Notice of Privacy Practices

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NOTICE OF PRIVACY PRACTICES

This Notice is effective March 26, 2013

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 ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU

We are required by law to protect the privacy of medical information about you and that identifies you. This medical information may be information about healthcare we provide to you or payment for healthcare provided to you. It may also be information about your past, present, or future medical condition. We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical information in the manner that we have described in this Notice. We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all medical information that we maintain. If we make changes to the Notice, we will:

· Post the new Notice in our waiting area.

· Have copies of the new Notice available upon request.

The rest of this Notice will:

· Discuss how we may use and disclose medical information about you.

· Explain your rights with respect to medical information about you.

· Describe how and where you may file a privacy-related complaint.

If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact us at any of the numbers listed above.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES


We use and disclose medical information about patients every day. This section of our Notice explains in some detail how we may use and disclose medical information about you in order to provide healthcare, obtain payment for that healthcare, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose medical information about you.

1. Treatment

We may use and disclose medical information about you to provide healthcare treatment to you. In other words, we may use and disclose medical information about you to provide, coordinate or manage your healthcare and related services. This may include communicating with other healthcare providers regarding your treatment and coordinating and managing your healthcare with others.

2. Payment

We may use and disclose medical information about you to obtain payment for healthcare services that you received. This means that, within the health department, we may use medical information about you to arrange for payment (such as preparing bills and managing accounts). We also may disclose medical information about you to others (such as insurers, collection agencies, and consumer reporting agencies). In some instances, we may disclose medical information about you to an insurance plan before you receive certain healthcare services because, for example, we may need to know whether the insurance plan will pay for a particular service.

3. Healthcare Operations

We may use and disclose medical information about you in performing a variety of business activities that we call “healthcare operations.” These “healthcare operations” activities allow us to, for example, improve the quality of care we provide and reduce healthcare costs. For example, we may use or disclose medical information about you in performing the following activities:

· Reviewing and evaluating the skills, qualifications, and performance of healthcare providers taking care of you.

· Providing training programs for students, trainees, healthcare providers or non-healthcare professionals to help them practice or improve their skills.

· Cooperating with outside organizations that evaluate, certify or license healthcare providers, staff or facilities in a particular field or specialty.

· Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients.

· Improving healthcare and lowering costs for groups of people who have similar health problems and helping manage and coordinate the care for these groups of people.

· Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and private organizations.

· Planning for our organization’s future operations.

· Resolving grievances within our organization.

· Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes.

· Working with others (such as lawyers, accountants and other providers) who assist us to comply with this Notice and other applicable laws.

4. Persons Involved in Your Care

We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care and the information is relevant to your care. If the patient is a minor, we may disclose medical information about the minor to a parent, guardian or other person responsible for the minor except in limited circumstances. We may also use or disclose medical information about you to a relative, another person involved in your care or possibly a disaster relief organization (such as the Red Cross) if we need to notify someone about your location or condition. You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the patient is a minor. If the patient is a minor, we may or may not be able to agree to your request.

5. Required by Law

We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require us to use and disclose medical information. For example, state law requires us to report gunshot wounds and other injuries to the police and to report known or suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with all other applicable laws.

6. National Priority Uses and Disclosures

When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as “national priorities.” In other words, the government has determined that under certain circumstances (described below), it is so important to disclose medical information that it is acceptable to disclose medical information without the individual’s permission. We will only disclose medical information about you in the following circumstances when we are permitted to do so by law. Below are brief descriptions of the “national priority” activities recognized by law:

· Threat to health or safety: We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety.

· Public health activities: We may use or disclose medical information about you for public health activities. Public health activities require the use of medical information for various activities, including, but not limited to, activities related to investigating diseases, reporting child abuse and neglect, monitoring drugs or devices regulated by the Food and Drug Administration, and monitoring work-related illnesses or injuries. For example, if you have been exposed to a communicable disease (such as a sexually transmitted disease), we may report it to the State and take other actions to prevent the spread of the disease.

· Abuse, neglect or domestic violence: We may disclose medical information about you to a government authority (such as the Department of Social Services) if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic violence.

· Health oversight activities: We may disclose medical information about you to a health oversight agency – which is basically an agency responsible for overseeing the healthcare system or certain government programs. For example, a government agency may request information from us while they are investigating possible insurance fraud.

· Court proceedings: We may disclose medical information about you to a court or an officer of the court (such as an attorney). For example, we would disclose medical information about you to a court if a judge orders us to do so.

· Law enforcement: We may disclose medical information about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or identify a missing person.

