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.
Life Supply Corporation is required by law to maintain the privacy of Protected Health Information (PHI), to provide individuals with notice of its legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI.
Life Supply Corporation believes that the information we gather about you is of a very private nature and we are dedicated to keeping this information confidential. The records we create in providing you with care are by law kept confidential. We are also required to inform you of our policies concerning the use and storage of your personal health information.
Life Supply Corporation maintains the right to update our Privacy Notice. Your personal health information will always be maintained by our current policies designated in our current Privacy Notice and we must follow the privacy practices described in this Notice. Life Supply Corporation retains the right to change its privacy practices described in this Notice at any time. A current copy of our Privacy Notice is prominently displayed in our lobby and our website. If you have any comments or questions about our Privacy Notice you may call Michele Margeson at (413) 593-5555 ext. 123.
The following describes the manner in which we will use and disclose your personal health information. Except for the purposes listed below, we will use and disclose your health information only with your written permission. You may revoke permission at any time by writing to our privacy officer. We also will not disclose your PHI for marketing purposes, nor will we make any disclosures that constitute a sale of your PHI. We will disclose health information when required to do so by federal, state or local law.
We may collect and share appropriate information about you to document the medical necessity of the equipment, supplies or services we are providing. Examples include diagnosis, prescription, referral and physician or health care provider information.
We may share appropriate information about you to bill and collect payment for the health care we provide, including insurance companies and third parties, which includes family members or other financially responsible parties of which you have informed us. Examples include insurance coverage and eligibility verification. We may also release appropriate information about you to family or friends that are helping you with financial responsibilities incurred while receiving equipment, supplies or services from us.
We may use and disclose information to monitor and operate our business. Examples include satisfaction surveys, health care outcomes and utilization reporting, accreditation bodies, reports provided to any federal, state or local authority (as required by law), or to remind you of equipment, supplies or service needs.
We may use and disclose information about you to respond to a court or legal authoritative body that legally requests information about you. Examples include providing documents for legal subpoenas or discovery proceedings and having our staff testify about the care and services we have provided.
We may release health information for workers’ compensation or similar programs.
We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
We may disclose your health information to public health or legal authorities responsible for preventing or controlling disease, injury or disability.
Data Breach Notification
We may use or disclose your PHI to provide legally required notices of unauthorized access to or disclosure of your health information.
Inspect and copy: You have a right to inspect and copy health information that may be used to make decisions about your care or payment for your care. This includes medical and billing records. To inspect and copy this health information, you must make your request, in writing, to Michele Margeson. We have up to 30 days to make your protected health information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
Electronic Copy of Electronic Medical Records: If your PHI is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your PHI in the form or format you request, if it is readily producible in such form or format. If the PHI is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
Breach notification: You have the right to be notified upon a breach of any of your unsecured PHI.
Amendments: If you feel that Life Supply Corp has incorrect or incomplete information, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to Michele Margeson.
Accounting of disclosures: You have the right to request a list of certain disclosures we made of health information for purposes other than services, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to Michele Margeson.
Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to Michele Margeson. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your protected health information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Out-of-Pocket-Payments: If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your protected health information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communications, you must make your request, in writing, to Michele Margeson. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Michele Margeson. All complaints must be made in writing. You will not be penalized for filing a complaint. Complaints may be filed with us at the address below:
Life Supply Corp
711 East Main Street
Attention: Michele Margeson
Chicopee, MA 01022
413-593-5555 Ext. 117
Rights & Responsibilities
The Patients’ Bill of Rights
As a patient of Life Supply , you have the right to, which includes but is not limited to, the following:
1. Be given information about your rights for receiving homecare services.
2. Receive a timely response from Life Supply regarding your request for homecare services.
3. Be given information about Life Supply policies, procedures and charges for services.
4. Choose your homecare providers.
5. Be given appropriate and professional quality homecare services without discrimination against your race, color, creed, religion, sex, national origin, sexual orientation, handicap or age.
6. Be treated with courtesy and respect by all who provide homecare services to you.
7. Be free from physical and mental abuse and/or neglect.
8. Be given proper identification by name and title of everyone who provides homecare services to you.
9. Be given the necessary information regarding treatment and choices concerning rental or purchase options for durable medical equipment, so you will be able to give informed consent for your service prior to the start of any service.
10. Be given complete and current information concerning your diagnosis, treatment, alternatives, risks and prognosis as required by your physician’s legal duty to disclose in terms and language you can reasonably be expected to understand.
11. A plan of service that will be developed to meet your unique service needs.
12. Participate in the development of your plan of care/service.
13. Be given an assessment and update of your developed plan of care/service.
14. Be given data privacy and confidentiality.
15. Review your clinical record at your request.
16. Be given information regarding anticipated transfer of your homecare service to another healthcare facility and/or termination of homecare service to you.
17. Voice grievance with and/or suggest a change in homecare services and/or staff without being threatened, restrained and discriminated against.
18. Refuse treatment within the confines of the law.
19. Be given information concerning the consequences of refusing treatment.
20. Have an advance directive for medical care, such as a living will or the designation of a surrogate decision maker, respected to the extent provided by the law.
21. Participate in the consideration of ethical issues that arise in your care.
The Patients’ Responsibility
As a patient of Life Supply, our employees have the right to expect from you and your family reasonable behavior. As a patient of Life Supply, you have the responsibility to notify us of the following:
1. Notify Life Supply with problems you encounter with equipment or staff.
2. Notify Life Supply with any changes in your condition, prescription, or needs.
3. Contact Life Supply if you are hospitalized upon admission and discharge.
4. Notify Life Supply before changing your address and/or telephone number.
5. Contact Life Supply of any insurance changes, responsible party changes, and emergency contact information changes.
6. Notify Life Supply when you are unable to keep a home visit appointment.
7. Contact Life Supply if you acquire an infectious disease during the time you are receiving services from us, except where exempted by law.
8. Contact Life Supply for further information concerning anything you do not understand9. Maintain a safe home environment.
10. You should maintain on-going communication with your physician, and report any changes in your condition.
If you have a question, complaint or suggestion about Life Supply, call your local branch manager. You can also contact us by e-mail at email@example.com.
We at Life Supply Corporation strive to meet the needs of every customer by providing the very best products and services available. If you feel that we do not measure up in any way or you have concerns about patient care and safety, we want and need to know about it. To file a complaint with Life Supply Corporation, customers may contact the individuals listed below, or may forward a written complaint to the address below. All complaints will be acted upon promptly and appropriately. Customers may be assured all complaints will be addressed and the customer need not fear retribution for filing such complaint.
Contact the General Manager:
Life Supply Corporation, 413-593-5555
Contact the General Manager 413-593-5555
Life Supply Corporation
711 East Main Street
Chicopee, MA. 01020
If, after contacting Life Supply Corporation Management, you are still not satisfied and you feel that you have an issue that can not be resolved by dealing with Life Supply Corporation, you may contact the Joint Commission on Accreditation of Healthcare Organizations by any of the following manners:
Calling: The Joint Commission toll free at 1-800-994-6610
Faxing: The Office of Quality Monitoring at 1-630-792-5636.
E-Mail: Complaints to firstname.lastname@example.org
Office of Quality Monitoring
Joint Commission on Accreditation of Healthcare Organizations
1 Renaissance Boulevard
Oakbrook Terrace, IL 60181
Life Supply 711 E. Main St Suite A Chicopee, MA 01020
Business Hours: Mon - Fri 8:00 To 4:00 On Call 24 Hours
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