Effective Date: December 1, 2009
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Please read carefully.
ACG Medical Supply, Inc., believes that the information we gather about you is of a very private nature and we are dedicated to keeping this information confidential. The records we create in providing you with care are by law kept confidential. We are also required to inform you of our policies concerning the use and storage of your Personal Health Information (PHI).
ACG Medical Supply, Inc., maintains the right to update our Notice of Privacy Practices, a detailed notice regarding your PHI. Your PHI will always be maintained by our policies designated by our current Notice of Privacy Practices, prominently displayed at our location, a copy of which can be obtained by visiting our location. If you have comments or questions about this document or our Notice of Privacy Practices, please call ACG Medical Supply, Inc., at 972-463-0737.
The following describes the manner in which we will use and disclose your Personal Health Information:
We may collect and share appropriate information about you to document the medical necessity of the equipment, supplies, or services we are providing. Examples include diagnosis, prescription, referral, and physician or health care information.
We may share appropriate information about you to bill and collect payment for the services we provide, including insurance companies and third parties, which includes family members or other financially responsible parties. Examples include insurance coverage and eligibility verification.
We may use and disclose information to monitor and operate our business. Examples include satisfaction surveys, reports provided to federal, state, or local authorities (as required by law), or to remind you of equipment, supplies, or service needs.
We may release appropriate information about you to family or friends that are helping you with the financial responsibilities incurred while receiving equipment, supplies, or services. Examples include family members accompanying you to help with your care.
We may use and disclose information about you to respond to a court or legal authoritative body that legally requests information about you. Examples include providing documents for legal subpoenas or discovery of proceedings.
The following describes your rights to the information we maintain about you:
You have the right to direct the use of your Personal Health Information (PHI) at any of our locations.
You have the right to terminate or revise your authorizations or consents that pertain to our use of your PHI, and have those terminations or revisions affect any new equipment, supply, or service provisions. We are not required to accept your terms. If we do accept your restrictions, we will honor your specification except where prohibited by law. All requests must be in written form.
You have the right to request a copy of your PHI as long as any federal, state, or local law does not prohibit it. This request must be in writing. There is a charge for copying, producing, and delivering your information.
You have the right to request, in writing, a revision to your Personal Health Information (PHI). Revision requests will be evaluated on an individual basis and amended if appropriate. At no time will a revision be made that will erroneously record the PHI stored by ACG Medical Supply, Inc. Your written request must detail the requested revision and the reasons for the modification. If no explanation is provided, no revision will be made. If we deny your request for amendment, you have the right to file a statement of disagreement.
You have the right to request an accounting of non-routine disclosures we have made of your PHI. You can receive one free accounting in a twelve (12) month period. We will charge for any accounting of services that exceed one per twelve (12) months. You must agree to this charge before we will provide any accounting of services. These requests cover dates of service on or after April 14, 2003.
You have the right to file a complaint about our use of your Personal Health Information with us or with the Secretary of Health and Human Services.