| ||125 Masarik Avenue|
Stratford, CT 06615
| ||22 Shepard Drive|
Newington, CT 06111
| ||82 Boston Post Road|
Waterford, CT 06385
Privacy Practices Notice
Effective April 14, 2003
This Notice describes how protected health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our company is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the services we provide to you. This Notice tells you about the ways in which Landauer-Metropolitan, Inc. (referred to as “we”) may collect, use, and disclose your protected health information and your rights concerning your protected health information. “Protected health information” is information about you that identifies and relates to you, or payment for your care.
We are required by law to maintain the confidentiality of health information that identifies you. We are also required by federal and state laws to provide you with this Notice about your rights and our legal duties and privacy practices with respect to your protected health information. We must follow the terms of this Notice while it is in effect. Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than the federal standards.
If you have questions about this Notice, please contact the Privacy Officer at Landauer- Metropolitan, Inc. at 914-665-9050 for further information.
The terms of this Notice apply to all records containing your health information that are created or retained by our organization. We reserve the right to revise or amend our Notice of Privacy Practices at any time. Any revision or amendment to this Notice will be effective for all of your records we have 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 office in a prominent location, and you may request a copy of our most current Notice by calling us.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We may use and disclose your protected health information for different purposes. The examples below are provided to illustrate the types of uses and disclosures we may make without your authorization for payment, home care operations, and treatment.
- Payment. We use and disclose your protected health information in order 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 we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your equipment. We also may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your health information to bill you directly for services and items.
- Health Care Operations. We use and disclose your protected health information in order to perform our health care activities, such as providing equipment appropriate to your needs, or administrative activities, including data management or quality assessment activities.
- Treatment. We may use and disclose your protected health information to coordinate services with other health care providers involved in your care. For example, we may perform an oximetry test to evaluate the appropriateness of oxygen equipment; collect physical measurements to identify appropriate seating and mobility system(s).
- Appointment Reminders. We may use and disclose your health information to contact you and remind you of visits / deliveries.
- Health-Related Benefits and Services. We may use and disclose your health information to inform you of health-related benefits or services that may be of interest to you.
- Release of information to Family / friends. We may release your health information to a friend or family member that is helping you to pay for your health care, or who assists in taking care of you.
- Disclosures Required by Law. We will use and disclose your health information when we are required to do so by federal, state or local law.
OTHER PERMITTED OR REQUIRED DISCLOSURES
- As Required by Law. We must disclose protected health information about you when required to do so by law.
- Emergency. We may disclose protected health information about you when necessary to prevent a serious threat to your health or safety or the health and safety of another person. However, we will only disclose the information to someone who can help prevent the threat.
- Public Health Activities. We may disclose protected health information to public health agencies for reasons such as preventing or controlling disease, injury, or disability.
- Victims of Abuse, Neglect, or Domestic Violence. We may disclose protected health information to government agencies to report suspected cases of abuse, neglect, or domestic violence.
- Business Associates. Some of the services we provide involve our business associates. For example, we contract with independent contractors to provide delivery services. When we contract for these services, we may disclose your protected health information to our business associates so they can perform the job we have hired them to do. To protect your privacy, we require our business associates to sign an agreement to safeguard your protected health information.
- Health Oversight Activities. We may disclose protected health information to government oversight agencies. 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 to monitor government programs, compliance with civil rights laws and the health care system in general.
- Judicial and Administrative Proceedings. We may disclose protected health information in response to a court or administrative order. We may also disclose protected health information about you in certain cases in response to a subpoena, discovery request, or other lawful process.
- Law Enforcement. We may disclose protected health information under limited circumstances to a law enforcement official in response to a warrant or similar legal process; to identify or locate a suspect; or to provide information about the victim of a crime.
- To Avert a Serious Threat to Health or Safety. We may disclose protected health information about you, with some limitations, when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- Special Government Functions. We may disclose information as required by military authorities or to authorized federal officials for national security and intelligence activities.
- Workers Compensation. We may disclose protected health information to the extent necessary to comply with state law for workers’ compensation programs.
USES AND DISCLOSURES NOT COVERED IN THIS NOTICE
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only upon specific written authorization you provide to us which allows us to use your medical information for the purpose listed in that authorization document. If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, by writing to LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. The revocation, however, will not have any effect on any action we take before we receive your revocation.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have certain rights regarding protected health information that we maintain about you.
Right To Access Your Protected Health Information. You have the right to review or obtain copies of your protected health information records, with some limited exceptions. Usually the records include referral information, delivery forms, billing, claims payment, and medical management records. Your request to review and/or obtain a copy of your protected health information records must be made in writing to LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer. We may charge a fee for the costs of producing, copying, and mailing your requested information, but we will tell you the cost in advance.
Right To Amend Your Protected Health Information.If you feel that protected health information maintained by us is incorrect or incomplete, you may request that we amend the information. Your request must be made in writing to LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer and must include the reason you are seeking a change. We may deny your request if, for example, you ask us to amend information that was not created by us, or you ask to amend a record that is already accurate and complete. If we deny your request to amend, we will notify you in writing. You then have the right to submit to us a written statement of disagreement with our decision and we have the right to rebut that statement.
Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures we have made of your protected health information. The list will not include our disclosures related to your treatment, our payment or health care operations, or disclosures made to you or with your authorization. The list may also exclude certain other disclosures, such as those made for national security purposes. Your request for an accounting of disclosures must be made in writing to LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer and must state the time period for which you want an accounting. This time period may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first accounting that you request within a 12-month period will be free. For additional lists within the same time period, we may charge for providing the accounting, but we will tell you the cost in advance.
Right To Request Restrictions on the Use and Disclosure of Your Protected Health Information. You have the right to request that we restrict or limit how we use or disclose your protected health information for services, payment, or health care operations. We may not agree to your request. If we do agree, we will comply with your request unless the information is needed for an emergency. Your request for a restriction must be made in writing to LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit how we use or disclose your information, or both; and (3) to whom you want the restrictions to apply.
Right To Receive Confidential Communications. You have the right to request that we use a certain method to communicate with you or that we send information to a certain location. For example, you may ask that we contact you at work rather than at home. Your request to receive confidential communications must be made in writing to LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have a right at any time to request a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time, by contacting LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer.
Contact Information for Exercising Your Rights. You may exercise any of the rights described above by contacting our Privacy Officer.
Complaints. If you believe that your privacy rights have been violated, you may file a complaint with us by writing to us at LANDAUER METROPOLITAN, INC., One Bradford Road, Mount Vernon, NY 10550, Att: Privacy Officer and/or the Secretary of the Department of Health and Human Services, Office of Civil Rights, 200 Independent Ave. SW, Rm 509, HHH Bldg., Washington, DC 20201. All complaints must be submitted in writing. You will not be penalized for filing a complaint.