Privacy | Rights
HIPPA NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Notice of Privacy Practices
Kids Korner Medical Supply (KKMS)
San Jose, California
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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) including (ePHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
“Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by our organization, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the organization, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for equipment or supplies coverage may require that your relevant protected health information be disclosed to the health plan to obtain approval for coverage.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to accrediting agencies as part of an accreditation survey. We may also call you by name while you are at our facility. We may use or disclose your protected health information, as necessary, to contact you to check the status of your equipment.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Criminal Activity, inmates, Military Activity, National Security, and Worker’s Compensation. Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law.
You may revoke this authorization, at any time, in writing, except to the extent that your physician or this organization has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights: Following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Our organization is not required to agree to a restriction that you may request. If our organization believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively (i.e., electronically).
You may have the right to have our organization amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.
Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.
This notice was published and becomes effective on/or before April 14, 2003
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any questions concerning or objections to this form, please ask to speak with our HIPAA Compliance Officer, Kristie Weyhe, in person or by phone at 1-800-971-1034.
Patient Bill of Rights/Responsibilities
We believe that all client/patients receiving services from Kids Korner Medical Supply (KKMS) should be informed of their rights.
Therefore, you are entitled to:
1. Receive reasonable coordination and continuity of services from the referring agency.
2. Receive a timely response from Kids Korner Medical Supply (KKMS) when incontinence supply is needed or requested.
3. Be fully informed in advance about the incontinence supplies to be provided and any modifications to the initial request of service. Also, be fully informed of any provider service limitations.
4. Participate in the development and the periodic revision of the incontinence plan.
5. Have one’s property and person treated with respect, consideration, and recognition of client/patient’s dignity and individuality.
6. Voice grievances/complaints or recommend changes in policy, staff or incontinence service without restraint, interference, coercion, discrimination or reprisal and to have those grievances/complaints properly investigated.
7. Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information(PHI) and (ePHI).
8. Be fully informed orally and in writing of one’s financial responsibilities in advance of service being provided. There is no fee for the service as Medi-Cal is the payor and all charges will be billed directly to Medi-Cal for payment on your behalf.
It is the Client’s right:
1. To be free from mental and/or physical abuse.
2. To be informed of one’s responsibilities.
3. To receive or not receive service when the consequences of the refusal of service are fully presented.
4. To choose a health care provider.
5. To be able to identify visiting staff members through proper i.d., if applicable.
6. The Client has the right to be granted their civil rights without any discrimination by Kids Korner Medical Supply (KKMS).
CLIENT RESPONSIBILITIES
1. Client agrees to notify Kids Korner Medical Supply (KKMS) of any hospitalization, change in customer insurance, address, telephone number, or physician.
2. Client agrees to assist Kids Korner Medical Supply (KKMS) in obtaining prescriptions and insurance denials if we are unable to get a response from the physician or insurance company.
3. Client understands that Kids Korner Medical Supply (KKMS) retains the right to refuse delivery of service to any client at any time.
4. Client agrees to contact Kids Korner Medical Supply (KKMS) in a timely manner (48 hours) if there is a mistake with their order or an order has been stolen. Otherwise, it is at the discretion of Kids Korner Medical Supply (KKMS) to replace or exchange the items received.
5. Client agrees that any legal fees resulting from a disagreement between the parties shall be borne by the unsuccessful party in any legal action taken.
** All staff members will understand and be able to discuss the Client Bill of Rights and Responsibilities with the client/patient and caregiver(s). Each staff member will receive training during orientation and attend an annual in-service education class on the Client Bill of Rights and Responsibilities.
To download a printable copy of this document, click here.