Patient Rights and Responsibilities

Patient Rights:
1. The patient has the right to considerate and respectful service.
2. The patient has the right to obtain service without regard to race, creed, national origin, sex, age, disability, diagnosis or religious affiliation.
3. Subject to applicable law, the patient has the right to confidentiality of all information pertaining to his/her medical equipment service. Individuals or organizations not involved in the patient’s care may not have access to the information without the patient’s written consent.
4. The patient has the right to make informed decisions about his/her care.
5. The patient has the right to reasonable continuity of care and service.
6. The patient has the right to voice grievances without fear of termination of service or other reprisal in the service process.

Patient Responsibilities:
1. The patient should promptly notify Health Aid Supplies, LLC of any equipment failure or damage.
2. The patient is responsible for any equipment that is lost or stolen while in their possession and should promptly notify Health Aid Supplies, LLC in such instances.
3. The patient should promptly notify Health Aid Supplies, LLC of any changes to their address or telephone.
4. The patient should promptly notify Health Aid Supplies, LLC of any changes concerning their physicia
5. The patient should notify Health Aid Supplies, LLC of discontinuance of use.
6. Except where contrary to federal or state law, the patient is responsible for any equipment rental and sale charges which the patient’s insurance company/companies does not pay.

PROTOCOL FOR RESOLVING COMPLAINTS FROM MEDICARE BENEFICIARIES
The patient has the right to freely voice grievances and recommend changes in care or services without fear of reprisal or unreasonable interruption of services. Service, equipment, and billing complaints will be communicated to the management of Health Aid Supplies, LLC. These complaints will be documented in the Medicare Beneficiaries Complaint Log, and completed forms will include the patient’s name, address, telephone number, and health insurance claim number, a summary of the complaint, the date it was received, the name of the person receiving the complaint, and a summary of actions taken to resolve the complaint.
All complaints will be handled in professional manner. All logged complaints will be investigated, acted upon, and responded to in writing or by telephone by a manager within a reasonable amount of time after the receipt of the complaint. If there is no satisfactory resolution to the complaint, the next level of management will be notified progressively and up to the president of the company. The patient will be informed of this complaint resolution protocol at the time off set-up service

EQUIPMENT WARRANTY INFORMATION
Every product sold or rented by our company carriers a 1year manufacturer’s warranty. Health Aid Supplies, LLC will notify all Medicare beneficiaries of the warranty coverage, and we will honor all warranties under applicable law. Health Aid Supplies, LLC will repair or replace, free of charge, Medicare-covered equipment that is under warranty. In addition, an owner’s manual with warranty information will be provided to beneficiaries for all durable medical equipment where this manual is available. I have been instructed and understand the warranty coverage on the product I have received.

 MEDICARE DMEPOS SUPPLIER STANDARDS

  1. A supplier must be compliance with all applicable Federal and State Licensure and regulatory requirements and cannot contract with an individual or entity to provide licensed services.
  2. A supplier must provide complete and accurate information on the DMEPOS supplier application.  Any changes to this information must be reported  to the National Supplier Clearinghouse within 30 days.
  3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.
  4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.
  5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
  6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered  items that are under warranty.
  7. A supplier must maintain a physical facility on an appropriate site. This standard requires that the location  is accessible to the public and staffed during posted hours of business, with visible signage. The location must be at least 200 square feet and contain space for storing records.
  8. A supplier must permit CMS, or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards.
  9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.
  10. A supplier must have comprehensive liability insurance in the amount of at  least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.
  11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from contacting a Medicare beneficiary based on a physician’s oral order unless an exception applies.
  12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered  items, and  maintain proof  of delivery.
  13. A supplier must answer questions and  respond  to complaints of beneficiaries and maintain documentation of such contacts.
  14. A supplier must maintain and  replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
  15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
  16. A supplier must disclose these supplier standards to each beneficiary to whom  it supplies a Medicare-covered  item.
  17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
  18. A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.
  19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards.  A  record of these complaints must be maintained at the physical facility.
  20. Complaint  records must include: the name, address, telephone number and health  insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
  21. A supplier must agree to furnish CMS any information required by the Medicare statue and implementing regulations.
  22. All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals).  Implementation Date – October 1, 2009
  23. All suppliers must notify their accreditation organization when a new DMEPOS location is opened.
  24. All supplier locations, whether owned or subcontracted, must meet DMEPOS quality standards and be separately accredited in order to bill Medicare.
  25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.
  26. Must meet the surety bond  requirements specified in 42 C.F.R. 424.57©. Implementation date – May 4,  2009
  27. A supplier must obtain oxygen from a state-licensed oxygen supplier.
  28. A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.F.R. 424.516(f).
  29. DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare provider and suppliers.
  30. DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions. 

Health Aid Supplies, LLC

 

NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  This notice describes how health information about you may be used and disclosed and how you can get access to your identifiable health information. Please review this notice carefully.

