Modern Medical, Inc. Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.
If you have any questions about this Notice, please contact our Privacy Officer.
Modern Medical, Inc. is required by law to maintain the privacy of protected health information and to provide patients with notice of our legal duties and privacy practices with respect to protecting your protected health information. This Notice of Privacy Practices applies to Modern Medical, Inc. and describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required to abide by the terms of this Notice of Privacy Practices so long as it remains in effect. We reserve the right to change the terms of our Notice at any time, and to make the new Notice effective for all protected health information that we maintain at that time.
You may receive a copy of any revised Notice of Privacy Practices by accessing our web site www.modernmedical.com or by mailing a request to Attention: Privacy Officer, PO Box 549, Lewis Center, OH 43035.
Except as outlined below, we will not use or disclose your protected health information for any purposes unless you have signed a form authorizing the use or disclosure. You have the right to revoke that consent or authorization in writing unless we have taken any action in reliance on the consent or authorization. Following are examples of the types of uses and disclosures of your protected health care information. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our company.
We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary; to another organization to assist in providing medical products or care to you. We would also disclose your protected health information to a nurse case manager or claims adjuster handling your claim.
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your workers’ compensation insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities.
We may use or disclose, as needed and as permitted by law, your protected health information in order to support the business activities of Modern Medical, Inc. These activities include, but are not limited to, quality assessment activities, employee review activities, training of new employees, licensing, marketing activities, and conducting or arranging other business activities.
For example, we may use or disclose your protected health information, as necessary, to contact you to obtain information on your use of provided medical equipment and/or supplies, and your progress while using the equipment and/or supplies.
We will share your protected health information with third party “business associates” that perform various activities (e.g., pharmacies, medical equipment providers, auditors, accreditation, etc.) for Modern Medical, Inc. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Family, Friends, and Others Involved In Your Care
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.
We may use and disclose your protected health information if representatives of Modern Medical attempt to obtain consent from you but are unable to do so due to substantial communication barriers and the representative determines, using professional judgement, that you intend to consent to use or disclosure under the circumstances.
Reminders and Services
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about our company and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact our Privacy Officer to request that these materials not be sent to you. Your information will never be leased or sold to another company or organization.
We may use or disclose your demographic information and the dates that you received services from Modern Medical, Inc., as necessary, in order to contact you for progress reports.
Other Permitted and Required Uses and Disclosures
We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
We may use or disclose your protected health information for treatment or notification purposes in the event of a disaster or for disaster relief efforts.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request or other lawful process.
We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the Practice, and (6) medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.
Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
1A. Required Uses and Disclosures
Under the law, we must make disclosures to you when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
1B. Additional Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. If we plan to use or disclose your protected health information in this manner, we will first obtain your written authorization. You may revoke this authorization, at any time, in writing, except to the extent Modern Medical, Inc. has taken an action in reliance on the use or disclosure indicated in the authorization.
2. YOUR RIGHTS
The following is a statement of your rights with respect to your protected health information, and a brief description of how you may exercise these rights.
Access To Your Protected Health Information
You have the right to obtain and inspect a copy of the protected health information about you that is contained in our designated record for as long as we maintain the protected health information. All requests for access must be made in writing and signed by you or your representative. The first request in a 12 month period for your protected health information will be at no charge. For each subsequent request for your patient health information in the same 12 month period, there will be a charge to you for research and processing. If you request a mailed copy, there will be an additional charge for postage. Click on this link to access a printable Individual Request From the Notice of Privacy Practices .
Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable.
Restrictions On Use and Disclosure of Your Protected Health Information
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health. You may also request that any part of your protected health information is not to be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your written request must state the specific restriction requested and to whom you want the restriction to apply. All requests for restrictions must be made in writing and signed by you or your representative. Click on this link to access a printable Individual Request From the Notice of Privacy Practices . Modern Medical, Inc. is not required to agree to a restriction that you may request. If it is determined that it is unreasonable to limit use and disclosure of your protected health information, your protected health information will not be restricted. If it is determined that it is reasonable to restrict use and disclosure of your protected health information, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. All requests to receive confidential communications must be made in writing and signed by you or your representative. Click on this link to access a printable Individual Request From the Notice of Privacy Practices .
Amendments to Your Protected Health Information
You have the right to request to have Modern Medical, Inc. amend your protected health information about you in a designated record for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please see attachment A for guidelines on how to request an amendment. All requests to amend protected health information must be made in writing and signed by you or your representative. Click on this link to access a printable Individual Request From the Notice of Privacy Practices .
Accounting of Disclosures of Your Protected Health Information
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations. All requests for an accounting of disclosures of protected health information must be made in writing and signed by you or your representative. The first accounting in a 12 month period will be at no charge. For each subsequent request of accounting in the same 12 month period, there will be a charge to you for research and processing. If you request a mailed copy, there will be an additional charge for postage. Click on this link to access a printable Individual Request From the Notice of Privacy Practices .
Update of Notice of Privacy Practices
You have the right to obtain the most updated paper copy of this notice from us, upon written request. All requests for the most current Notice of Privacy Practices must be made in writing and signed by you or your representative. You can view and print the most recent Notice of Privacy Practices at www.modernmedical.com .
You may contact us if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your concern/complaint. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. We will not retaliate against you for filing a complaint.
If you have questions or require further assistance regarding this Notice, you may contact our Privacy Officer, Kathleen Hofmeister, at 740-201-0315 or email@example.com.
To contact Modern Medical’s Privacy Officer in writing, please write to:
Kathleen Hofmeister, Privacy Officer
Modern Medical, Inc.
PO Box 549
Lewis Center, OH 43035