If you have any questions about this
notice, please contact
Inverse Technology Corporation, 1000 West O Street, Suite B,
Lincoln, NE
68528.
OUR COMMITMENT
TO YOUR PRIVACY
Our organization is committed to protecting the privacy of
your identifiable health information.
In our business, we create a record regarding you and the treatment
provided to you. We are required by
law to maintain the confidentiality of health information that identifies you. We also are required by law to provide
you with this notice of our legal duties and privacy practices concerning your
identifiable health information. By
law, we must follow the terms of the notice of privacy practices that we have in
effect at the time.
In summary, this notice provides you with the following
important information:
How we may use and disclose your identifiable health
information
Your privacy rights in your identifiable health information
Our obligations concerning the use and
disclosure of your identifiable health information.
The terms of this notice
apply to all records containing your identifiable health information that are
created or retained by our organization.
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 organization has created or
maintained in the past and for any of your records we may create or maintain in
the future. We will post a copy of the current notice in our facility and on our
website: www.protonics.com. The notice will contain the effective
date on the lower right corner of the page.
You are entitled to
receive additional copies of this notice at your request. We ask that you send your request in
writing to our organization, Inverse
Technology Corporation, 1000 West O Street, Suite B, Lincoln, NE 68528.
WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE
FOLLOWING WAYS
The following categories describe the different ways that we
are permitted to use and disclose your identifiable health information, although
certain of these categories may not apply to our business and we may not
actually use or disclose your medical information for such purposes.
1. Treatment
We may use your identifiable health information to supply you
with the medical device ordered for you.
Many of the people who work for our organization may use or disclose your
identifiable health information in order to treat you or to assist others in
your treatment. Additionally, we
may disclose your identifiable health information to others who may assist in
your care, such as your physician, therapists, spouse, children or parents.
2. Payment
We may use and disclose
your identifiable health information in order to bill and collect payment for
the treatment, services and items you may receive from us. For example, we may contact your health
insurer to certify that you are eligible for benefits, your range of benefits,
and we may provide your insurer with details regarding your treatment to
determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your
identifiable health information to obtain payment from third parties that may be
responsible for such costs, such as family members. Also, we may use your identifiable
health information to bill you directly for services and items.
3. Health Care Operations
We may use and disclose your identifiable health information
for our business operations. As
examples of the ways in which we may use and disclose your information for our
operations, our organization may use your health information to evaluate the
quality of product you received from us.
We many also disclose information to medical professional for reviewing
and learning purposes. We may
remove information that identifies you from medical information so not to
identify the specific patients.
4. Appointment Reminders
We may use and disclose your identifiable health information
to contact you as an appointment reminder or delivery.
5. Health-Related Benefits and Services
We may use and disclose
your identifiable health information to inform you of health-related benefits or
services that may be of interest to you.
6. Release of Information to Family/Friends
We may release your
identifiable health information to a friend or family member that is helping you
in your medical care or helping you pay for your health care.
7. Coordination with Equipment Suppliers
We may release your
Individually Identifiable Health Information (IIHI) to a supplier of medical
equipment while assisting with your medical treatment.
8.
Disclosures Required By Law
We will disclose medical
information about you when we are required by federal, state or local law.
WE MAY USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH
INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique situations in
which we may use or disclose your identifiable health information:
1. Public Health Risks
We may disclose your
identifiable health information to public health authorities that are authorized
by law to collect information.
These activities generally include the following:
·
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 may be at risk for spreading or contracting a disease or
condition;
·
Reporting reactions to medications or problems with products
or devices;
·
Notifying individuals if a product or device they may be
using has been recalled;
·
Notifying
the appropriate government authority regarding the potential abuse, neglect, or
domestic violence of an adult patient. We will only disclose this information
if the patient agrees or we are required or authorized by law.
2. Health Oversight Activities
We may disclose your
identifiable health information 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
We may use and disclose your identifiable health information
in response to a court or administrative order, if you are involved in a lawsuit
or similar proceeding. We also may
disclose your identifiable health information in response to a subpoena,
discovery request, or other lawful process by another party involved in the
dispute, but only if efforts have been made to inform you of the request or to
obtain an order protecting the information requested.
4. Law Enforcement
We may release identifiable health information if asked to do
so by law enforcement official:
-
In response to a warrant, summons, court order, subpoena or
similar legal process;
-
To identify/locate a suspect, material witness, fugitive or missing person;
-
Regarding a crime victim, under 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 occurring at our offices;
-
In an emergency to report a crime (including the location of the crime; or
victim (s), or the description, identity or location of the perpetrator).
5.