· Coroners and others: We may disclose medical information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye and tissue transplants.

· Workers’ compensation: We may disclose medical information about you in order to comply with workers’ compensation laws.

· Research organizations: We may use or disclose medical information about you to research organizations if the organization has satisfied certain conditions about protecting the privacy of medical information.

· Certain government functions: We may use or disclose medical information about you for certain government functions, including but not limited to military and veterans’ activities and national security and intelligence activities. We may also use or disclose medical information about you to a correctional institution in some circumstances.

7. Authorizations

Other than the uses and disclosures described above (#1-6), we will not use or disclose medical information about you without the “authorization” – or signed permission – of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask us to disclose medical information and we will ask you to sign an authorization form. If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization or fill out an Authorization Revocation Form. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action.

The following uses and disclosures of medical information about you will only be made with your authorization (signed permission):

q Uses and disclosures for marketing purposes.

q Uses and disclosures that constitute the sales of medical information about you.

q Most uses and disclosures of psychotherapy notes, if we maintain psychotherapy notes.

q Any other uses and disclosures not described in this Notice.

YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU


You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights.

1. Right to a Copy of This Notice

You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting area.

2. Right of Access to Inspect and Copy

You have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain groups of records. If we maintain your medical records in an Electronic Health Record (EHR) system, you may obtain an electronic copy of your medical records. You may also instruct us in writing to send an electronic copy of your medical records to a third party. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person. If you would like a copy of the

medical information about you, we will charge you a fee to cover the costs of the copy. Our fees for electronic copies of your medical records will be limited to the direct labor costs associated with fulfilling your request. Access; charges – we will charge patient and/or his/her authorized representative a handling fee of fifty cents per page as a copying fee. We will also charge you the actual cost of postage if you have the copies sent to you.

3. Right to Have Medical Information Amended

You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing and explain why you would like us to amend the information. You may either write us a letter requesting an amendment or fill out an Amendment Request Form. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future.

4. Right to an Accounting of Disclosures We Have Made

You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive an accounting, you may send us a letter requesting an accounting, fill out an Accounting Request Form. The accounting will not include disclosures made prior to April 14, 2003. If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting. Access; charges – we will charge patient and/or his/her authorized representative a handling fee of fifty cents per page as a copying fee. We will also charge you the actual cost of postage if you have the copies sent to you.

5. Right to Request Restrictions on Uses and Disclosures

You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and healthcare operations. Under federal law, we must agree to your request and comply with your requested restriction(s) if:

1. Except as otherwise required by law, the disclosure is to a health plan for purpose of carrying out payment of healthcare operations (and is not for purposes of carrying out treatment); and,

2. The medical information pertains solely to a healthcare item or service for which the healthcare provided involved has been paid out-of-pocket in full.

Once we agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation. You also have the right to request that we restrict disclosures of your medical information and healthcare treatment(s) to a health plan (health insurer) or other party, when that information relates solely to a healthcare item or service for which you, or another person on your behalf (other than a health plan), has paid us for in full. Once you have requested such restriction(s), and your payment in full has been received, we must follow your restriction(s).

6. Right to Request an Alternative Method of Contact

You have the right to request to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to your work address rather than to your home address. We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative Contact Request Form.

7. Right to Notification if a Breach of Your Medical Information Occurs

You also have the right to be notified in the event of a breach of medical information about you. If a breach of your medical information occurs, and if that information is unsecured (not encrypted), we will notify you promptly with the following information:

q A brief description of what happened;

q A description of the health information that was involved;

q Recommended steps you can take to protect yourself from harm;

q What steps we are taking in response to the breach; and,

q Contact procedures so you can obtain further information.

8. Right to Opt-Out of Fundraising Communications

If we conduct fundraising and we use communications like the U.S. Postal Service or electronic email for fundraising, you have the right to opt-out of receiving such communications from us. Please contact our Privacy Officer to opt-out of fundraising communications if you chose to do so.

YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a written complaint either with us or with the federal government.

We will not take any action against you or change our treatment of you in any way if you file a complaint.

To file a written complaint with us, you may mail it to the following address:

Frontier Home Medical

304 West 8th Street

Cozad, NE 69130

888-326-3818

To file a written complaint with the federal government, please use the following contact information:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

Toll-Free Phone: 1-(877) 696-6775

Website: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

Email: OCRComplaint@hhs.gov

Patient’s Rights and Responsibilities

Each client/patient has the right to:

· Be treated with respect and dignity without regard to race, color, creed, sexual orientation, national or ethnic origin, diagnosis, or source of payment.

