Mitchell Home Medical
Notice of Privacy Practices

As required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.

A.            OUR COMMITMENT TO YOUR PRIVACY

Mitchell Home Medical is dedicated to maintaining the privacy of your protected health information.  In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you.  Your "protected health information (PHI)" means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by the company and that relates to your past, present or future physical or mental health or condition. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your PHI. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

The terms of this notice apply to all records containing your PHI that are created or retained by our company. We reserve the right to revise or amend our notice of privacy practices.  Any revision or amendment to this notice will be effective for all of your records our company has created or maintained in the past, and for any of your records we may create or maintain in the future. Our organization will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice during any office visit.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
               
                                                Mitchell Home Medical
                                                HIPAA Privacy Officer
                                                4811 Carpenter Road
                                                Ypsilanti, MI  48197)
                                                Phone:  734-572-0203-or (800) 420-0202

C. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your PHI.

1.             Treatment and Medical Equipment Usage. Our company may use your PHI to treat you by providing your medical equipment and supplies. For example, we may ask you for results of laboratory work or a diagnosis to help us in the proper equipment needs for your particular condition. Many of the people who work for our organization may use or disclose your PHI in order to treat you, assess your physical condition in response to the treatment prescribed to others who may direct or assist in your care, such as your physician, therapists, spouse, children or parents.

2.             Payment. Our company may use and disclose your PHI in order to bill and collect payment for the services and equipment items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment/medical equipment requests to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose you PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for medical supplies, equipment and services.

3.             Health Care Operations. Our organization may use and disclose your PHI to operate our business.  As examples of the ways in which we may use and disclose your information for our operations, our organization may use your PHI to evaluate the quality of care and service you received from us, or to conduct cost-management and business planning activities for our company.
4.             Appointment/Delivery Reminders. Our company may use and disclose your PHI to contact you and remind you of visit/delivery times.

5.             Health Related Benefits and Services. Our company may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you or to inform you of potential treatment options.

6.             Release of Information to Family/Friends. Our company may release your PHI to a friend or family member who is helping you pay for your health care, or who assist in taking care of you.

D.            YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding the PHI that we maintain about you:

1.             Confidential Communications. You have the right to request that our company communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to our Privacy Administrator, specifying the requested method of contact, or the location where you wish to be contacted. Our company will accommodate reasonable requests. You do not need to give a reason for the request.

2.             Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations.  Additionally, you have the right to request that we limit our disclosure of your PHI to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to our Privacy Administrator. Your request must describe in a clear and concise fashion; (a) the information you wish restricted; (b) whether you are requesting to limit our company's use, disclosure or both; and (c) to whom you want the limits to apply.

3.             Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes or information compiled in reasonable anticipation of, or for the use in, a civil, criminal or administrative action or proceeding, and other PHI disclosure prohibited by law. You must submit your request in writing to our Privacy Administrator in order to inspect and/or obtain a copy of your PHI.  Our company may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.  Our company may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Diane Loewen, Vice President of Mitchell Home Medical, will conduct reviews.

4.             Alternative Means or Location. You have the right to request that we communicate with you in certain ways.  We will accommodate reasonable requests.  We may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not require you to provide an explanation for your request. Requests must be made in writing to our Privacy Administrator.

5.             Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our company. To request an amendment, your request must be made in writing and submitted to our Privacy Administrator. You must provide us with a reason that supports your request for amendment. Our company will deny your request if you fail to submit your request (and the reason supporting the request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the PHI dept by or for the organization; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our organization, unless the individual or entity that created the information is not available to amend the information.

6.             Accounting of Disclosures. All of our patients have the right to request an "accounting of disclosures."  An "accounting of disclosures" is a list of certain disclosures our organization has made of your PHI.  In order to obtain an accounting of disclosures, you must submit your request in writing to our Privacy Administrator. All requests for "accounting of disclosure" must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our organization may charge you for additional lists within the same 12-month period. Our company will notify you of the cost involved with additional request, and you may withdraw your request before you incur any costs.

7.             Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, call the corporate office of Mitchell Home Medical at 734-572-0203.

8.             Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services.  To file a complaint with our organization, contact our Privacy Administrator. All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

9.             Right to Provide an Authorization for Other Uses and Disclosures. Our company will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note we are required to retain records of your care.

10.          Disclosures Required by Law. Our organization will use and disclose your PHI when we are required to do so by federal, state or local law.

E.             USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH
                INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your PHI:

1.             Public Health Risks. Our organization may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of: Maintaining vital records, such as births and deaths; Reporting child abuse or neglect; Preventing or controlling disease, injury or disability; Notifying a person regarding potential exposure to a communicable disease or condition; Reporting reaction to drugs or problems with products or devices; Notifying individuals if a product or device they may be using has been recalled; Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information; Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2              Health Information Activities. Our company may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; 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.

3.             Lawsuits and Similar Proceedings. Our organization may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

1. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:

Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement; Concerning a death we believe might have resulted from criminal conduct; Regarding criminal conduct at our offices; In response to a warrant, summons, court order, subpoena or similar legal process; To identify/locate a suspect, material witness, fugitive or missing person; In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5.             Serious Threats to Health or Safety. Our company may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

6.             Military. Our company may disclose your PHI if you are a member of the U.S. or foreign military forces (including veterans) and if require by the appropriate military command authorities.

7.             National Security. Our company may disclose your PHI to federal officials for intelligence and national securities activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

8.             Inmates. Our company may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary; (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

9.             Workers' Compensation. Our organization may release your PHI for workers' compensation and similar programs.

10.          To Report Abuse, Neglect or Domestic Violence. We may notify government authorities if we believe that a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

11.          To Conduct Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of heath care or public benefits.

12.          In Connection With Judicial and Administrative Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a signed authorization (in a format approved by the Michigan Court Administrator).

13.          To Coroners, Funeral Directors, and for Organ Donation. We may disclose PHI to a coroner or medical examiner for identification purposes, to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law.  We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties.  We may disclose such information in reasonable anticipation of death.  PHI may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

14.          For Research Purposes. We may use or disclose your PHI for research when the use or disclosure for research has been approved by an institutional review board or privacy board that has reviewed the research proposal and research protocols to address the privacy of your PHI.

15.          For Specified Government Functions. In certain circumstances, the Federal regulations authorize the practice to use or disclose your PHI to facilitate specified government functions relating to military and veterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.

1. EFFECTIVE DATE: This Notice is effective April 14, 2003.