Effective April 14, 2003

Genesee Home Healthcare Products, Inc.

d.b.a. Rothschild’s Home Healthcare Center

Notice of Privacy Practices
www.rothhomehealth.com

As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW CAREFULLY

OUR COMMITMENT TO PRIVACY

Our organization is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law we must follow the terms of the notice of privacy practices that we have in effect at the time.

To summarize, this notice provides you with the following important information:

  • How we may use and disclose your identifiable health information
  • Your privacy rights in your identifiable health information
  • Our obligations concerning the use and disclosure of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our company. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our company has created or maintained in the past, and for any of your records we may create or maintain in the future. Our organization will post a copy of our current notice in our store in a prominent location, and you may request a copy of our most current notice at any time.

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Privacy Officer, Rothschild’s Home Healthcare Center, 817 East Genesee Street, Syracuse, NY, 13210, (315) 475-5181.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION:

In general, uses and disclosures of your identifiable health information will be made only with your written authorization to do so. You may revoke an authorization for the use or disclosure of identifiable health information at any time, except to the extent that we have already relied upon the authorization. The following categories, however, describe way in which our office may use and disclose your identifiable health information without your written authorization. For each category we have provided a description and some examples of such uses and/or disclosures. The examples are illustrative and are not meant to be exhaustive.

  • Treatment. Our organization may use your identifiable health information to provide you with medical equipment or services. Many of the people who work at our office may disclose your identifiable health information to treat you or to assist others in your care or treatment. We may also disclose identifiable health information about you to health care providers outside of our office that is also involved in your care or treatment. For example, we may disclose your identifiable health information to a referring physician for treatment purposes. Additionally, we may disclose your identifiable health information to others that may assist in your care, such as your physician, therapists, spouse, children or parents.
  • Payment. Our organization may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items.
  • Health Care Operations. Our organization may use and disclose your identifiable health information to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our organization may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our organization.
  • Appointment Reminders/Follow up Phone Calls (if applicable). Our organization may use and disclose your identifiable health information to contact you to remind you of visits/deliveries. Messages may be left by a staff member to follow up on a product order you may have placed with us or to contact you regarding an appointment or delivery.
  • Health-Related Benefits and Services. Our organization may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.
  • Release of Information to Family/Friends. Our organization may release your identifiable health information to a friend or family member that is helping you pay for your health care, or who assists in taking care of you.
  • Emergencies. Our organization may use or disclose your identifiable health information in emergency situations if the opportunity to object to such uses and disclosures cannot be obtained because of your incapacity or an emergency treatment circumstance.
  • Disclosures Required by Law. Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

  • Public Health Risks. Our organization may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:
  • Maintaining vital records, such as births and deaths
  • Reporting child abuse or neglect
  • Preventing or controlling disease, injury, or disability
  • Notifying a person regarding potential exposure to a communicable disease
  • Notifying a person regarding a potential risk of spreading or contracting a disease or condition
  • Reporting reactions to drugs or problems with products or devices
  • Notifying individuals if a product or device they may be using has been recalled
  • Notifying appropriate government agency(ies) and authority(ies) regarding potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
  • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
  • Health Oversight Activities. Our organization may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and health care system in general.
  • Lawsuits and Similar Proceedings. Our organization may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health information in response to a discovery request, subpoena, or lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
  • Law Enforcement. We may release identifiable health information if asked to do so by a law enforcement official:
  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
  • Concerning a death we believe might have resulted from criminal conduct
  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoena or similar legal process
  • To identify/locate a suspect, material witness, fugitive or missing person
  • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
  • Serious Threats to Health of Safety. Our organization may use and disclose your

identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

  • Specialized Government Functions. Our organization may use and disclose identifiable health information regarding:
  • Military and veteran activities;
  • Intelligence, counter-intelligence, and other national security activities authorized by law;
  • Protective services for the President, to foreign heads of state, or to other persons authorized by law;
  • Inmates to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual.
  • Workers’ Compensation. Our organization may release your identifiable health information for workers’ compensation and similar programs that provide benefits for work-related injuries or illness without regard to fault.

YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the identifiable health information that we maintain about you:

  • Confidential Communications. You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Privacy Officer, 817 East Genesee Street, Syracuse, NY 13210, (315) 475-5181 specifying the requested method of contact, or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.
  • Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment of your care, such as family members and friends. We are not required to agree with your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your identifiable health information, you must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our organizations use, disclosure or both; and (c) to whom you want the limits to apply.
  • Inspections and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records. You must submit your request in writing to Privacy Officer, 817 East Genesee Street, Syracuse, NY, 13210 (315)475-5181 in order to inspect and/or obtain a copy of your identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our organization may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another official, chosen by us, who did not participate in the original decision to deny your request.
  • Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, your request must be made in writing and submitted to Privacy Officer, 817 East GeneseeStreet, Syracuse, NY, 13210, (315) 475-5181. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by or for our organization; (c) not part of the identifiable health information which you would be permitted to inspect and copy; or (d) not created by our organization, unless the individual or entity that created the information is not available to amend the information.
  • Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures”. An “accounting of disclosures” is a list of certain disclosures our organization has made of your identifiable health information. An accounting of disclosures will include all disclosures except the following:
  • Disclosures to carry out treatment, payment, and health care operations;
  • Disclosures made to you;
  • Disclosures made pursuant to your authorization;
  • Disclosures made in a facility directory or to persons involved in your care;
  • Disclosures for national security or intelligence purposes;
  • Disclosures to correctional institutions or law enforcement officials; or
  • Disclosures made before April 14, 2003.

In order to obtain an accounting of disclosures, you must submit your request in writing to Privacy Officer, 817 East Genesee Street, Syracuse, NY, 13210, (315) 475-5181. All requests must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our organization may charge you for additional lists within the same 12-month period. Our organization will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

  • Right to Receive a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Privacy Officer, 817 East Genesee Street, Syracuse, NY 13210, (315) 475-5181.
  • Right to Provide an Authorization for Other Uses and Disclosures. Our organization will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note: We are required to retain records of your care.
  • Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization, contact Privacy Officer, 817 East Genesee Street, Syracuse, NY, 13210, (315) 475-5181. All complaints must be made in writing. You will not be penalized for filing a complaint.

RETURN POLICY

Rothschild’s Home Healthcare Center will gladly accept the return or exchange of products purchased when presented in a new condition and accompanied by a Rothschild’s store receipt within 30 days of purchase.

Any items presented for return not accompanied by a store receipt where it can be ascertained that the item was purchased at Rothschild’s will be issued a store credit if original purchase was within 30 days of purchase and upon discretion of store manager.

Seat Lift Chairs, Scooters, and Power Wheelchairs are NON-REFUNDABLE and NON-RETURNABLE. ALL SALES OF THESE PRODUCTS ARE FINAL.

Rothschild’s cannot accept for return or exchange:

Pillows, Sterile Goods, Personal Care Products, Special and Custom Orders.

Rothschild’s reserves the right to refuse a return or exchange of an item where it deems defect may be due to purchaser misuse.

**10 day waiting period on payments made with a check**