 

  1. OUR COMMITMENT TO YOUR PRIVACY

Our organization is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

To summarize, this notice provides you with the following important information:

  • How we may use and disclose your identifiable health information
  • Your privacy rights in your identifiable health information
  • Our obligations concerning the use and disclosure of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our practice. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our practice has created or maintained in the past, and for any of your records we may create or maintain in the future. Our organization will post a copy of our current notice in our offices in prominent location, and you may request a copy of our most current notice during any office visit.

 

  1. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE. PLEASE CONTACT:

Health Aid Supplies, LLC 100 E Pearce Blvd. Wentzville, MO 63385 (314)-324-5554 (314) 445-1903 fax 636-887-0133

 

  1. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your identifiable health information.

  1. Treatment. Our organization may use your identifiable health information to treat you. For example, we may perform & follow-up interview and we may use the results to help us modify your treatment plan. Many of the people who work for our organization may use of disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children, or parents.
  2. Payment. Our organization may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties who may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items
  3. Health Care Operations. Our organization may use and disclose your identifiable health information to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our organization may use your health information to evaluate the quality of care you received from us or to conduct cost-management and business planning activities for our practice.
  4. Appointment Reminders. Our organization may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.
  5. Health-Related Benefits and Services. Our organization may use and disclose your identifiable health information to inform you of health related benefits or services that may be of interest to you.
  6. Release of Information to Family/Friends. Our organization may release your identifiable health information to a friend or family member who assists in taking care of you.
  7. Disclosures Required By Law. Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.

 

  1. USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH IN CERTAIN SPECIAL CIRCUSTANCES

The following categories describe unique scenario in which we may use or disclose your identifiable health information.

  1. Public Health Risks. Our organization may disclose your identifiable health information to public health authorities who are authorized by law to collect information for the purpose of:
  • Maintaining vital records, such as births and deaths
  • Reporting child abuse or neglect
  • Preventing or controlling disease, injury, or disability
  • Notifying a person regarding potential exposure to a communicable disease
  • Notifying a person regarding a potential risk for spreading or contraction a disease or condition
  • Reporting reactions to drugs or problems with products or devices
  • Notifying individuals if a product or device they may be using has been recalled
  • Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
  • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
  1. Health Oversight Activities. Our organization may disclose you identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure, and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government programs, compliance with civil rights laws. And the health care system in general.
  2. Lawsuits and Similar Proceedings. Our organization may use and disclose your identifiable health information in response to court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
  3. Law Enforcement. We may release identifiable health information if asked to do so by a law enforcement official:
  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
  • Concerning a death we believe might have resulted from criminal conduct
  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoena, or similar legal process.
  • To identify/locate a suspect, material witness, fugitive, or missing person.
  • In an emergency, to report a crime (including the location or victim(s) of a crime, or the description, identity or location of the perpetrator)
  1. Serious Threats to Health or Safety. Our organization may use and disclose your identifiable health information 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 prevent the threat.
  2. Military. Our organization may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military authorities.
  3. National Security. Our organization may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We may also 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.
  4. Inmates. Our organization may disclose your identifiable health information 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.
  5. Workers’ Compensation. Our organization may release your identifiable health information form workers’ compensation and similar programs.  

 

  1. YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION.

You have the following rights regarding identifiable health information that we maintain about you:

 

  1. Confidential communications. You have the right to request that our organization 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 Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133 specifying the requested method of contact or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.

 

  1. Requesting restrictions. You have the rights to request a restriction in our use and/or disclose of your identifiable health information for the treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payments 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 the information is necessary to treat you. In order to request a restriction in our use of disclosure of your identifiable health information, you must make a request in writing to Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133. Your request must describe in a clear and concise manner: (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.

 

  1. Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be 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 Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133 in order to inspect and/or obtain a copy of you identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor, and supplies associated with you request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by us.

 

  1. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, you request must be in writing and submitted to Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting you 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 identifiable health information kept by or for the organization; (c) not part of the identifiable health information which you would be permitted to inspect and copy or (d) not created by the organization, unless the individual or entity that created the information is not available to amend the information.

 

  1. 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 disclosures our organization has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133. All requests for an “accounting of disclosures” must state a time period which may not be longer than six years and may not include the dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but our practice may charge you for additional lists requested 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.

 

  1. Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our privacy practices. You may ask us to give you a copy of this notice as any time. To obtain a paper copy of this notices contact Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385, ph. 314-324-5554, fax 636-887-0133.

 

  1. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization, Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385, fax 636-887-0133. All complaints must be in writing. You will not be penalized for filing a complaint.

 

  1. Right to Provide an Authorization for Other Uses and Disclosures. Our organization will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted under the applicable law. Any authorization you provide us regarding the use and the disclosure of you identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclosure your identifiable health information for the reasons described in the authorization. Please note that we are required to retain records of your care.

Health Aid Supplies, LLC

 

NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  This notice describes how health information about you may be used and disclosed and how you can get access to your identifiable health information. Please review this notice carefully.

