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Policy Statement and Disclosures
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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
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TYPICAL USES AND DISCLOSURES OF HEALTH INFORMATION
We will keep your health information confidential, using it only for the following purposes:
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Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary or need to know” standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.
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Disclosure: We may disclose and/or share your healthcare information with other healthcare professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may be disclosed to your family, friends and/or other persons you choose to involve in your care, only if you agree that we may do so.
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Payment: We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include organizations or other businesses that may become involved in the process of mailing statements and /or collecting unpaid balances.
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Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death. If at all possible we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated we will use our professional judgment to disclose only that information relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions and/or supplies unless you have advised us otherwise.
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Healthcare Operations: We will use and disclose your health information to appropriate authorities to keep our practice operable. Examples of personnel who may have access to this information include, but are not limited to, our medical records staff, outside health or management reviewers and individuals performing similar activities.
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Required by Law: We may use or disclose your health information when we are required to do so by law. (Court or administrative orders, subpoena, discovery request or other lawful process.) We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of the law enforcement.
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Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonable believe that you are a possible victim of abuse, neglect, or domestic violence or to the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious thereat to your health or safety or that of others.
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Public Health and Responsibilities: We will disclose your health care information to report problems with products, reactions to medications, product recalls, disease/infection exposure and to prevent and control disease, injury, and/or disability.
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Marketing Health-Related Services: We will not use your health information for marketing purposes unless we have your written authorization to do so.
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Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders, including, but not limited to voicemail messages, postcards, or letters.
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Access: Upon written request, you have the right to inspect and get copies of your health information (and that of an individual for whom you are a legal guardian.) There will be some legal exceptions. If you wish to examine your health information, you will need to complete and submit an appropriate request form. Contact our privacy officer for a copy of the Request Form. You may also request access by sending us a letter to the address and the end of this Notice. Once approved, an appointment can be made to review your records. Copies, if requested, will be $0.35 for each page and the staff time charged will be $ per hour including the time required to locate and copy your health information. If you want the copies mailed to you, postage will also be charged. If you prefer a summary or an explanation of your health information, we will provide it of a fee. Please contact our Privacy Officer for a fee and/or an explanation of our fee structure.
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Amendment: You have the right to amend your healthcare information, if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, our request may be denied.
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Non-routine Disclosures: You have the right to receive a list of non-routine disclosures we have made of your care information. (When we make a routine disclosure of your information to a professional for treatment and/or payment purposes, we do not keep a record of routine disclosures: therefore these are not available.) You have the right to a list of instances in which we, or our business associates, disclosed information for reasons other than treatment, payment or healthcare operations. You can request non-routine disclosures going back 6 years starting on April 14, 2003. Information prior to that date would not have to be released. (Example: If you request information on May 1, 2004, the disclosure period would start on April 14, 2003 up to May 15, 2004. Disclosures prior to April 14, 2003 to not have to be made.)
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Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We do not have to agree to these additional restrictions, but if we do, we will abide by our agreement. (Except in emergencies.) Please contact our Privacy Officer if you want to further restrict access to your health care information. This request must be submitted in writing.
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Questions and Complaints:
You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us in writing. Request a Complaint Form from our Privacy Officer. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
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HOW TO CONTACT US
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Facility Name:
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Diabetes Care & Education, Inc.
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Privacy Officer:
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Patty Rose
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Address:
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10101 Linn Station Road, Suite 560
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Telephone:
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502.412.3253 ext. 114
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Patient Bill of Rights & Responsibilities
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Patients of Diabetes Care & Education, Inc. have a right to be notified in writing of their rights and
obligations before care/service is begun. Diabetes Care & Education, Inc. have an obligation to protect and
promote the rights of their patients to care, treatment and services within their capability and mission,
and in compliance with applicable laws, regulations and standards, including the following rights.
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YOU HAVE THE RIGHT TO:
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• Be fully informed in advance about services/care to be provided, including the company representatives that provide care/services, and the frequency of visits as well as any modifications to the service/care plan.
• Be treated, and have your property treated, with dignity, courtesy and respect, recognizing that each person is a unique individual.
• Choose a Durable Medical Supplier.
• Have relationships with Diabetes Care & Education, Inc. that are based on honesty and ethical standards of conduct.
• Receive information about the scope of care/services that are provided by Diabetes Care and Education, Inc. directly or through contractual arrangements, as well as any limitations to the company’s care/service capabilities.
• Reasonable coordination and continuity of services from the referral source to Diabetes Care and Education, Inc. timely response when home care equipment is needed or requested and to be informed in a timely manner of impending discharge.
• Be fully informed upon admission of the company’s policies, procedures, ownership or control of the local facility and the process for receiving, reviewing and resolving your complaints or concerns about your care, treatment and/or services.
