Health Insurance Portability and Accountability Act of 1996 Effective Date April 14, 2003

A federal law has created new rights for customers of health care organizations. The law is called the Health Insurance Portability and accountability Act of 1996. This notice describes how medical information about you may be used. In addition, this notice discloses how you can get access to your personal health information. Please review this document carefully.

SPARTAN MEDICAL will recognize that uses and disclosures can be made to carry out treatment, payment or healthcare operations.

  • TREATMENT: We will use and disclose your protected health information to provide, coordinate or manage your health care and related services. This includes the coordination or management of your health care with a third party.

  • PAYMENT: Your protected health information will be used, as needed to obtain payment for your health care services.

  • HEALTHCARE OPERATIONS: We may use or disclose your protected health information in the following situations without your authorization. These situations include as required by Public Health issues as required by Communicable Disease, Health Oversight, Abuse or Law, Neglect, Food and Drug Administration requirements, Legal proceedings, Law Enforcement, Criminal activity, Inmates, National Security, Workers Compensation. Other permitted and required uses and disclosures will be made only with your consent.

  • RIGHTS: You have the right to inspect and copy your protected health information under federal law. However, you may not inspect or copy information compiled in reasonable anticipation of our use in a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

  • COMMUNICATION: You have the right to request to receive confidential communications from SPARTAN MEDICAL by alternative means or at an alternate location.

  • TERMS: We reserve the right to change the terms of this notice and will inform you by mail of any changes. We are required by law to maintain the privacy of an individual.

COMPLAINTS - If you believe that your privacy rights have been violated, you may complain to the Agency or to the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing, and should state the specific incident(s) in terms of subject, date and other relevant matters. A complaint to the Secretary must be filed in writing within 180 days of when the act or omission complained of occurred, and must describe the acts or omissions believed to be in violation of applicable requirements. [45 CFR ยง 160.306] For further information regarding filing a complaint, contact: (269)668-6066

EFFECTIVE DATE - This notice is effective April 16, 2003. We are required to abide by the terms of the notice currently in effect, but we reserve the right to change these terms as necessary for all protected health information that we maintain. If we change the terms of this notice, we will promptly revise and distribute a revised notice to you as soon as practicable by mail, e-mail (if you have agreed to electronic notice) or hand delivery.

If you require further information about matters covered by this notice, please contact: SPARTAN MEDICAL SUPPLY: (269)668-6066