Serious Threats to Health or Safety
We may use and
disclose your identifiable health information when necessary to reduce or
prevent a serious threat to your health and safety or the health and safety of
another person or the public. We
will only make disclosures to a person or organization able to help prevent the
threat.
6. Military and Veterans
We may disclose your
identifiable health information if you are a member of U.S. armed forces or
foreign military forces (including veterans) and if required by the appropriate
military command authorities.
7. National Security
We may
disclose your identifiable health information to authorized federal officials
for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to
authorized federal officials in order to protect the President, other officials
or foreign heads of state or to conduct investigations.
8. Inmates
We may disclose your
identifiable health information 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 correctional
institution, and/or (c) to protect your health and safety or the health and
safety of other individuals.
9. Workers’ Compensation
We may release your
identifiable health information for workers’ compensation and similar programs. These programs provide for
work-related illness or injuries.
10. Sale of Business Assets
We reserve the right to transfer your identifiable health
information to a third party in conjunction with the sale of our company or
certain assets belonging to our company.
YOUR RIGHTS
REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION
You have the following rights regarding the identifiable
health information that we maintain about you:
1. Confidential
Communications
You have the right to request that we communicate with you
about your health and related issues in a particular way or at a certain
location. For example, you may ask
that we contact you at home. To
request a type of confidential communication, you must make a written request to Inverse Technology Corporation, 1000 West O
Street, Suite B, Lincoln, NE 68528
specifying the requested method of contact or the location where you wish to be
contacted. We will accommodate reasonable requests. You do not need to give a reason for
your request.
2. Requesting Restrictions
You have the right to request a restriction in our use or
disclosure of your identifiable health information for treatment, payment or
health care operations. Also, you
have the right to request a limit on the disclosure of your identifiable health
information to individuals involved in your care or the payment for your care,
such as a family member and friend. We are
not required to agree to your request. 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 to you. To request a restriction in our use or disclosure of your
identifiable health information, you must make your request in writing to Inverse Technology Corporation, 1000 West O
Street, Suite B, Lincoln, NE 68528. Your request must describe in a clear
and concise fashion: (a) the information you want restricted; (b) whether you
are requesting to limit our 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
identifiable health information about you, including patient medical records and
billing records. You must submit
your request in writing to Inverse
Technology Corporation, 1000 West O Street, Suite B, Lincoln, NE 68528 in order to inspect and/or
obtain a copy of your identifiable health information. We may charge a fee for the costs of copying, mailing or
other supplies associated with your request.
We may deny your request to inspect and/or copy in certain limited
circumstances; however, you may request a review of our denial. Reviews will be conducted by another
licensed health care professional chosen by us and we will comply with the
outcome of the review.
4. Amendment
You may ask us to amend your health information if you
believe it is incorrect or incomplete.
You may request an amendment for as long as the information is kept by or
for our organization. To request an
amendment, your request must be made in writing and submitted to Inverse Technology Corporation, 1000 West O
Street, Suite B, Lincoln, NE 68528. You must provide us with a reason that
supports your request for amendment.
We will deny your request if you fail to submit your request (and the
reason supporting your 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 identifiable health
information kept by or for the organization; (c) not part of the identifiable
health information 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.
5. Accounting of Disclosures
You have the right to request an “accounting
of disclosures.” This “accounting
of disclosures” is a list of certain disclosures we made of your identifiable
health information.
This list will not include disclosures made for treatment,
payment or our business operations, disclosures previously authorized by you or
disclosures specifically exempt from disclosure accounting requirements by the
federal rule governing such disclosures.
To obtain an accounting of disclosures, you must submit your request in
writing to Inverse Technology
Corporation, 1000 West O Street, Suite B, Lincoln, NE 68528. All requests for 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 we may charge you for additional lists
within the same 12-month period. We
will notify you of the costs involved with additional requests, and you may
withdraw your request before any costs are incurred.
6. 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, mail a written request to Inverse Technology Corporation, 1000 West O
Street, Suite B, Lincoln, NE 68528.
7. Right to File a Compliant
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, mail a written request to Inverse Technology Corporation, 1000 West O
Street, Suite B, Lincoln, NE 68528. All complaints must be submitted in
writing.
You will not be penalized for filing a
complaint.
8. Right to Provide an Authorization for
Other Uses and Disclosures
We 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 identifiable health
information may be revoked at any time in writing. After you revoke your
authorization, we will no longer use or disclose your identifiable health
information for the reasons described in the written authorization. You understand that we are unable to take back any
disclosures already made by your permission and that we are required to retain
records of your care.
Inverse Technology Corporation - Notice of Privacy Practices
Date: 03/18/08