 

  1. OUR COMMITMENT TO YOUR PRIVACY

Our organization is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

To summarize, this notice provides you with the following important information:

  • How we may use and disclose your identifiable health information
  • Your privacy rights in your identifiable health information
  • Our obligations concerning the use and disclosure of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our practice. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our practice has created or maintained in the past, and for any of your records we may create or maintain in the future. Our organization will post a copy of our current notice in our offices in prominent location, and you may request a copy of our most current notice during any office visit.

 

  1. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE. PLEASE CONTACT:

Health Aid Supplies, LLC 100 E Pearce Blvd. Wentzville, MO 63385 (314)-324-5554 (314) 445-1903 fax 636-887-0133

 

  1. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your identifiable health information.

  1. Treatment. Our organization may use your identifiable health information to treat you. For example, we may perform & follow-up interview and we may use the results to help us modify your treatment plan. Many of the people who work for our organization may use of disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children, or parents.
  2. Payment. Our organization may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties who may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items
  3. Health Care Operations. Our organization may use and disclose your identifiable health information to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our organization may use your health information to evaluate the quality of care you received from us or to conduct cost-management and business planning activities for our practice.
  4. Appointment Reminders. Our organization may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.
  5. Health-Related Benefits and Services. Our organization may use and disclose your identifiable health information to inform you of health related benefits or services that may be of interest to you.
  6. Release of Information to Family/Friends. Our organization may release your identifiable health information to a friend or family member who assists in taking care of you.
  7. Disclosures Required By Law. Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.

 

  1. USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH IN CERTAIN SPECIAL CIRCUSTANCES

The following categories describe unique scenario in which we may use or disclose your identifiable health information.

  1. Public Health Risks. Our organization may disclose your identifiable health information to public health authorities who are authorized by law to collect information for the purpose of:
  • Maintaining vital records, such as births and deaths
  • Reporting child abuse or neglect
  • Preventing or controlling disease, injury, or disability
  • Notifying a person regarding potential exposure to a communicable disease
  • Notifying a person regarding a potential risk for spreading or contraction a disease or condition
  • Reporting reactions to drugs or problems with products or devices
  • Notifying individuals if a product or device they may be using has been recalled
  • Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
  • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
  1. Health Oversight Activities. Our organization may disclose you identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure, and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government programs, compliance with civil rights laws. And the health care system in general.
  2. Lawsuits and Similar Proceedings. Our organization may use and disclose your identifiable health information in response to court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
  3. Law Enforcement. We may release identifiable health information if asked to do so by a law enforcement official:
  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
  • Concerning a death we believe might have resulted from criminal conduct
  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoena, or similar legal process.
  • To identify/locate a suspect, material witness, fugitive, or missing person.
  • In an emergency, to report a crime (including the location or victim(s) of a crime, or the description, identity or location of the perpetrator)
  1. Serious Threats to Health or Safety. Our organization may use and disclose your identifiable health information 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 prevent the threat.
  2. Military. Our organization may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military authorities.
  3. National Security. Our organization may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We may also 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.
  4. Inmates. Our organization may disclose your identifiable health information 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.
  5. Workers’ Compensation. Our organization may release your identifiable health information form workers’ compensation and similar programs.  

 

  1. YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION.

You have the following rights regarding identifiable health information that we maintain about you:

 

  1. Confidential communications. You have the right to request that our organization 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 Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133 specifying the requested method of contact or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.

 

  1. Requesting restrictions. You have the rights to request a restriction in our use and/or disclose of your identifiable health information for the treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payments 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 the information is necessary to treat you. In order to request a restriction in our use of disclosure of your identifiable health information, you must make a request in writing to Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133. Your request must describe in a clear and concise manner: (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.

 

  1. Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be 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 Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133 in order to inspect and/or obtain a copy of you identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor, and supplies associated with you request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by us.

 

  1. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, you request must be in writing and submitted to Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting you 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 identifiable health information kept by or for the organization; (c) not part of the identifiable health information which you would be permitted to inspect and copy or (d) not created by the organization, unless the individual or entity that created the information is not available to amend the information.

 

  1. 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 disclosures our organization has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385 fax 636-887-0133. All requests for an “accounting of disclosures” must state a time period which may not be longer than six years and may not include the dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but our practice may charge you for additional lists requested 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.

 

  1. Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our privacy practices. You may ask us to give you a copy of this notice as any time. To obtain a paper copy of this notices contact Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385, ph. 314-324-5554, fax 636-887-0133.

 

  1. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization, Compliance Officer, Health Aid Supplies, LLC, 100 East Pearce Blvd, Wentzville, MO, 63385, fax 636-887-0133. All complaints must be in writing. You will not be penalized for filing a complaint.

 

  1. Right to Provide an Authorization for Other Uses and Disclosures. Our organization will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted under the applicable law. Any authorization you provide us regarding the use and the disclosure of you identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclosure your identifiable health information for the reasons described in the authorization. Please note that we are required to retain records of your care.