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.
This Notice of Privacy Practices describes how your protected health information
may be sued and disclosed by SMS to carry out treatment, payment or healthcare
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 healthcare services.
SMS is required by law to maintain the privacy of protected health information
and to provide you with is notice of our legal duties and privacy practices with
respect to protected health information.
- TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS:
Because we provide you with healthcare services, we are permitted to use and disclose
your protected health information for treatment, payment, and healthcare operations.
- Treatment: Your protected health information may be used by us and released to other healthcare professionals to provide, coordinate, or manage your healthcare and any related services.
- Payment: Your protected health information may be used by us and released to your health plan or health insurer so that we may receive payment for providing you with needed healthcare services.
- Healthcare Operations: You protected health information may be used by us and released in order to support the business activities of SMS, which include certain administrative, financial, legal and performance improvement activities.
- SMS may also share your protected health information to third party business associates
if we have a written agreement, which requires them to maintain the privacy of your
protected health information consistent with the notice.
- SMS may contact you to schedule or remind you of appointments or deliveries, and provide
you with information about healthcare treatment options or other health services that may be
of interest to you.
- WRITTEN AUTHORIZATION REQUIRED:
Unless the disclosure is otherwise permitted or required by law, as described below,
SMS will ask for your written authorization or permission from your legal representative
to use and disclose your protected health information. For example, we require your
written authorization to use and disclose your protected health information for marketing
purposes. You have the right to revoke such authorization in writing, at any time, except
when SMS has acted in reliance on the authorization. You should understand that we will
not be able to take back any disclosures we have already made with your authorization.
- USES AND DISCLOSURES REQUIRING AN OPPORTUNITY TO AGREE OR OBJECT:
SMS may disclose your protected health information with your advance notification and verbal
consent, as described in this section. In the event you are not present or unable to agree
or object to the release of your protected health information, SMS may use professional
judgment in releasing your protected health information as deemed in the best interest of
Your protected health information may be released to a member of your family, a relative,
or close friend or any other person you identify. We may use or disclose protected health
information to notify or assist in notifying a family member, personal representative or
other person that is responsible for your care of your location, general condition or death.
The information released would be directly related to that personís involvement in healthcare.
- PERMITTED AND REQUIRED USES AND DISCLOSURES WITHOUT AUTHORIZATION OR OPPORTUNITY OT OBJECT:
SMS may use or disclose your protected health information without your prior written consent or
opportunity to object, where permitted or required by law as described in this section.
- Required By Law: Your protected health information may be sued or released required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
- Public Health: Your protected health information may be released to a public Health organization, which is permitted by law to collect information to control disease, injury, or disability.
- Federal Organization: Your protected health information may be released to a federal organization or company who is required to report to a federal organization about adverse events, product defects or problems or biologic product deviations.
- Communicable Disease: Your protected health information may be released, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
- Abuse or Neglect: Your protected health information may be released to public or law enforcement officials in the event we believe that you are a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made as required by federal and state laws.
- Health Oversight: Your protected health information may be released to a health oversight agency for activities authorized by law. These activities may include audits, investigations and inspections. Oversight agencies seeing this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.
- Legal Proceedings: Your protected health information may be released in any judicial or administrative proceeding. This release will be authorized by an order of a court or administrative tribunal. It may also be in response to a subpoena, discovery request or other lawful process.
- Law Enforcement: Your protected health information may be released, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include: (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on our premises, and (6) medical emergency where it is likely that a crime has occurred.
- Criminal Activity: Consistent with applicable federal and state laws, we may release you protected health information 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. We may also release protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
- Military Activity and National Security: When the appropriate conditions apply, we may release the protected health information of Armed Forces personnel: (1) for activities required by military command authorities; (2) for the Department of Veterans Affairs to determine your eligibility for benefits; and, (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including the provision of protective services to the President or other persons legally authorized.
- Inmates: Your protected health information may be released if you are an inmate of a correctional facility when SMS created or received your protected health information in the course of providing care to you.
- Worker's Compensation: Your protected health information relating to a work-related illness or injury may be released to your employer to comply with workerís compensation laws and other similar programs.
- YOUR RIGHTS:
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
- Restriction on Use and Disclosure: You have the right to request a restriction or limitation on protected health information we use or disclose about you for treatment, payment or healthcare operations, or that we disclose to someone who may be involved in your care or payment for your care, like a family member or friend. While we will consider your request, we are not required to agree to it. If we do agree to it, we will comply with your request, unless your protected health information is needed to provide emergency treatment. To request a restriction, you must complete SMSís Release or Restriction of Patient Information Consent Form and tell us the specific restriction requested and to whom you want the restriction to apply. We will not agree to restrictions on protected health information uses and disclosures that are legally required or which are necessary to administer our business.
- Review of your Medical Record: You have the right to inspect and copy your protected health information that we maintain about you. To inspect and copy your protected health information, you must submit your request in writing to an SMS Vice President. To receive a copy of your protected health information, you may be charged a fee for the cost of copying, mailing, or other supplies associated with request. Under federal law, certain types of protected health information will not be made available for inspection or copying, including (1) psychotherapy notes; (2) information compiled in anticipation of a civil, criminal, or administrative action or proceeding; and, (3) protected health information that may be prohibited from access by law. In very limited circumstances we may deny your request to inspect and obtain a copy of your protected health information. If we do, you may request that the denial be reviewed. The review will be conducted by an individual chosen by us who was not involved in the original decision to deny your request. We will comply with the outcome of that review.
- Confidential Communications: In order to avoid risk of unwanted disclosures, you have the right to request that we communicate with you about your healthcare by alternative means or at an alternative location. Please make this request in writing to an SMS Vice President. We will attempt to accommodate all reasonable requests.
- Changes to Medical Record: You have the right to request changes to your medical record for as long as we maintain this information. You must provide your request and the reason for your request in writing, submitted to an SMS Vice President. In certain cases, we may deny your request for a change. If we deny your request for a change, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and we will provide you with a copy of any rebuttal.
- List of Disclosures: You have the right to request a list of the disclosures we have made of your protected health information and the purpose of the disclosures. This right excludes disclosures made: (1) for treatment, payment, or healthcare operations; (2) to you; (3) to family members or friends involved in your care; (4) for notification purposes; (5) for national security purposes; or (6) to law enforcement personnel. You have the right to receive information about disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions, and limitations. To request this list, you must submit your request in writing to an SMS Vice President. The first list you request within a 12-month period will be free. We may charge you for responding to additional requests. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any cost is incurred.
- Copy of Notice: You have the right to obtain a paper copy of this Notice form us, upon request, even if you have agreed to accept this Notice electronically.
- Compliance with Notice: SMS agrees to the terms of this notice. SMS reserves the right to make changes to this notice at any time. We reserve the right to make the revised or changed notice effective for protected health information we already have about you as well as any protected health information we received in the future. Upon request, you will receive a revised copy of this notice.
- COMPLAINTS OR QUESTIONS:
You have the right to complain to SMS or the Secretary of the Department of Health and
Human Services if you believe we have violated your right to privacy. All complaints
will be investigated. You will not be penalized for filing a complaint with the company.
Please direct your complaint or questions to us at:
Sleep Management Solutions
Attn: VP, Compliance
15 Kenny Roberts Memorial Drive, Unit 2
Suffield, CT 06078
Or contact our toll free Corporate Compliance Hot Line: 1-888-49-Sleep