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 THIS INFORMATION. 

Uses and Disclosures: We will use and disclose elements of your protected health information (PHI) in the following ways:

Without your signed authorization

  • Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or health plan or other third party. For example, we may need to give your health plan a copy of your chart so your health plan will pay for your visit. We may have our client's bills and payment arrangements outsourced to one or more third party providers who issue, process and collect bills on behalf of our clients (i.e. collection agencies).
  • Health Care Operations: We may use and disclose medical information about you for operations. These uses and disclosures are necessary to make sure we are following our policies correctly. For example, we may disclose information to personnel for learning purposes. We may use your information for educating clients and personnel when discussing proper coding procedures. We may remove information that identifies you from this set of medical information so that others may learn from the information without learning who the specific patients are.
  • As Required by Law: We will disclose medical information about you when required to do so by federal, state, or local law.
  • Other Health Care Providers: We may disclose information about you to other health care providers so that they may obtain payment for their services related to your visit.
  • All other uses and disclosures: All other uses and disclosures will require us to obtain from you a written authorization in addition to and other permission you will provide us.

Your Rights: You have the following rights concerning your PHI:

  • Restrictions: To request restricted access to all or part of your PHI. To do this, you must send your request in writing to our office. Your written request must tell us (1) what information you want to limit; (2) whether you want to limit use, disclosure or both; (3) to whom you want the limits to apply. We are not required to grant your request.
  • Confidential Communications: To receive correspondence of confidential information by  alternate means or location. You must submit your request in writing to our office. Your request must tell us how or where you wish to be contacted. We will accommodate all reasonable requests.
  • Access: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. All requests for access to the medical record must be made to the facility where the service was rendered. To request a copy of the billing record, submit your request in writing to our office. If you request a copy of your billing information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request in certain very limited circumstances. 
  • Amendments: If you feel the information we have about you is incorrect or incomplete, you may ask us to amend the information. To amend your billing information, you may submit a request in writing to our office. Your written request must provide us a reason that supports your request. We are not required to grant your request. To amend your medical record, you must contact the facility where the service was rendered.
  • Accounting: You have the right to request an "accounting of disclosures." This is a list of disclosures we have made of medical information about you, with some exceptions. The exceptions are governed by the federal health privacy law, and may include (1) many routine disclosures for treatment, payment and operations, and (2) disclosures to you. You must submit your request in writing to our office. Your written request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003, when current federal health privacy laws became effective.
  • This Notice: You have the right to receive updates or reissue of this notice, at your request.
  • Complaints: If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. To file a complaint to our office, send your written complaint to:
 
Attn: Privacy Officer
Extended Care Specialists
3512 Stellhorn Road
Fort Wayne IN 46815