Your Rights
You have the following rights with respect to PHI about you:
Obtain a Paper copy of the Notice Upon Request
You may request a copy of the most current version of this Notice at any time. Even if you have agreed to re-ceive the notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact Shay Moore Chief Privacy Officer.
Inspect and Obtain a Copy of PHI
You have the right to inspect and obtain a copy of the PHI about you contained in a designated record set forth as long as Craft Wheelchair Repair maintains the PHI. The “designated record set” usually will include pre-scription, physician orders and billing records. To inspect or receive a copy of your PHI for your inspection, you must send a written request to Privacy Officer, Shay Moore. Under federal law, however you may not inspect or copy the following records: information compiled in reasonable anticipation of, or 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. We may charge you a fee for the costs of copying, mailing or other supplies that are necessary to grant your request. We may deny your request to inspect and copy in certain limited circum-stances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an Amendment of PHI
If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to the Chief Privacy Officer, Shay Moore. In addition, you must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we will reply to your statement.
Request a Restriction on Certain Uses and Disclosures if PHI
You have the right to request restrictions on our use and disclosure of PHI about you by sending a written re-quest to the Chief Privacy Officer, Shay Moore. You may request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction and to whom you want the restriction to apply. We are not required to agree to those restrictions.
Receive an Accounting of Disclosure PHI
You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude disclosures we have made directly to you, disclosures to friends or family members involved in your care, inci-dental disclosures permitted by law, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations. To request an accounting, you must submit your request in writing to
This notice is effective in its entirety as of April 14, 2003.
the Chief Privacy Officer, Shay Moore. Your request must specify the time period but may not be longer than six years. The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for their cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Request Communication of PHI By Alternative Means or At Alternative Locations
You may request that we communicate with you by alternative means or at an alternate location. For example, you may request that we contact you about medical matters only in writing or at a different residence or post office box. We will not request an explanation from you as to the basis for the request. To request confidential communication of PHI about you, you must submit your request in writing to the Chief Privacy Officer, Shay Moore. We will accommodate all reasonable requests.
Complaints
You may complain to Craft Wheelchair Repair and to the Department of Health and Human Services if you be-lieve your privacy rights have been violated. You will not be retaliated against for filling a complaint. If you wish to file a complaint, please contact our Chief Privacy Officer at 5515 West San Vicente Blvd., Los Angeles, CA 90019.
Contact Information
If you have any questions or other concerns, please contact Chief Privacy Officer, Shay Moore at 5515 West San Vicente Blvd Los Angeles, CA 90019. We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of each consecutive page. We reserve the right to make the revised or changed notice effective for health information about you that we already have and information we receive in the future. We will post a copy of our current notice in our office in a prominent location. You may obtain any revised Notice of Privacy Practices by calling our office and requesting a revised copy be sent to you in the mail.
Sincerely,
Shay Moore
This notice is effective in its entirety as of April 14, 2003.