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HIPAA

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.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

Required Uses and Disclosures

By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you.  We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Treatment
• Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment.  For example, results of tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
Payment  
• Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services.  For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health Care Operations
• Your health information may be used, as necessary, to support the day to day activities and management of E Tenn Urological Supplies Inc.  For example, information on the services you received that may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Business Associates
• Your health information may be disclosed to our business associates, such as subcontractors, so they can perform the jobs we have asked them to do.  To protect your health information, we require the business associate to appropriately safeguard your health information.
Law Enforcement
• Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting.
Public Health
• We may disclose your protected health information to a public health authority who is permitted by law to collect or receive the information.  The disclosure may be necessary to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or, notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
Worker(s) Compensation
• Your health information may be disclosed to comply with worker(s) compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
Communicable Diseases
• We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight
• We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.  These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Abuse or Neglect
• We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.  In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration
• We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects, or problems, biologic product deviations, track products; enable product recalls; to make repairs or replacements, or to conduct post-marketing surveillance as required.
INDIVIDUAL RIGHTS
• You have certain rights under the federal privacy standards which include:
- The right to request restrictions on the use and disclosure of your protected health information.
- The right to receive confidential communications concerning your medical condition and treatment.
- The right to inspect and copy your protected health information.
- The right to amend or submit corrections to your protected health information.
- The right to receive an accounting of how and to whom your protected health information has been disclosed.
- The right to receive a printed copy of this notice.
E TENN UROLOGICAL SUPPLIES INC. DUTIES
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.

We are also required to abide by the privacy policies and practices that are outlined in this notice.
RIGHT TO REVISE PRIVACY PRACTICES
• As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.
REQUESTS TO INSPECT PROTECTED HEALTH INFORMATION
• You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting Customer Service or the Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.
RIGHT TO FILE A COMPLAINT
• If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.  You may also use the above names and address to contact us for further information concerning our privacy practices. If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:  
Privacy Officer
E TENN UROLOGICAL SUPPLIES
7605 Blueberry Rd
Powell, TN 37849
Toll Free1-855-938-3887
Local 1-865-938-3887

EFFECTIVE DATE
This notice is effective on or after November 1, 1997.