Effective Date of Notice: April 14, 2003.

DETROIT OXYGEN & MEDICAL EQUIPMENT CO.

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 it carefully.

If you have any questions about this Notice please contact our Privacy Officer.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations 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.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. We will post a copy of the current Notice at our facility. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

Understanding Your Health Record/Information

Each time you visit a healthcare provider a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

• basis for planning your care and treatment
• means of communication among the many health professionals who contribute to your care
• legal document describing the care you received
• means by which you or a third-party payer can verify that services billed were actually provided a tool in educating heath professionals
• source of data for medical research
• source of information for public health officials charged with improving the health of the nation
• source of data for facility planning and marketing
• a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

• ensure its accuracy
• better understand who, what, when, where, and why others may access your health information
• make more informed decisions when authorizing disclosure to others

Your Health Information Rights

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

• request a restriction on certain uses and disclosures of your information, however we are not required to agree to the requested restriction, but we can if we believe it is reasonable to do so.
• obtain a paper copy of the notice of information practices upon request
• inspect and obtain a copy of your health record
• amend your health record
• obtain an accounting of disclosures of your health information
• receive confidential communications of your health information by alternative means or at alternative locations.

To exercise any the rights described above, please send a written request to our Privacy Official at the address listed below in the section entitled “Contacting Us About Disclosure of Your Health Information”.

Our Responsibilities

This organization is required to:

• maintain the privacy of your health information
• provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• abide by the terms of this Notice

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact our Privacy Officer, at (586) 756-1400 for further information about the complaint process.

Your Health Information

In some circumstances, we may use or disclose your health information without asking for your authorization in advance or giving you an opportunity to object. These circumstances include:

For Treatment. We may use or disclose health information about you to provide you with medical treatment or services. For example: Information obtained by a therapist or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. We may provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you.

For Payment. We may use and disclose your health information for purposes of receiving payment for treatment and services that you receive. For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

For Health Care Operations. We may use and disclose health information about you for health care operations purposes. For example: Members of our quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Business associates: There are some services provided in our organization through contracts with business associates. Examples include our billing service and a copy service we use when making copies of your health record. We may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Individuals involved in your care or payment for your care: Unless you object we will share relevant information about your care with your family or friends who are helping you with your care or with payment for your care. If you are incapacitated, we may use or disclose relevant information about your care to your personal representative, if available. Further, in such circumstances, our health professionals, using their professional judgment, may also use and disclose health information in an effort to notify, identify, or locate a family member, your personal representative or another person responsible for you care of your location and general condition or death. In a disaster situation, we may disclose your health information to organizations that are involved in locating and notifying relatives and close friends.

Research: We may disclose information to researchers when their research has been approved by an institutional review board and ensures the privacy of your health information.

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Appointments, Treatment Alternatives and Services: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fund raising: We may contact you as part of a fund-raising effort for our organization. If you do not want to continue to receive fundraising communication, all you have to do is tell us. Each fundraising communication we make or send will tell you how to opt out of receiving future fundraising materials.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.

Inmates: We may disclose health information about you necessary for your health and the health and safety of other individuals to the correctional institution or law enforcement official if you are an inmate of a correctional institution or under the custody of a law enforcement official.

Required by law. We will disclose your health information when required to do so by federal, state, or local law. These include, for judicial and administrative proceedings pursuant to legal authority, to report information related to victims of abuse, neglect, or domestic violence, and to assist law enforcement officials in their law enforcement duties.

To avert a serious threat to health and safety. We may use and disclose health 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 pursuant to law.

Government functions. We may use and disclose health information for specialized government functions such as protection of public officials or reporting to various branches of the armed services.

The Federal Department of Health and Human Services (DHHS). Under the privacy standards, we must disclose your health information to DHHS as necessary for them to determine our compliance with those standards.

Our use and disclosure of your health information must comply not only with federal privacy regulations but also with applicable Michigan law. Michigan law provides different protections to your health information. For example, Michigan provides extra protection for sensitive information, like HIV/AIDS information and mental health information.

Other Uses and Disclosures

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose health 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 health information about you covered in the revocation. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain your health information. To revoke your authorization for use or disclosure, you must send written revocation to the Privacy Officer. The address and phone number are provided below.

Contacting Us About Disclosure of Your Health Information

Please direct all inquiries, requests for records, requests to revoke a previously signed authorization, requests for copies of our Notice of Privacy Practice, complaints, or concerns to our Privacy Officer, at (586) 756-1400.

Detroit Oxygen & Medical Equipment Co.
24560 Forterra Drive
Warren, Michigan 48089
Attention: Privacy Officer