SUMMARY NOTICE OF PRIVACY PRACTICES
The following information is a summary of the attached NOTICE OF PRIVACY PRACTICES. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of your medical information. When we have a direct treatment relationship with you, we must present a copy of this notice to you. We must follow the terms of this notice. If the notice is changed in any material way, a revised notice will be available upon request.
We will use your medical information for Treatment. For example, a nurse or technician who is providing your care will report any changes in your condition to your doctor. We will use your medical information for Payment. For example, we may need to give your insurance plan information about your diagnosis, treatment and supplies used. We will use your medical information for Health Care Operations. For example, we may use your medical information to evaluate our services. We do not require authorization to use your medical information for these purposes. We may contact you at any phone number or address you have provided to us to discuss the treatment and its procedures or other health care matters or to obtain payment for our services.
We may use and disclose your medical information to inform you of treatment alternatives or other health related benefits and services. We may disclose your medical information to family members or others who are involved in your care or payment for that care. You must notify our Privacy Officer in writing if you do not want us to communicate with you in any of these ways.
We may use your medical information for any uses that are required or permitted by law.
Other uses and disclosures will be made only with your written authorization. You may cancel an authorization at any time by notifying our Privacy Officer in writing.
You have the following rights:
- Right to privacy notice;
- Right to request restrictions on uses and disclosures of your medical information;
- Right to receive confidential communications;
- Right to inspect and copy your medical information;
- Right to request an amendment to your medical information; and
- Right to an accounting of disclosures of your medical information.
If you feel that your privacy rights have been violated, please contact our Privacy Officer at the following address: United Therapies Privacy Officer, c/o HealthTronics, Inc., 9825 Spectrum Drive, Building 3, Austin, Texas 78717, or (512) 314-4528, or email@example.com or you may contact the U.S. Department of Health and Human Services Office for Civil Rights at the address set forth in the attached Notice of Privacy Practices.
|NOTICE OF PRIVACY PRACTICES|
|THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.|
Purpose of This Notice
This notice tells you about how United Shockwave Services, Ltd., referred to in this notice by its licensed service mark, “United Therapies”, will use and disclose your medical information, which is termed “Protected Health Information”. Protected Health Information is health information that individually identifies you and that we create or receive from you or another health care provider, health plan or health care clearinghouse that relates to your past, present, or future physical or mental health or conditions, the provision of health care to you, or the past, present, or future payment for your health care.
It tells you about your rights and our responsibilities regarding your medical information. It also tells you how to submit a complaint to us or the government if you believe that we have violated any of your rights or any of our responsibilities.
We are required by law to maintain the privacy of your medical information, to notify you of our legal duties and privacy practices regarding your Protected Health Information, and to notify you if there is a breach (unlawful use or disclosure) of your Protected Health Information. When we have a direct treatment relationship with you, we must present you with a copy of this notice on the date that you first receive medical treatment from United Therapies and attempt to obtain your written acknowledgement of its receipt. In an emergency, we will give you the notice as soon as possible after the emergency treatment has been given. We must follow the terms of this notice that are currently in effect.
We reserve the right to change the terms of this notice. A copy of the revised notice is available upon request and will be posted at our centers and on our website. We may change our practices and those changes may apply to medical information we already have about you as well as any new information.
United Therapies is a member of a group of entities referred to collectively as an “Affiliated Covered Entity”. An Affiliated Covered Entity is a group of covered entities under common ownership or control that designated itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (as amended, “HIPAA”). The members of the Affiliated Covered Entity may share protected health information with each other for treatment, payment and health care operations of the Affiliated Covered Entity as permitted by HIPAA and this notice. For a complete list of the members of the Affiliated Covered Entity or to receive any further information regarding matters covered by this notice, please contact our Privacy Officer at the following address: United Therapies Privacy Officer, c/o HealthTronics, Inc., 9825 Spectrum Drive, Building 3, Austin, Texas 78717, or (512) 314-4528, or firstname.lastname@example.org.
How We May Use or Disclose Your Medical Information Without Your Authorization
We will use your medical information to provide you with treatment and services. We may share this information with members of our healthcare staff or with others involved in your care such as doctors, nurses, or health care facilities. For example, a nurse who is providing your care may report changes in your condition to your doctor, or a technician assisting with a procedure may provide your doctor with information during a procedure.
We may use or disclose your medical information to bill and collect payment for the services we provided to you. For example, we may need to give your health insurance plan or your plan’s third party administrator information about your diagnosis, treatment and supplies used. We may also contact your insurance plan to confirm your coverage or to request prior approval for a planned treatment or service.
Health Care Operations
We may use or disclose your medical information for our operational purposes. For example, we may use your medical information to evaluate our services, including the performance of our staff in caring for you. We may also use this information to learn how to continually improve the quality and effectiveness of the health care services that we provide to you (for example, for review and training purposes).
Your name and address may be used to send out patient satisfaction surveys.
There are some services that are provided to us by our business associates such as accountants, consultants and attorneys. Whenever we share medical information with our business associates, we are required to have a written contract with them that requires that they protect the privacy of your medical information.
