Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO HEALTH INFORMATION ABOUT YOURSELF. PLEASE REVIEW THIS NOTICE CAREFULLY.
USES AND DISCLOSURES:
We will use and disclose health information that identifies you in the following ways:
Without Your Signed Authorization:
Sterling Medical Services will ask for health information from you, your health care provider, or your caregivers in order to provide you with necessary medical supplies. Your health information also may be exchanged with your properly identified healthcare providers or caregivers to determine future supply orders.
Sterling Medical Services may use and disclose your health information to others for the purposes of receiving payment for the treatment or services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The bill may contain information that identifies you, your diagnosis, or supplies used in the course of your treatment.
Health Care Operations:
Sterling Medical Services may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to limited members of the organization to evaluate the performance of our staff or to learn how to improve quality and service.
When Release is Required by Law:
Sterling Medical Services may use and disclose information about you as required by law. For example, Sterling Medical Services may disclose information for the following purposes: For judicial and administrative proceedings pursuant to legal authority; To report information related to victims of abuse, neglect, or domestic violence; and To assist law enforcement officials in their enforcement duties.
Sterling Medical Services may disclose your health information for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
For Decedents: Sterling Medical Services may disclose your health information to medical examiners, coroners, or funeral directors to aid in identifying you or to help them in performing their duties.
Organ/Tissue Donation: Sterling Medical Services may disclose your health information for cadaver organ, eye, or tissue donation purposes.
Research: Sterling Medical Services may use and disclose your health information for research based on existing records when an institutional review board or privacy board has approved the research after reviewing the research proposal and establishing procedures to ensure the privacy of your health information.
Health and Safety: Sterling Medical Services may disclose your health information pursuant to applicable law to avert a serious threat to your health and safety or the health and safety of any other person.
Government Functions: Sterling Medical Services may use and disclose your health information for specialized government functions such as protection of public officials or reporting to various branches of the armed services that may need your health information.
Workers Compensation: Sterling Medical Services may disclose your health information in order to comply with laws and regulations related to Workers Compensation.
Treatment Alternatives: In addition to calling periodically about your future supply needs, Sterling Medical Services may contact you about treatment alternatives and other health-related benefits and services that the company offers.
Minimum Necessary: Whenever Sterling Medical Services uses or discloses health information about you for treatment, payment, health care operations, or public policy purposes, the company will take reasonable steps to limit the information used to the minimum necessary to accomplish the task at hand.
With Your Signed Authorization:
Sterling Medical Services will only use or disclose your protected health information for purposes other than those described above if you sign an authorization permitting the use or disclosure. You may revoke an authorization at any time except to the extent that action has already been taken. A request to revoke an authorization must be in writing and addressed to the Privacy Contact listed below.
You have the following rights concerning your protected health information:
Restrictions: To request restricted access to all or part of your health information. All requests must be in writing and addressed to the Privacy Contact listed below. All requests will be reviewed, but Sterling Medical Services is not required to agree to the requested restriction. We will tell you if we can agree to your request.
Confidential Communications: To receive correspondence of confidential information by alternate means or at alternate locations. All requests must be in writing and addressed to the Privacy Contact listed below. We will honor all reasonable requests.
To inspect or receive copies of your health information in our medical or billing records. All requests must be in writing and addressed to the Privacy Contact listed below. There will be a charge for all copies requested.
To request changes be made to your health information. All requests, along with the reason, must be in writing and addressed to the Privacy Contact listed below. Sterling Medical Services is not required to agree to every requested amendment, but the company will add a statement from you to your record explaining your concern if we cannot make a change that you want.
To receive an accounting of the public policy disclosures of your health information made by us in the six years prior to your request. Please note that no disclosures made before April 14, 2003 will be listed. All requests for an accounting must be in writing and addressed to the Privacy Contact listed below.
To get updates or reissued copies of this notice, at your request, by writing or calling the Privacy Contact listed below.
OUR DUTIES: Sterling Medical Services is required to:
- Maintain the privacy of your health information;
- Provide you with this notice of its legal duties and privacy practices with respect to your health information;
- Abide by the terms of this notice;
- Respect your privacy rights;
- Notify you when we are unable to agree to a requested restriction on how your information is used or disclosed; and
- Accommodate reasonable requests that you may have to communicate health information by alternate means or at alternate locations.
Sterling Medical Services reserves the right to change its privacy practices at any time and to make the new provisions effective for all protected health information it maintains. Revised notices of our privacy practices will be made available upon request. Just call the Privacy Contact listed below.
To complain about our privacy practices, please call the Privacy Contact at 1-800-216-5500. If you wish to complain to the U.S. Department of Health and Human Services because you believe Sterling Medical Services has violated your privacy rights, you must write to the Office for Civil Rights, U.S. Department of Health & Human Services, 26 Federal Plaza - Suite 3313, New York, NY 10278, 212-264-3313. Or contact the Community Health Accreditation Program (CHAP). Call CHAP at 1-800-656-9656 between 8 AM - 5 PM EST. From the time you become aware of your concerns, you have 180 days to contact the Department. The law forbids us from taking retaliatory action against you if you complain to us or the government.
For more information about our privacy
practices or to exercise your privacy rights, please contact:
Natalie M. Coniglio, CPC
Manager, Corporate Compliance and Regulatory Affairs
1-800-216-5500. Ext. 2273
2 Twosome Drive, Moorestown, NJ 08057 email@example.com
This notice is effective April 14, 2003.