Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can obtain access to this information.

PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices ("Notice") describes the privacy practices of Direct Medical Incorporated (DMI). It applies to the services you receive from DMI. DMI is a DME company, a third-party biller; therefore, staff, insurance companies, and accreditation surveyors may review this information. In this Notice, DMI and its departments collectively referred to as "we" or "us."

We are required by law to give you this Notice of our privacy practices, legal responsibilities and your rights.
We are required to follow the terms of this Notice or other notice in effect at the time we use or disclose your health information. This Notice also describes (i) the types of uses and disclosures we may make with your health information; and (ii) your rights to access and control your health. There are other laws that provide additional protections for certain medical information related to services or treatment for certain conditions including genetic testing, mental health, alcohol abuse, drug abuse, and HIV/AIDS.
We will follow the requirements of those laws with respect to these types of medical information.

We May Use and Disclose Information for the Following Purposes

Processing Your Supply Orders: We may use or disclose your health information to provide supplies, and to coordinate, or manage those supply orders. For example, we give information to our billing partners if we are out of network with your insurance carrier. We may provide information to other providers outside of the DMI to arrange for a referral.

Payment: We may use or disclose your health information, as needed, to obtain payment for our health care services. For example, we may contact your insurer to verify the benefits for which you are eligible, obtain prior authorization, and give them the details they need about your treatment to make sure they will pay for your care. We may also use or disclose your medical information to obtain payment from third parties that may be responsible for payment, such as family members.

Healthcare Operations: We may use or disclose your health information, as needed, in order to perform organization operations. Organization operations include, but are not limited to: training and education, quality assessment/improvement activities, risk management, claims management, legal consultation, physician and employee review activities; licensing; regulatory surveys; and other business planning activities.

Business Associates: We may also disclose your health information to our third-party business associates (for example, an accounting firm or billing company) that perform activities or services on our behalf. Each business associate must agree in writing to protect the confidentiality of your information.

Marketing Activities: We may use or share your health information to discuss products or services with you. For any other types of marketing activities, including sending you marketing materials (excluding direct mail sent to targeted zip codes that are not based on patient lists), we must obtain your written permission before using or disclosing your health information.

Appointments and Services: We may use and disclose your health information to remind you of an appointment, or to give you information about treatment alternatives or other health-related benefits or services that may interest you.

Individuals Involved In Your Care/Disaster Relief Organizations: We may disclose your health information to a friend or family member who is involved in your care unless you ask us not to. We may disclose information to disaster relief organizations, such as the Red Cross so that your family can be notified about your condition and location.

Other Uses and Disclosures We May Make Without Your Authorization, Consent or Opportunity to Object

Required By Law: We may use or disclose your health information to the extent that the use or disclosure is required by federal, state or local law, but only to the extent and under the circumstances provided in such law.

Legal Proceedings: We may disclose your health information in response to court or administrative orders, or under certain circumstances in response to subpoenas, discovery requests or other lawful processes.

Law Enforcement: We may disclose your health information to law enforcement in certain circumstances, i.e., to identify or locate suspects, fugitives or witnesses, or victims of crime, to report deaths from crime, to report crimes on the premises, or in emergencies, the commission of a crime.

National Security: We may disclose your health information to authorized federal officials for conducting national security and intelligence activities including for the provision of protective services to the President.

Criminal Activity: We may disclose your health information consistent with applicable federal and state laws if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law such as audits, administrative or criminal investigations, inspections, licensure or disciplinary action and monitoring compliance with the law.

Abuse, Neglect or Domestic Violence: We may disclose your health information to a public health authority that is authorized by law to receive reports of abuse or neglect, including reporting child and sexual abuse. In addition, we may disclose your health information if we believe you may be a victim of abuse, neglect, or domestic violence to the governmental agency or entity authorized to receive such information. This disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration (FDA): We may disclose your health information to a person or company required by the FDA to report adverse events, product defects or problems, or to track products; to enable product recalls; to make repairs or replacements, or to conduct post-marketing surveillance, as required.

