Click here if you live in New York
MediPlant Funding
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.
1.
Purposes for which MediPlant Funding may use or disclose your personal
health information.
MediPlant Funding may use or disclose your personal health
information for the following purposes.
Except as discussed in item 2 of this Notice relating to
Sensitive Health Information, MediPlant Funding may use or disclose your protected
health information for the following purposes without your written
permission:
·
Treatment Purposes.
For example, MediPlant Funding may disclose your personal
health information to your doctor for the provision of treatment or to
coordinate your care.
·
Payment.
For example, MediPlant Funding may use or disclose your
personal health information to obtain pre-authorization of the MediPlant
Funding
Devices and related medical procedure from your health or workers’
compensation insurer, to be paid for claims for covered health care
services, or to otherwise recover costs from other medical, workers
compensation or other insurance
or probate estates.
·
Health Care
Operations.
For example, MediPlant Funding or its contractors may use
or disclose your personal health information (1) to conduct quality
assessment and improvement activities; (2) to manage, plan, or develop
MediPlant Funding services and budget; and (3) to conduct or arrange for legal
services or auditing functions.
·
As Required by Law.
For example, MediPlant Funding is required by law to allow
the United States Department of Health and Human Services to audit
MediPlant Funding
records. MediPlant Funding may also be required
to disclose personal health information about abuse, neglect, or
domestic violence to governmental or social services agencies.
·
Where required by
law, or where permitted by law, for the following kinds of public health
and interest activities, judicial and administrative proceedings, law
enforcement, and other public benefit functions:
o
To comply with legal
proceedings, such as a court or administrative order or where permitted,
a subpoena;
o
To law enforcement
officials or to correctional institutions for limited law enforcement
and health and safety purposes;
o
To a family member,
friend or other person, to help you with your health care;
o
To your personal
representative appointed by you or designated by law;
o
To a health
oversight agency for activities authorized by law (these activities
include, for example, audits, investigations, inspections and licenses);
o
To a coroner,
medical examiner, or funeral director to identify a deceased person;
o
To an organ
procurement organization in limited circumstances;
o
To avert a serious
threat to your health or safety or the health or safety of others;
o
To federal officials
for lawful national security purposes or to conduct special
investigations and provide protection to the President, other authorized
persons and foreign heads of state;
o
To authorized public
health authorities for public health purposes;
o
To appropriate
military authorities, if you are a member of the armed forces;
o
For workers
compensation and similar programs that provide benefits for work-related
injuries and illnesses.
2.
More stringent protections for Sensitive Personal Health Information.
“Sensitive
Health Information” means information relating to mental health, alcohol
or substance abuse, HIV/AIDS related information and test
results, and genetic test results.
Special legal protections apply to these types of information.
As a result, MediPlant Funding is generally required by applicable law to
obtain your written permission before disclosing your Sensitive Health
Information, unless the disclosure is required by law, or in limited
circumstances where the law expressly permits disclosure (for example,
for specified public policy reasons or where the disclosure is pursuant
to a court order or other legal process).
MediPlant Funding’s use and disclosure of Sensitive Health Information will be
subject to any special protections provided by applicable law.
3.
Uses and disclosures with your written authorization.
MediPlant Funding will not use or disclose your personal
health information, including any Sensitive Health Information, for any
other purposes unless you give MediPlant Funding your written authorization to do so.
You may revoke your written authorization (or any other written
permission mentioned in this Notice) at any time.
Your revocation will be effective from the date MediPlant Funding receives the
revocation forward, for all your personal health information that
MediPlant Funding
maintains.
4.
Your rights.
You may make a written request to MediPlant
Funding to do
one or more of the following concerning your personal health information
that MediPlant Funding maintains:
·
To put additional
restrictions on MediPlant Funding’s use and disclosure of your personal health
information. MediPlant
Funding does not
have to agree to your request.
·
To have MediPlant
Funding
communicate with you in confidence about your personal health
information by a different means or at a different location than
MediPlant Funding is
currently doing. Your request must be in writing specifying the
alternative means or location to communicate with you.
·
To see and get
copies of your personal health information.
You may be charged a nominal fee for
the copies.
·
To request that we
amend your health information. MediPlant Funding may deny your request.
·
The right to receive
an accounting of disclosures as provided by law.
·
To have MediPlant
Funding send you
a paper copy of this Notice upon request.
If you want to exercise any of these rights described
in this Notice, please contact the MediPlant Funding Privacy Officer at the address
below.
5.
Complaints.
If you believe your privacy rights have been violated
by MediPlant Funding, you have the right to complain to MediPlant
Funding or to the Secretary of the
U.S. Department of Health and Human Services.
You may file a complaint with MediPlant Funding at the address below.
MediPlant Funding will not retaliate against you if you choose to
file a complaint with either MediPlant Funding or with the U.S. Department of Health
and Human Services.
6.
Privacy Officer.
To request additional copies of this Notice or to
receive more information about MediPlant Funding’s privacy practices, your rights or
to file a complaint, please contact the Privacy Officer at the following
address:
Privacy Officer
Dana Bowen-Privacy Officer
866-867-9077
