Notice of Privacy Practices

USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

1. We may disclose your protected health information to public health authorities authorized by law to collect information for the purpose of: Maintaining vital records, such as births and deaths;
2. Reporting child abuse or neglect;
3. Preventing or controlling disease, injury or disability;
4. Notifying a person regarding potential exposure to a communicable disease;
5. Notifying a person regarding a potential risk for spreading or contracting a disease or condition;
6. Reporting reactions to drugs or problems with products or devices;
7. Notifying individuals if a product or device they may be using has been recalled;
8. Notifying appropriate government agencies and authorities regarding potential abuse/neglect of an adult patient (including domestic violence); however, we will only do so if the patient agrees or we are required/authorized by law and;
9. We may disclose your personal health information to a health agency authorized by law for activities such as investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and healthcare system in general.

We may release personal health information if asked to do so by a law enforcement official in response to a warrant, summons, court order, subpoena or similar legal process.We may use and disclose your personal health information when necessary to reduce or prevent a serious threat to your health and safety or 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.

We may disclose your personal health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

We may disclose your personal health information to federal officials for intelligence and national security activities authorized by law. We also may disclose this information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the right to request 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 work. In order to request a type of confidential communication, you must make a written request to us specifying the requested method of contact or location. We will accommodate reasonable requests. You do not need to give a reason for your request.

You have the right to request a restriction in our use or disclosure of your Protected health information for treatment, payment or health care operations. Additionally, you have the right to request we limit our disclosure of your informationto individuals involved in your care or payment for your care, such as family members and 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 information is necessary to treat to you. A request for restriction in our use or disclosure of your iinformation must be made in writing and must describe in a clear and concise fashion the information you wish restricted; whether you are requesting to limit our use, disclosure or both; and to whom you want the limits to apply.

You have the right to inspect and obtain a copy of protected health information 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 us in order to inspect and/or obtain a copy of your information. We may charge a fee for copying, mailing, labor and supplies associated with your request. We may deny your request in certain limited circumstances; however, you may request a review of our denial which will be conducted by another licensed health care professional chosen by us. You may ask us to amend your health information if you believe it is incorrect or incomplete for as long as the information is kept by or for Integra Healthcare Equipment. To request an amendment, your request must be submitted in writing to us and include a reason supporting your request. We may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of Protected health information kept by or for the organization; (c) not part of Protected health information which you would be permitted to inspect and copy; or (d) not created by Integra Healthcare Equipment, unless the individual or entity that created the information is not available to amend the information.

You have the right to request an accounting of disclosures we have made of your Protected health information. Your request must be submitted in writing to us and must state a time period which may not be longer than six years. 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. We will notify you of costs involved with additional requests.

If you believe your rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. To file a complaint with us, submit in writing to:

Integra Healthcare Equipment
Attention: Patient Services
747 North Church Road, Suite G7
Elmhurst, IL 60126

We will obtain your written authorization for uses and disclosures not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your information for reasons described in the authorization. Please note, we are required to retain records of your care.

If you have any questions or want additional information about this notice, please contact our Patient Services department at (630) 834-3700.