User Manual

Appendix
160
Req
uired Uses and Disclosures:
Under the law, we must make
disclosures to you when required by the Secretary of the
Department of Health and Human Services to investigate or
determine our compliance with the requirements of HIPAA.
Nonidentifiable Information: We may use or disclose your
Medical Information if we have removed from it any information
that is personally identifiable to you.
Your Rights
The following is a statement of your rights with respect to your
Medical Information and a brief description of how you may
exercise these rights.
You Have the Right to Inspect and Copy Your Medical
Information: This means you may inspect and obtain a copy of
Medical Information about you, provided, however, that
applicable law may limit your ability to inspect or copy certain
types of records. In certain circumstances, if we deny your
request to review Medical Information, you may have a right to
have this decision reviewed. If you would like to make a request
to review your Medical Information, please download our
Request Form at
http://www.myomniPod.com/images/upload/
HIPAA_Privacy_Notice_Request_Form.pdf
and follow the directions included on that form.
We will respond to your request in a reasonable amount of time.
If your request is honored, we may charge a nominal fee for
photocopying expenses. Please contact our Privacy Officer if you
have questions about access to your Medical Information.
You May Have the Right to Amend Your Medical Information:
If you believe that the Medical Information we have about you is
incorrect or incomplete, you may ask us to make an amendment
to your Medical Information. You may request an amendment as
long as the Medical Information is still maintained in our records.
If you would like to make a request to review your Medical
Information, please download our Request Form at
http://www.myomniPod.com/images/upload/
HIPAA_Privacy_Notice_Request_Form.pdf
and follow the directions included on that form.
We will respond to your request in a reasonable amount of time.
Please contact our Privacy Officer if you have questions about
requesting an amendment to your Medical Information
You Have the Right to Request a Restriction of Your Medical
Information: You may ask us not to use or disclose any part of
your Medical Information for the purposes of treatment,
payment, or healthcare operations. You may also request that
any part of your Medical Information not be disclosed to family
members or friends who may be involved in your care or for
notification purposes as described in this HIPAA Privacy Notice.