NOTICE OF PRIVACY PRACTICES

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. Mobile Sleep Services, Inc. is required, by law, to maintain the privacy and confidentiality of your Protected Health Information (PHI) and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

Disclosure of Your Health Care Information

Protected Health Information Gathered or Generated

We may gather information from different sources in order to perform your sleep study. This information may be gathered from the request form completed by your healthcare provider, a history and physical if sent, your patient record, facility generated forms where you sleep study is being done and information collected directly from you such as additional history and Insurance information. Information will also be generated while performing the sleep study.

Treatment

We will disclose your health care information to the entity were you are having your sleep study done so they may add the results to you patient record, to the physician that will read your sleep study and in some cases to the physician(s) who ordered your sleep study. Billing information is usually obtained for the interpreting physician so he can bill for his interpretation. This is done as a courtesy so that your final report is not delayed. We may also send copies of the physician interpretations by some of the physicians who read the sleep studies. We can only send a copy of interpretations of physicians that we have agreements with. We do not have agreements with all physicians who read sleep studies to send copies of their interpretations. In most cases physicians who order sleep studies want these interpretations instead of the 20 some odd pages generated by performing a sleep study. If you need a copy of the sleep study or physician interpretation you should first contact your physician and or the location where your sleep study was done. They should be able to help you obtain a copy.

If you are having trouble obtaining a copy of your sleep study or are not sure where to get a copy please contact our office at 303 932-2243 so we can help you locate the information you need. We are only able to provide you with a copy of the actual sleep study and the information that we generate. Physician interpretations are not generated by us so we are not able to provide you with this information unless we have an agreement with them. This may seem inconvenient but is designed to help protect your information. You will need fill out a release of information before we can send copies of your sleep study to you or anyone else.

Payment

In most cases we will bill the facility where your sleep study was done. The facility will in turn bill you and/or your insurance company. The physician who reads your sleep study will do their own billing.

Other Situations where we may be required to release your information

We may disclose your health information as necessary to comply with State Workers’ Compensation Laws. We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure. We may disclose your health information in the course of any administrative or judicial proceeding. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes. We may disclose your health information to coroners or medical examiners. It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public. We may disclose your health information for military, national security, prisoner and government benefits purposes. In the event that Mobile Sleep Services, Inc. is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

Changes to this Notice of Privacy Practices

Mobile Sleep Services, Inc. reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Mobile Sleep Services, Inc. is required by law to comply with this Notice. Mobile Sleep Services, Inc. is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: David W. Everett by calling this office at 303 932-2243. He will return your call as soon as possible.

Complaints

Complaints about your Privacy rights, or how Mobile Sleep Services, Inc. has handled your health information should be directed to David W. Everett by calling this office at 303 932-2243. He will return you call as soon as possible.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to: DHHS, Office of Civil Rights, 200 Independence Avenue, S.W., Room 509F HHH Building, Washington, DC 20201