Appointment Reminders/Post-Treatment Follow-Up/Related Services
We may contact you either by telephone or by mail at your home or your office to remind you of an appointment that you have with us, to discuss pre-procedure requirements, to follow up the treatment post-procedure, or any other matter related to the health care services we provide or payment for your health care services. We may leave messages for you. If you want us to contact you in a certain way or at a certain location, see “Right to Receive Confidential Communications” in this notice.
We may use and disclose your medical information to contact you about other health care treatment that is available to you. If you do not want to receive these communications, please notify our Privacy Officer in writing.
Health Related Benefits and Services
We may use and disclose your medical information to contact you about other health care benefits or services that may interest you. If you do not want to receive these communications, please notify our Privacy Officer in writing.
Uses or Disclosures of Your Medical Information for Which We Must Give You an Opportunity to Agree or Object
Individuals Involved in Your Care
We may disclose your medical information to a family member, other relative, close friend or any other person identified by you if they are involved in your care or payments related to your care. We may also use or disclose your medical information to notify those persons of your location, general condition or death. If you are present we may use or disclose your medical information if you agree or if we provide you with the opportunity to object and you do not object, or if you do not object and we can infer from the circumstances based on our professional judgment that you do not object. If you are not present or if you are unable to object, we may disclose such information as is necessary if we determine it is in your best interest based on our professional judgment. For example, we may disclose your medical information in an emergency or to an individual who is responsible for your transportation home after treatment. If there is a family member, other relative or close friend to whom you do not want us to disclose your medical information, please tell our staff at the time you receive treatment and, in addition, please notify our Privacy Officer in writing.
We may use or disclose your medical information to an entity assisting in disaster relief efforts. This will be done to coordinate disaster relief efforts and to notify family members or others of your location, general condition or death in the event of a natural or man-made disaster.
Other Uses or Disclosures That Are Required or Permitted by Law Without Your Authorization
Required by Law
We may use or disclose your medical information when we are required to do so by law.
Public Health Activities
We may disclose your medical information for certain public health activities, such as the following:
- To a person who may have been exposed to an infectious disease or who may be at risk of contracting or spreading the disease or condition.
- To prevent or control disease, injury or disability.
- To report child abuse or neglect.
- To report reactions to medications or problems with medical devices or other products.
- To notify people of recalls of devices or other products.
- To notify person(s) or organization(s) required to receive information on FDA-regulated products.
Victims of Abuse, Neglect or Domestic Violence
We may disclose your medical information to a government agency if we believe you are the victim of abuse, neglect or domestic violence.
Health Oversight Activities
We may disclose your medical information to a health oversight agency, such as a state medical board or the federal Medicare agency. Oversight activities can include, for example, investigations, inspections and audits; 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.
Food and Drug Administration
We may disclose your medical information for monitoring of drugs or devices controlled by the Food and Drug Administration.
Judicial and Administrative Proceedings
We may disclose your medical information in the course of a judicial or administrative proceeding. We may disclose your medical information in response to a court or administrative order. We may also disclose your medical information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have determined that an effort has been made to inform you of the request or to obtain an order protecting the information the party has requested.
Disclosures for Law Enforcement Purposes
We may disclose your medical information to law enforcement officials for law enforcement purposes:
- As required by law.
- In response to a warrant, summons court order, subpoena or similar legal process.
- To identify or locate a suspect, fugitive, material witness or missing person.
- When information is requested about an actual or suspected victim of a crime.
- To report a death as a result of possible criminal conduct.
- About crimes that occur on our premises.
- To report a crime in emergency circumstances.
We may disclose your medical information to comply with workers’ compensation laws that provide benefits for work-related injuries or illnesses.
Public Health or Safety
We may use or disclose your medical information if we believe it is necessary to prevent a threat to the health or safety of a person or the general public.
Specialized Government Functions
We may use or disclose your medical information for specialized government functions, such as the military, national security and presidential protective services.
We may disclose your medical information to a correctional institution or law enforcement official who has custody of you.
We may disclose your medical information to researchers under certain limited circumstances.
Coroners, Health Examiners and Funeral Directors
We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release information about patients to funeral directors as necessary to carry out their duties.
Uses or Disclosures That Require Your Authorization
Other uses and disclosures not covered by this notice or laws that apply to us will be made only with your written authorization. You may revoke (cancel) an authorization at any time by notifying our Privacy Officer in writing of your desire to revoke it. If you revoke an authorization it will not have any effect on information that we have already disclosed. Examples of uses or disclosures that require your written authorization include the following:
- Most uses and disclosures of medical information for marketing purposes.
- Disclosures that are the sale of medical information.
- Most uses and disclosures of psychotherapy notes (although we do not anticipate having any psychotherapy notes).
- Disclosure of Highly Confidential Information for purposes other than treatment, payment, or health care operations, or as allowed or required by federal or state law. Examples of Highly Confidential Information are mental health treatment information, substance abuse prevention, treatment or referral; developmental disability services, HIV/AIDS testing and treatment, venereal disease treatment, sexual assault treatment, and testing and treatment for genetic disorders.
