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763-757-8086

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Diabetic Shoe Source, Inc.
7362 University Ave NE, Ste 306
Fridley, MN 55432
FAX: 763-862-4797
diabeticshoesource@yahoo.com

Office Hours:
Mon-Fri, 9AM - 3PM
& by Appointment

NOTICE OF PRIVACY PRACTICES

January 1, 2012

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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.


We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. You may request any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail or by accessing our website at www.diabeticshoesource.com.


Although your health record is the physical property of the healthcare organization that compiled it, the information belongs to you. You have the right to:

  • Request a restriction on certain uses and disclosures of your information.
  • Obtain a copy of the Notice of Privacy Practices upon request.
  • Inspect and obtain a copy of your health record.
  • Amend your health record.
  • Obtain an accounting of disclosures of your health information.
  • Request communications of your health information by alternative means or at alternative locations.
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities are to:

  • Maintain the privacy of your health information.
  • Provide you with a notice to our legal duties and privacy practices with respect to information we collect and maintain about you.
  • Abide be the terms of this notice.
  • Notify you if we are unable to agree to a requested restriction.
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We will not use or disclose your health information without your authorization, except as described in this notice. If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact the Privacy Officer, Mark Ahlgren, at 763-757-8086.


Examples of Disclosures for Treatment, Payment and Health Operations


We will use your health information for treatment. For example, information obtained from a physician will be recorded in your record and used to fill orders for the equipment and supplies you may need.


We will use your health information for payment. For example, a bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis and supplies used.


We will use your health information for regular health operations. For example, members of our quality improvement team may use information in your health record to assess our compliance with applicable law, regulation and industry standards. This information will then be used in an effort to continually improve the quality and effectiveness of the service we provide.


Business Associates: There are some services provided in our organization through contracts with business associates. An example of a business associate of a DME provider is a distributor who ships for the company. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.


Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.


Communication with Family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.


Marketing: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.


Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls.


Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.


Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.


Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.


General Medicare, Medicaid, State and Federal Legal Purposes: Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.