Military Activity: We may disclose your health information if you are in the armed forces and information is required by command authorities, or for the purposes of a determination by the Department of Veteran Affairs of your eligibility for benefits.

Correctional Institutions: We may disclose your health information if you are an inmate for your health and the health and safety of others.

Workers' Compensation: We may disclose your health information as authorized to comply with workers' compensation laws and other similar legally-established programs. Any other uses and disclosures of your health information not described in this Notice will be made only with your authorization.

Examples of Uses and Disclosures Which Require Your Written Authorization Include:

most uses and disclosures of psychotherapy notices (private notes of a mental health professional kept separately from the record;
subject to limited exceptions (described above), uses and disclosures of your health information for marketing purposes; and
disclosures that constitute the sale of your health information. You may revoke your authorization at any time, in writing, but only as to future uses or disclosures, and only where we have not already acted in reliance on your authorization.

Your Health Information Rights

Right to Obtain a Copy of this Notice of Privacy Practices: You have the right to obtain a paper copy of the Notice currently in effect upon request. A copy of the current Notice is available in the first package you receive from us. You have the right to obtain a paper copy of this Notice upon request.

Right to Request a Restriction on Certain Uses and Disclosures: You have the right to request restrictions on the uses and disclosures of your medical information for the purposes of treatment, payment or healthcare operations. We ask that such requests be made in writing. Although we will consider your request, we are not required to abide by your request except in the following situation: If you have paid an item or service out-of-pocket in full, at your request, we will not disclose information relating solely to that item or service to your health plan for purposes of payment or health care operations, unless we are required by law to make the disclosure. It is your responsibility to notify any other providers about such a request. Please contact our Privacy Office if you have any questions about requesting restrictions on the uses and disclosures of your medical information.

Right to Inspect and Request a Copy of Your Health Record: You have the right to inspect and obtain a copy of your health record, except in limited circumstances defined by federal and state laws and regulations. You may request that we send copies of your health record to another person designated by you. A reasonable fee may be charged to copy and/or send your record, as permitted by law. If your record is maintained electronically, we will provide you with a copy of the record in a readable electronic form and format. If you are denied access to your health record for certain reasons the denial may be reviewable. Please contact our Privacy Officer at the telephone number or address below for more information or to request access to or copies of your records.

Right to Request an Amendment to Your Health Record: You may make a written request to amend your protected health information, as long as the information is kept by or for us. You must give us a reason for the amendment. In certain cases, we may deny your request for an amendment. 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. We will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have any questions about amending your health record.

Right to Obtain an Accounting of Disclosures of Your Health Information: You have the right to request an accounting of some of the disclosures of your health information made by us. The first accounting will be provided to you for free, but you may be charged for any additional accountings requested during the same calendar year. Please contact our Privacy Officer to obtain an Accounting and Disclosure Report.

Right to Request Communication of Your Health Information: You have the right to request that confidential communications be made by alternate means (e.g. fax versus mail) or at alternate locations (alternate address or telephone number). Your request must be in writing. We will honor your request if it is reasonable. Please make this request in writing to our Privacy Officer.

Right to Receive Notice of a Breach: You have the right to be notified in writing following a breach of your health information that was not secured in accordance with security standards as required by law.

Contact for Requests or Questions About this Notice

To exercise any of the rights described above, or if you have any questions about this Notice, please contact our Privacy Officer by mail at:

335 W. Main St.
Belleville, IL 62220
Attention: Privacy Officer

Complaints

If you believe that your privacy rights have been violated by us, you may file a complaint with us by contacting our Privacy Officer by mail at:

335 W. Main St.
Belleville, IL 62220
Attention: Privacy Officer

To file a complaint with the DMI compliance hotline, call 1-866-710-7679 ext. 1001. You also have the right to file a written complaint with:

The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 601818
Phone: (630) 792-5800
Website: www.jointcommission.org

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our corporate office.