• Receive in advance of care/services being provided, complete verbal and written explanations of charges for care, treatment, services and equipment, including the extent to which payment may be expected from Medicare, Medicaid, or any other third party payer, charges for which you may be responsible, and an explanation of all forms you are requested to sign.
• Receive quality durable medical equipment and services that meet or exceed professional and industry standards regardless of race, religion, political belief, sex, social or economic status, age, disease process, DNR status or disability.
• Receive durable medical equipment, treatment and services from qualified personnel and to receive instructions on self care, safe and effective operation of equipment and your responsibilities regarding home care equipment, treatment and services.
• Participate in decisions concerning the nature and purpose of any technical procedure that will be performed and who will perform it, the possible alternatives and/or risks involved and your right to refuse all or part of the services and to be informed of expected consequences of any such action.
• Be informed of the anticipated outcomes of care/services and of any barriers in achieving those outcomes.
• Confidentiality and privacy of all the information contained in your records and of Protected Health Information (except as otherwise provided for by law or third-party payer contracts) and to review and even challenge those records and to have your records corrected for accuracy.
• Receive information about to whom and when your personal health information was disclosed, as permitted under applicable law and as specified in the company’s policies and procedures.
• Express dissatisfaction/concerns/complaints about any care/treatment or service, lack of respect of property and to suggest changes in policy, staff or care/services without discrimination, restraint, reprisal, coercion, or unreasonable interruption of care/services.
• Have concerns/complaints/dissatisfaction about care/treatment/services that is (or fails to be) furnished, or lack of respect of property investigated in a timely manner.
• Be advised of any change in the plan of care/service before the change is made.
• Participate in the development and periodic revision of the plan of care/service.
• Receive information in a manner, format and/or language that you understand.
• Have family members, as appropriate and as allowed by law, with your permission or the permission of your surrogate decision maker, involved in care, treatment, and/or service decisions.
• Be fully informed of your responsibilities.
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PATIENT RESPONSIBILITIES
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• Adhere to the plan of treatment or service established by your physician.
• Adhere to the company’s policies and procedures.
• Participate in the development of an effective plan of care/treatment/services.
• Provide, to the best of your knowledge, accurate and complete medical and personal information necessary to plan and provide care/services.
• Ask questions about your care, treatment and/or services, or to have clarified any instructions provided by company representatives.
• Communicate any information, concerns and/or questions related to perceived risks in your care, treatment and/or services, and unexpected changes in your condition.
• Be available at the time deliveries are. Notify the company if you are going to be unavailable.
• Treat company personnel with respect and dignity without discrimination as to color, religion, sex, or national or ethnic origin and provide a safe environment for staff members to provide care and services.
• Care for and safely use equipment, according to instructions provided, for the purpose it was prescribed and only for/on the patient for whom it was prescribed.
• Communicate any concerns about your/caregiver’s/family member’s ability to follow instructions or use the equipment provided.
• Protect equipment from fire, water, theft or other damage. You agree not to transfer or allow your equipment to be used by any other person without prior written consent of the company and further agree not to modify or attempt to make repairs of any kind to the equipment. Modifying equipment or attempting equipment repairs releases the company from any liability related to the equipment and its uses, and from any resulting negative patient outcomes.
• Except where contrary to federal or state law, you are responsible for equipment rental and sale charges which your insurance company or companies does not pay. You are responsible for prompt settlement in full of your accounts unless prior arrangements have been approved by company administration.
• The company should be notified of any changes in your physical condition, physician’s prescription or insurance coverage. Notify the company immediately of any address or telephone changes whether temporary or permanent.
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PATIENT INFORMATION
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After-Hours Services
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• Diabetes Care and Education, Inc. has an after hour number that can be contacted outside normal business hours. You may leave a message or speak to a company representative that’s on call. Only equipment requiring emergency maintenance or replacement will be serviced after hours.
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Complaint Procedures
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• You have the right and responsibility to express concerns, dissatisfaction or make complaints about services you do or do not receive without fear of reprisal, discrimination or unreasonable interruption of services. The company telephone number is 888-388-4622. When you call, ask to speak with the Compliance Officer during regular business hours or the Administrator on call, if you are calling outside of regular business hours, including weekends and holidays.
• Diabetes Care & Education, Inc. has a formal grievance procedure that ensures that your concerns/complaints shall be reviewed and an investigation started within 5 business days of receipt of the concern/complaint. Every attempt shall be made to resolve all grievances within 14 days. You will be informed in writing of the resolution of the complaint/grievance. If more time is needed to resolve the concern/complaint, you will also be informed verbally and in writing.
• Patients may also report complaints to the Center for Medicaid and Medicare by calling 877-299-7900
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