· Be provided with information regarding ownership, available services and charges.

· Be informed about his/her illness and treatment, when and how services will be provided, the name and function of any person and agency providing care and service, and the name of person responsible for coordination of care.

· Continuity of care and service provided by personnel who are qualified through education and experience to perform the service for which they are responsible.

· Confidentiality and privacy in treatment and care, including confidential treatment of patient records, and to refuse their release to any individual outside, except in the case of transfer to another health facility, or as required by law or third-party contract.

· Voice complaint and grievance and be informed of procedure for registering complaints without reprisal, coercion, discrimination or unreasonable interruption of services. Anyone wishing to express dissatisfaction or concerns should contact Frontier Home Medical Monday through Friday 8:00 AM to 5:00 PM.

· Refuse Frontier Home Medical’s service and/or equipment and assumes full responsibility for any consequence relating to refusal of any service ordered by a healthcare professional for the patient.

Patient is Responsible

· For providing accurate and complete information regarding his/her medical history.

· For agreeing to a schedule of services and reporting any cancellation of scheduled appointments.

· For participating in the development and updating of a plan of care.

· For caring for Frontier Home Medical’s rental equipment, using it as instructed and returning it in good condition. Patient agrees to pay for replacement of damaged, lost, destroyed or neglected equipment.

· For notifying Frontier Home Medical to pick up rental equipment after it is no longer medically necessary.

· For communicating whether he/she clearly understands the course of treatment and plan of care.

· For following the plan of care and clinical condition.

· For reporting problems, unexpected changes in physical condition, re-hospitalizations, concerns or complaints.

· For accepting responsibility for his/her actions if refusing treatment.

· For fulfilling financial obligations for services.

· For respecting the rights of home care givers.

Frontier Home Medical’s Rights and Responsibilities

Frontier Home Medical’s Rights

· Rental equipment will always remain the property of Frontier Home Medical. Ownership can transfer only by consent. Frontier Home Medical shall retain the right to refuse delivery of service to any patient at any time to insure the health and safety of Frontier’s employees in accordance with the uniform commercial code.

· Sales returns will be accepted in unopened packages and/or saleable condition within thirty (30) days from the date of original invoice with proof of purchase. No merchandise will be accepted for return if worn next to the skin, used for sanitary or hygienic purposes, or if it is disposable. Special order items will require prepayment in full and are nonreturnable.

· All used equipment purchased shall have a 30 day guarantee. A maximum of 30 days rent may be credited to the purchase of rental equipment (where applicable).

· Any legal fees resulting from a disagreement between the parties shall be borne by the unsuccessful party in any legal action taken.

Frontier Home Medical’s Responsibilities:

· Frontier Home Medical guarantees that all equipment to be delivered will be operating within manufacturer’s specifications to be fully warrantied to the manufacturer’s current policy.

· Frontier Home Medical will fill orders from its own inventory of other companies with which it has contracts to fill such orders; or fabricates or fits items for sale from supplies it buys under a contract.

· Frontier Home Medical is also responsible to assure delivery of items that Frontier Home Medical ordered for the beneficiary.

· Frontier Home Medical is also responsible to assure delivery of large items to the beneficiary.

· Frontier Home Medical honors all warranties, express or implied, under applicable State law.

· Frontier Home Medical will answer questions or complaints a beneficiary has about an item or use of an item that is sold or rented to the beneficiary. If the beneficiary has questions about Medicare, Frontier Home Medical will refer beneficiary to the appropriate carrier.

· Frontier Home Medical maintains and repairs directly, or through a service contract with another Company, items it rents to a beneficiary.

· Frontier Home Medical accepts returns of substandard (less than full quality for a particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and/or sold) from the beneficiary.

· Frontier Home Medical discloses consumer information to each Medicare customer. This consists of a copy of these supplier standards to which it must conform.

· Frontier Home Medical complies with the disclosure provisions in Title XI of the Social Security Act, section 1124A(a).

· Frontier Home Medical will instruct the patient on how to use the equipment, as well as daily maintenance and cleaning if required.

· Frontier Home Medical makes no representation as to its therapeutic value, or purpose, any use to which it may be put or the length of time it shall be needed. The patient exonerates Frontier Home Medical, its owners and employees of any and all liability for injuries and damages resulting from its use.

· All employees of Frontier Home Medical will maintain all patient information in strict confidence.

· Routine deliveries will be scheduled during normal business hours which are between 8:00 AM to 5:00 PM Monday through Friday.