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HOW UTMD USES AND DISCLOSES YOUR PHI
Providing Medical Devices -- The devices which UTMD sells directly
to patients are available only by prescription. The prescription
and order form from your health care provider will typically
include a statement of your condition, related problems,
anticipated benefits of the device, and the information required
for shipping and billing. The uses and disclosures of this PHI are
regulated by law to protect your privacy.
Payment
-- UTMD keeps billing and collection records which document
product(s) shipped and receipt of payment information. Your PHI
may be disclosed by UTMD to verify coverage, obtain
pre-authorization and request payment from your insurance company,
Medicare, or another third party. This information will typically
include your name, address, date of birth, social security number,
phone number, employer and insurance provider information, credit
card information (if you choose to pay in that manner), and enough
information from your health care provider's diagnosis and
evaluation to satisfy pre-authorization requirements.
Required by Law -- UTMD will not use or disclose your PHI for
any purpose other than those described above, unless required to
do so by law. As an example, a health oversight agency which
ensures compliance with the rules of government health programs
such as Medicare or Medicaid could require UTMD to disclose your
PHI to them. The U.S. Department of Health and Human Services,
which enforces the Privacy Rule, may audit a company's compliance,
thereby possibly having access to your PHI.
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HOW
UTMD PROTECTS YOUR PHI
UTMD controls access to the files which contain the diagnosis of
your condition, related health problems and anticipated benefits
of the device. This information is archived in a filing cabinet
which is kept in a locked room. A limited number of customer
service representatives and their supervisors have access to these
records. These physical records are archived for seven years and
then shredded before disposal. None of the PHI is entered into a
computer or otherwise shared electronically.
Shipping, billing and accounting information is entered into a
computer system which is protected by two layers of passwords,
with access limited to those whose jobs require access.
All those who have contact with your PHI have been trained to
comply with the privacy policy outlined above, and a Privacy
Officer has been appointed to monitor compliance.
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YOUR
RIGHTS
You can request a copy of the material in your file from UTMD by
contacting the Privacy Officer listed below. UTMD reserves the
right to charge a reasonable fee for the cost of producing and
mailing any copies of your PHI record which you request.
If you are concerned that UTMD may have failed to follow the
requirements outlined in this notice, you may file a complaint
with the Privacy Officer of UTMD at:
Privacy Officer
Utah Medical Products, Inc.
7043 South 300 West
Midvale, UT 84047
(801) 566-1200
info@utahmed.com
If you are not satisfied with the resolution of a complaint about
possible violation of the privacy practices, the Privacy Officer
will give you information that you will need to file a complaint
with the U.S. Department of Health and Human Services.
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PRIVACY PRACTICES NOTICE REVISION
UTMD is required by law to follow the privacy practices described
in this notice while it is in effect. This notice takes effect
April 14, 2004, and will remain in effect until replaced,
modified, or amended. Revised privacy practices may go into effect
only after the revised notice has been sent to affected
individuals.
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