Notice of Privacy Practices
This notice is provided by [[SA-CONFIRM:legal-entity-name]] ("Sleep America," "we," "us," or "our").
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.
Sleep America provides sleep-medicine services, including sleep studies and related durable medical equipment such as CPAP machines and supplies, based on referrals from your physician. To do that work, we create and receive health information about you. Federal law (the Health Insurance Portability and Accountability Act, or HIPAA) requires us to keep that information private, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
The following categories describe the ways we may use and disclose your health information. Not every use or disclosure in a category is listed, but every way we are permitted to use or disclose information falls within one of the categories below.
Treatment
We may use your health information to provide you with care, and we may share it with other health care professionals involved in your care. For example, after you complete a sleep study, we share the results and interpretation with the physician who referred you so that your doctor can plan your treatment. We may also share information with an equipment supplier or respiratory therapist who sets up or adjusts your CPAP equipment.
Payment
We may use and disclose your health information to bill for our services and to collect payment. For example, we may send information about your sleep study or CPAP equipment to your health insurance plan or to Medicare so that the service can be paid for, and we may contact your plan to confirm your coverage before scheduling a study.
Health care operations
We may use and disclose your health information to run our organization and to make sure our patients receive quality care. For example, we may review sleep-study records as part of a quality-review program, use information for staff training, or evaluate how well our scheduling and equipment services are working.
Other permitted or required disclosures
We may also use or disclose your health information without your written authorization in the following situations, subject to legal requirements and limits:
- Public health. To public health authorities for activities such as preventing or controlling disease, or reporting problems with medical devices.
- Health oversight. To health oversight agencies for audits, investigations, inspections, and licensure activities authorized by law.
- Legal proceedings. In response to a court or administrative order, or in certain cases in response to a subpoena or other lawful request when required protections are in place.
- Law enforcement. To law enforcement officials when required by law or in other limited circumstances permitted by law.
- To avert a serious threat. When necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
- Workers' compensation. As authorized by, and to the extent necessary to comply with, workers' compensation laws and similar programs.
- As otherwise required by law. When federal, state, or local law requires the use or disclosure.
Uses and disclosures that require your written authorization
We will obtain your written authorization before we:
- Use or disclose your health information for marketing purposes;
- Sell your health information; or
- Use or disclose psychotherapy notes, in the rare event we hold any.
Other uses and disclosures not described in this notice will also be made only with your written authorization. If you give us an authorization, you may revoke it in writing at any time. If you revoke your authorization, we will stop the uses and disclosures it covered, except to the extent we have already acted in reliance on it.
Your rights
You have the following rights regarding the health information we keep about you. To exercise any of these rights, contact our privacy official using the information at the end of this notice.
Right to access your records
You have the right to see and get a copy of your health information, including an electronic copy if we keep your records electronically. We will respond to your request within the time required by law and may charge a reasonable, cost-based fee for copies.
Right to amend
If you believe the health information we have about you is incorrect or incomplete, you may ask us in writing to amend it. We may deny your request in certain cases, and if we do, we will tell you why in writing and explain your options.
Right to an accounting of disclosures
You have the right to request a list of certain disclosures we have made of your health information, other than disclosures for treatment, payment, health care operations, and certain other exceptions.
Right to request restrictions
You have the right to ask us to limit how we use or disclose your health information for treatment, payment, or health care operations. We are not required to agree to every request, but if you pay for a service in full out of pocket and ask us not to tell your health plan about it, we must honor that request unless the law requires the disclosure.
Right to confidential communications
You have the right to ask us to contact you in a specific way or at a specific location — for example, only by mail or only at a certain phone number. We will accommodate all reasonable requests.
Right to a paper copy of this notice
You have the right to a paper copy of this notice at any time, even if you agreed to receive it electronically. You may also view it on our website or ask us for a copy at any visit.
Right to breach notification
You have the right to be notified if a breach occurs that compromises the privacy or security of your unsecured health information.
Our duties
We are required by law to maintain the privacy and security of your health information, to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach compromises your unsecured health information. We reserve the right to change this notice and to make the new notice apply to health information we already hold. If we make a material change, we will post the revised notice on our website and make copies available on request.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. To complain to us, contact our privacy official, [[SA-CONFIRM:privacy-official-name-title]], at [[SA-CONFIRM:privacy-official-phone-email]] or by mail at [[SA-CONFIRM:mailing-address]]. To complain to the Office for Civil Rights, you may write to the U.S. Department of Health and Human Services, Office for Civil Rights, or file online. We will not retaliate against you in any way for filing a complaint.
Privacy official
Questions about this notice or about our privacy practices should be directed to our privacy official: [[SA-CONFIRM:privacy-official-name-title]], reachable at [[SA-CONFIRM:privacy-official-phone-email]], [[SA-CONFIRM:mailing-address]].
Effective date
This notice is effective as of [[SA-CONFIRM:effective-date]].
[[SA-CONFIRM:state-law-addenda]]
Effective date: TBD