TEMPLATE. This notice must be reviewed, completed and approved by counsel and the Privacy Officer before publication. Placeholders are marked.
Who we are
Prism Medical Products, LLC, 112 Church St, Suite 101, Elkin, NC 28621. This notice applies to protected health information created or received by Prism Medical Products in the course of providing home medical supplies and related services.
How we may use and disclose your health information
Treatment
We use your information to provide the supplies your clinician prescribes. For example, coordinating with your physician or therapist about your order, sizing or documentation.
Payment
We use and disclose information to bill and collect payment. For example, verifying your insurance benefits, submitting claims to your health plan and processing payments through our secure billing partner.
Healthcare operations
We use information to run our business responsibly. For example, quality review, accreditation activities and staff training.
Other permitted or required uses
As required by law; for public health activities; to report suspected abuse or neglect; for health oversight; in judicial or administrative proceedings; and in other circumstances permitted by HIPAA. Uses and disclosures beyond those described here require your written authorization, which you may revoke at any time.
Your rights
- Access: inspect and receive a copy of your health information.
- Amendment: request correction of information you believe is inaccurate.
- Accounting of disclosures: receive a list of certain disclosures we have made.
- Restrictions: request limits on how we use or share your information.
- Confidential communications: ask us to contact you in a specific way or at a specific location.
- Paper copy: receive a paper copy of this notice on request.
- Breach notification: be notified if a breach compromises your unsecured PHI.
Our responsibilities
We are required by law to maintain the privacy and security of your PHI, provide this notice of our legal duties and privacy practices, and abide by the terms of the notice currently in effect. We reserve the right to change this notice; the current version will always be available on this page and by request.
Complaints and contact
Contact our Privacy Officer at 888.244.6421 or in writing at 112 Church St, Suite 101, Elkin, NC 28621. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.
Effective date: [EFFECTIVE DATE: set before publication]