), we may use your health information for treating you, billing for services, and conducting our normal business known as health care operations. Examples of how we use your information include:
Treatment – We keep records of the care and services provided to you. Health care providers use these records to deliver quality care to meet your needs. For example, your doctor may share your health information with a specialist who will assist in your treatment. Some health records, including some confidential communications with a mental health professional and some substance abuse records, may have additional restrictions on the use and disclosure under state and federal laws.
Payment – We keep billing records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment from you, your insurance company, or other third party. We may also contact your insurance company to verify coverage for your care or to notify them of upcoming services that may need prior notice or approval. For example, we may disclose information about the services provided to you to claim and obtain payment from your insurance company or Medicare.
Health Care Operations – We use health information to improve the quality of care, train staff and students, provide customer service, manage costs, conduct required business duties, and make plans to better serve our communities. For example, we may use your health information to evaluate the quality of treatment and services provided by our products.
Other Uses of Your Health Information
We may also use your health information to:
For more information about the practices and rights described in this notice, contact our office manager at the phone number and address at the bottom of this notice.
Sharing Your Health Information
There are limited situations when we are permitted or required to disclose health information without your signed authorization. These situations are:
We may also submit your personal health information to the Medicaid eligibility database, the Children’s Health Insurance Program eligibility database, and/or other shared clinical databases or health information exchanges. All other uses and disclosures, not described in this notice, require your signed authorization. You may revoke your authorization at any time with a written statement (with limited exceptions as provided by federal regulations).
Your Individual Rights
You have the right to:
Our Privacy Responsibilities
MDS is required by law to:
Changes to Notice
We reserve the right to make changes to this notice at any time and make the new privacy practices effective for all information we maintain. Current notices will be posted in our facilities and on our website, www.mdsdme.com/hipaa. You may also request a copy of any notice from our office manager.
This notice describes the privacy practices of MDS. MDS includes medical professionals, employees and its agents. This notice also describes the privacy practices of affiliated providers while they are performing services in behalf of MDS unless they provide you with a notice of their specific privacy practices. Affiliated providers are not employed by MDS but are authorized to provide services to patients. Affiliated providers may have different privacy practices from those described in this notice. For more information about the privacy practices of affiliated providers, please contact them directly.
If you would like further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to your health information, contact: MDS’s office manager at 801-475-0303.
We will investigate all complaints and will not retaliate against you for filing a complaint. You may also file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services.
I have read and understand this Privacy Notice:
I give permission for the following family members or friends to be contacted regarding my medical care (List Name and Telephone):
Patient Signature: __________________________________________________
Witness Signature: Date Signed: __________________________________________________
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