Your Rights Regarding Your Medical Information
The medical records that we maintain are our property, but you have the right to access and have a copy of the information in your medical record. More specifically, you have the following rights:
Right to Inspect and Copy Your Medical Information – You have the right to request to inspect and obtain a copy of your medical information. You must submit your request in writing to our Privacy Officer. If you request a copy of the information, or that we provide you with a summary of the information, we may charge a fee for the costs of copying, summarizing and/or mailing it to you.
We may deny your request to access your medical information under certain limited circumstances. If your request is denied, we will let you know in writing and you may be able to request a review of our denial.
Right to Request Restrictions – You may request limitations on your medical information we use or disclose for health care treatment, payment, or operations (e.g., you may ask us not to disclose that you have had a particular procedure), but in most instances we are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
You have the right to request and we must agree to restrict disclosure of your medical information to a health plan if the disclosure: (i) is for the purpose of carrying out payment or health care operations and the disclosure is not required by law; and, (ii) the health information pertains solely to a health care item or service for which you or some other person (other than the health plan) has paid us in full.
All requests for restrictions on use or disclosure of your medical information must be made in writing to our Privacy Officer. In your request, you must tell us what information you want to limit and to whom you want the limits to apply; for example, use of any information by a specified nurse, or disclosure of specified treatment to your spouse.
Right to Receive Confidential Communications – You have the right to ask that we communicate with you in a certain manner or at a certain place. For example, you may request that we only contact you at work or by mail to a post office box. If you want to request confidential communications the request must be made in writing to our Privacy Officer. We must agree to your request if it is reasonable.
Right to Request Amendments to Your Medical Information – You have the right to request that we correct your medical information. If you believe that any medical information in your record is incorrect or that important information is missing, you must submit your request for an amendment in writing to our Privacy Officer. Additionally, you must provide a reason that supports your request.
We do not have to agree to your request. If we deny your request we will tell you why. You have the right to submit a statement disagreeing with our decision. We may deny your request if we determine that the information:
- Was not created by us.
- Is not part of the medical information that we maintain.
- Is in records that you are not allowed to inspect and copy.
- Is already accurate or complete.
Right to an Accounting of Disclosures of Health Information – You have the right to find out what disclosures of your medical information have been made. The list of disclosures is called an accounting. The accounting may be for up to six (6) years prior to the date on which you request the accounting.
We are not required to include disclosures for treatment, payment or healthcare operations or certain other exceptions. Requests for an accounting of disclosures must be submitted in writing to our Privacy Officer. You are entitled to one free accounting in any twelve (12) month period. We may charge you for the cost of providing additional accountings. If there will be a charge we will notify you in advance.
Right to an Electronic Copy of Electronic Protected Health Information – If we maintain your medical information in electronic form, you have the right to receive an electronic copy of that medical information or have us transmit it to another individual or entity. We must provide it to you in the electronic form or format that you request if it is readily producible in such form or format. Otherwise it will be produced in a readable electronic form and format as agreed to by you and us.
Right To Obtain a Copy of the Notice – You have the right to request and get a paper copy of this notice. If we make any revisions to this notice we will make a copy of the revised notice available to you. You can request a copy by writing to our Privacy Officer.
You may also obtain a copy of this notice either from our website, www.unitedtherapies.com, or by requesting a copy of this notice be sent through electronic mail to our Privacy Officer, at email@example.com If we know that the electronic message failed to be delivered, a paper copy of the notice will be provided. Even if you have received a notice electronically, you still retain the right to receive a paper copy upon request.
How to Exercise Your Rights
To exercise your rights under this notice, send a written request to our Privacy Officer at the address listed below. You may be asked to fill out a form that we will supply.
United Therapies Privacy Officer
c/o HealthTronics, Inc.
9825 Spectrum Drive, Building 3
Austin, Texas 78717
You have the right to complain to us and to the United States Department of Health and Human Services if you believe we have violated your privacy rights. You will not be retaliated against for filing a complaint.
To file a complaint with us, contact our Privacy Officer by telephone, email or US Mail at the contact information above under the “How to Exercise Your Rights” section.
To file a complaint with the United States Department of Health and Human Services Office of Civil Rights, send your complaint to the following address:
Office of Civil Rights
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F HHH Bldg.
Washington, D.C. 20201
(877) 696-6775 (toll free),
Or, go to the website for the HHS Office for Civil Rights http://www.hhs.gov/ocr/privacy
Questions and Information
If you have any questions or want more information about this Notice of Privacy Practices, please contact our Privacy Officer at the contact information above under “How to Exercise Your Rights” section of this notice.
Acknowledgement of Receipt of this Notice
We will request that you sign a separate form or notice acknowledging you have received a copy of this notice. If you choose, or are not able to sign, a staff member will sign his/her name, and date to document he/she made a reasonable effort to provide you with this notice. This acknowledgement will be filed with your records.
|The revision dates of this privacy notice are Apr 14, 2003; Jun 9, 2011; Sep 23, 2013; Oct 1, 2017; March 8, 2021.|