INCUTECH INC. - NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 THIS NOTICE
DESCRIBES HOW INFORMATION WE HAVE ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW CAREFULLY. Your privacy is as important to Incutech as it is to
you. When you contact us to request
information, samples and/or place an order, we create a record of the
information you give us. This
information includes, but is not necessarily limited to, name, address, phone
number, ‘medical condition’ (e.g. what kind & size of stoma), products
being used, product information/samples requested, and for orders also billing,
payment, insurance information, etc. We
use this information to fill your request(s) and/or order(s). This information is called “Protected Health
Information” (or “PHI” for short). Our
policy is to keep this information private.
Under the Health Insurance Portability and Accountability Act (“HIPAA”),
we have to, as of April 14, 2003, inform you in writing about our policy
through this Notice of Privacy Practices. This Notice of Privacy Practices (“Notice”) describes
how we may use and disclose PHI as permitted or required by law. This Notice
also describes your rights with respect to PHI about you. We will not use or disclose PHI about you
without your written authorization, except as described in this Notice. We reserve the right to change our practices
and to revise this Notice and to make the new Notice effective for all PHI we
maintain. Upon written request, we will
provide any revised Notice to you. This
Notice of Privacy Practices - as well as any revision – will also be made
available at our website, www.incutech.com. Your Health Information Rights You have the following rights with respect to our
information about you: Right to obtain a paper copy of the Notice. Upon written
request to our Privacy Office¹, you have the right to receive a paper copy of
this Notice and/or an electronic copy by e-mail. As stated above, this Notice will also be available at our
website, www.incutech.com. Right to inspect and obtain a copy of PHI. You may also
request a copy of our information about you, by sending a written request to
our Privacy Office. Right to request an amendment of PHI. If you feel
that the information we have about you is incorrect, you may request that we
amend and/or correct it. To request an
amendment, you must send a written request – including information on what you
want to be amended/corrected and how - to our Privacy Office. Right to find out about
any disclosures we’ve made of your information (other than as requested by
you). You have the right to request (in writing) information on any
disclosures of your PHI we have made on or after April 14, 2003 Right to choose how we contact you. You
have the right to request (in writing)
that we contact you in a certain way or at a certain location. For example, you may request that we contact
you only by e-mail, only in writing at a specific address, etc. Right to request restrictions. You have the
right to request additional restrictions on our use or disclosure of
information about you by sending a written request to our Privacy Office. We will consider your request, but are not
required to agree to those restrictions. Incutech Inc., Notice of Privacy Practices (NPP0403),
Effective Date 4/14/2003, page 1 of 3 Right to file
a complaint about our privacy practices.
If you believe that your
privacy rights have been violated, you can file a complaint with the Privacy
Office at Incutech or the Secretary of the Department of Health and Human
Services². All complaints must be
submitted in writing. You will not be
penalized in any way for filing a complaint. The following are ways that your information could be
used and disclosed without your permission: 1. For
Treatment. We may use your PHI to inform you of new
alternatives and/or products that may
help you manage your health. We may
disclose your information to physicians, nurses or other health care entities
involved in providing you with your supplies. 2. For
Payment. We may contact you regarding an order from you for
product(s) and/or payment for products ordered. We may also disclose your information if contacted by your
insurance company. 3. For Health
Care Operations. Our information about you could also be used
to monitor our inventory levels (by keeping track of products we sell to you we
try to keep ‘your’ products in stock) or to evaluate the performance of our
staff in providing services and products to you. We may use
or disclose your information for other reasons, even without your
permission. The following is a listing
of ‘other special circumstances’ under which we are permitted or required to
use or disclose your information: Marketing: We may use your information
to contact you to advise you of services or products that we think may be of
interest to you. However, your
information will not be disclosed to third parties for marketing purposes. Individuals Involved in Your
Care or Payment for Your Care: We may disclose your
information to a friend or family member whom you have listed as a contact
involved in your care, or to an individual who helps pay for your care. As Required By Law: We will use and disclose your information when
required to do so by federal, state and/or local law. Public Health Risks: We may disclose information about you for public
health activities; examples include notification for product recall or
reporting of problems about products. Health Oversight
Activities: We
may disclose information about you to a health oversight agency for activities
authorized by law; examples include audits, investigations, inspections and
licensure. Lawsuits/Disputes/Court
Proceedings: If you are involved in a law
suite, dispute or court proceeding, we may disclose information about you in
response to a court or administrative order.
We may disclose information about you in response to the following: subpoenas, discovery requests or other
lawful processes by others involved in the dispute. This will only be done after efforts have been made to inform you
about such a request. Law Enforcement: We may release information about you if asked to do so by a law
enforcement official. Threat to Health/Safety: We may use and disclose information about you when necessary to
prevent a serious threat to your health and safety or the health and safety of
the public or another person. Incutech Inc., Notice of Privacy Practices (NPP0403),
Effective Date 4/14/2003, page 2 of 3 Certain Government
Functions: We may release information about you to
authorized federal officials for the following government functions: intelligence, counterintelligence and other
national security activities authorized by law; to authorized federal officials
so they may provide protection to the President, other authorized persons or
foreign heads of state; or to conduct special investigations; to a member of
the armed forces as required by military command authorities; or to
correctional institutions or law enforcement officials. Workers’ Compensation: We may release information about you for Workers’ Compensation or
similar programs. These programs
provide benefits for work-related injuries or illnesses. Other Uses of Your Information We will obtain your written
authorization before using or disclosing any of your information for purposes
other than those provided for above or as otherwise permitted or required by
law. If you provide us with permission to
use or disclose information about you, you may revoke that authorization in
writing at any time. If you revoke your authorization, we will no longer use or
disclose information about you, except to the extent that we have already taken
action in reliance on such an authorization. For more information, to report a problem or to submit requests, amendments and/or corrections please contact: If you believe that your privacy rights have been violated, you can send a written complaint to: Incutech Inc., Notice of Privacy Practices (NPP0403),
Effective Date 4/14/2003, page 3 of 3 |