Sleep Testing, Evaluations, Consultations
Training, Technologies & Solutions

SLEEP SUDIES

NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003

This Notice of Privacy Practices describes the practices of Sleep Resources Inc. This notice applies to the following delivery sites: all services we provide in your home or at our locations. We all will follow what is said in this Notice.

We will share medical information about you with each other as necessary to carry out treatment, payment, or our health care operations. We use and disclose medical information about you for a number of different purposes. Each of those purposes is described below.

For Treatment. We may use medical information about you to provide, coordinate or manage your health care and related services by both us and other health care providers. We may disclose medical information about you to doctors, nurses, hospitals and other health facilities who become involved in your care. We may consult with other health care providers concerning you and as part of the consultation share your medical information with them. Similarly, we may refer you to another health care provider and as part of the referral share medical information about you with that provider. For example, we may conclude you need to receive services from a physician with a particular specialty. When we refer you to that physician, we also will contact that physician’s office and provide health care information about you to them so they have information they need to provide services for you.

For Payment. We may use and disclose medical information about you so we can be paid for the services we provide to you. We also may need to provide your insurance company or a government program, such as Medicare or Medicaid, with information about your health care condition and the health care you need to receive to obtain information to determine if you are covered by that insurance or program.

Healthcare Operations: SDSD may use and disclose your medical information as it pertains to our healthcare operations. Examples of this would be for purposes of Performance Improvement, outcomes analysis, evaluating professional staff performance, accreditation, certification, licensing or credentialing activities.
How We Will Contact You. Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see "Right to Receive Confidential Communications" on page 3 of this Notice.

Marketing Communications. We may use and disclose medical information about you to communicate with you about a product or service to encourage you to purchase the product or service. This may be:

1. To describe a health-related product or service that is provided by us;
2. For your treatment;
3. For case management or care coordination for you;
4. To direct or recommend alternative treatments, therapies, health care providers, or settings of care.

We may communicate to you about products and services in a face-to-face communication by us to you. All other use and disclosure of medical information about you by us to make a communication about a product or service to encourage the purchase or use of a product or service will be done only with your written authorization.

Individuals Involved in Your Care. We may disclose your medical information to family or friends involved in your care, however, a signed authorization or legal document must be on record prior to disclosure. In instances where the patient’s authorization is unable to be obtained and a good faith effort was made, our staff will use their professional judgment to disclose and will only disclose medical information required for immediate care or service.

Required by Law. We may use or disclose medical information about you when we are required to do so by law. We may disclose medical information about you in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal. We also may disclose medical information about you in response to a subpoena, discovery request, or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed. We may disclose medical information about you to a law enforcement official for law enforcement purposes.

Public Health Activities. We may disclose medical information about you for public health activities and purposes. This includes reporting health care information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease. Or, one that is authorized to receive reports of child abuse and neglect. We may use or disclose medical information about you if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.

Health Oversight Activities. We may disclose medical information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. These and similar types of activities are necessary for appropriate oversight of the health care system, government benefit programs, and entities subject to various government regulations.

Specialized Government Functions. We may use and disclose your medical information to units of the government with special functions, such as the U. S. military or the U. S. Department of State under certain circumstances.

Workers Compensation. We may disclose medical information about you to the extent necessary to comply with workers’ compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.

Other Uses and Disclosures. Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying our Privacy Officer, at Sleep Resources Inc., 1137 N. 26th Street, Plymouth, WI 53081 in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect on actions taken by us in reliance on it.

You have the following rights with respect to medical information that we maintain about you.

Right to Request Restrictions. You have the right to request that we restrict the uses or disclosures of medical information about you. You also have the right to request that we restrict the uses or disclosures we make to a family member, other relative, a close personal friend or any other person identified by you. We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction.

Right to Receive Confidential Communications. You have the right to request that we communicate medical information about you to you in a certain way or at a certain location. We will accommodate your request.

Right to Inspect and Copy. With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of medical information about you.

Right to Amend. You have the right to ask us to amend medical information about you. You have this right for so long as the medical information is maintained by us. Your request must state the amendment desired and provide a reason in support of that amendment.

1. Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment;
2. Is not part of the medical information maintained by us;
3. Would not be available for you to inspect or copy; or,
4. Is accurate and complete.

Right to an Accounting of Disclosures. You have the right to receive an accounting of disclosures of medical information about you. The accounting may be for up to six (6) years prior to the date on which you request the accounting but not before April 14, 2003. You must submit your request in writing.

Right to Copy of this Notice. You have the right to obtain a paper copy of our Notice of Privacy Practices. You may request a copy of our Notice of Privacy Practices at any time.

Generally. We are required by law to maintain the privacy of health care information about you and to provide individuals with notice of our legal duties and privacy practices with respect to medical information. We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.

Our Right to Change Notice of Privacy Practices. We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice.

Availability of Notice of Privacy Practices. A copy of our current Notice of Privacy Practices will be posted at Sleep resources, Inc., 1137 N. 26th Street, Plymouth, WI 53081. In addition, each time you are admitted to services at Sleep Resources, a copy of the current notice will be made available to you. At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting our Privacy Officer, at Sleep Resources, 1137 N. 26th Street, Plymouth, WI 53081.

Complaints. You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. All complaints should be submitted in writing. You will not be retaliated against for filing a complaint.

Questions and Information. If you have any questions or want more information concerning this Notice of Privacy Practices, please contact our Privacy Officer, at Sleep Resources, Inc., 1137 N. 26th Street, Plymouth, WI 53081.