Notice of Health Information Privacy Practices

This Notice describes how information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

(HME RELAY) Pledge Regarding Health Information

HME RELAY understands that health information about you is personal. We are committed to protecting health information about you. We need this information to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records about you generated by HME RELAY

We will not use or disclose your health information without your consent or authorization except as provided by law or otherwise described in this notice. We reserve the right to change our practices and make new provisions effective for all protected health information. Should our practices change, we will make the new version available to you upon request. We are required by law to:

Make sure that health information that identifies you is kept private.

Give you this notice of our legal duties and privacy practices with respect to health information about you.

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, and follow the terms of the notice that is currently in effect.

Your Health Information Rights

Although your health record is the physical property of HME RELAY, the health information contained in the record belongs to you. You have the right to:

Inspect and Copy You have the right to inspect and obtain a copy of your health information. Such a request must be made in writing. This right is not absolute and in some cases we may deny access. We may charge a fee for the cost of copying, mailing, or other services associated with your request.

Amend You have the right to request to amend your health information. Such a request must be made in writing.

An Accounting of Disclosures You have the right to request an accounting of uses and disclosures of your health information. An accounting does not include disclosures associated with treatment, payment, and healthcare operations, disclosures made pursuant to an authorization, disclosures required by law, incidental disclosures, or some other disclosures. This request must be in writing and pertain to a specific time frame of less than six (6) months. We will act upon the request for an accounting no later than 60 days after receipt of your written request, but may extend this time frame an additional 30 days under certain circumstances. You may have one accounting per year free of charge, but will be charged a reasonable fee for any additional accountings.

Right to Request Restrictions on Uses and Disclosures You have the right to request a restriction on the health information we use or disclose about you however, we may refuse to accept the restriction. You also have the right to request a limit on the health information we disclose to someone who is involved in your care or the payment for such care. If we do agree with your request, we will comply unless the information is needed to provide you emergency treatment. Such a request must be made in writing.

Request Confidential Communications You have the right to request communications of your health information by alternative means or at alternative locations. We will accommodate reasonable requests that are submitted in written form and specify how and where you wish communication.

Revoke Your Authorization You have the right to revoke your authorization to HME RELAY to use or disclose health information about you. Your revocation will be honored to the extent that action has not already been taken and as otherwise provided by law. Revocation must be submitted in writing.

Paper Copy of This Notice The most current Notice of Health Information Practices will be posted in visible areas of HME RELAY You will also receive a paper copy of the Notice of Information Practices and can request an additional copy if needed.

How We May Use and Disclose Health Information About You

The following categories describe different ways that we use and disclose health information about you. Not every use or disclosure in a category will be listed.

For Treatment We may use health information about you to plan your care and provide for medical treatment or services. We may disclose health information to your treating physician(s), or other health care provider(s) rendering services to you. For example: information obtained by our staff will be recorded in our record. Your physician may sign orders for your care or provide other communications. This information becomes a legal document describing the care you received and is part of your health records.

For Payment We may use and disclose health information about you so that third-party payers can verify that you actually received the services billed for and to verify your benefits. We may use and disclose health information about you so that the medical care and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example: the information on or accompanying the bill may include information that identifies you, as well as your diagnosis, care provided, and supplies used. In the event that payment is not made, we may also provide limited information to collection agencies, attorneys, credit reporting agencies, and other organizations as are necessary to collect for services rendered.

For Health Operations We may use and disclose health information about you for purposes ofhealth care operations. We may use health information as a source of data for facility planning, community outreach, and to continually work to improve the care we render and the outcomes we achieve. These uses and disclosures are necessary to run the company and help make sure that all of our clients receive quality care. For example: for the purposes of quality we may use information in your health record to assess the care and outcomes in your case and others like it.

Business Associates There are some services provided at HME RELAY through contracts with business associates. For example: collection agencies and medical storage company(s). When these services and others like them are contracted, we may disclose your health information to our business associates so that they can perform the job we have asked them to do. To protect your health information, we will require the business associate to appropriately safeguard your information.

Research We may disclose health information to researchers when their research has been approved using established protocol to ensure the privacy of your health information.

Funeral Directors We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

As Required By Law We will disclose health information about you when required by federal, state, or local law. This includes disclosures required to the Department of Public Health, which is responsible for preventing or controlling disease, injury, or disability. It also includes disclosure for law enforcement purposes as required by law or in response to a valid subpoena.

Worker’s Compensation We may release health information about you to the extent authorized by, and to the extent necessary to comply with laws relating to worker’s compensation.

Organ and Tissue Donation If you are an organ donor, we may release health information about you to organizations that handle organ procurement or transplantations.

Health Oversight Activities We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and certification. These activities are necessary for the government, accreditation, and licensing bodies to monitor the health care system.

Community Resources We may use and disclose health information about you to make referrals for discharge planning, or other community resources. Examples include, but are not limited to, infusion, medical equipment companies, hospice, certified home care, and nursing homes or other health related services.

Uses or Disclosures of Your Health Information to Which You May Object.

We may use or disclose your health information for the following purposes, unless you ask us not to.

Individuals Involved in Your Care or Payment for Your Care 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.

Appointment Reminders We may use and disclose health information to contact you at your home, office, or other location that you have designated to provide a reminder that you have an appointment, or other services provided by MME.

Informing You About Treatment Alternatives or other health-related benefits and services that may be of interest to you.

Other uses and disclosures of health information not covered by this notice will be made only with your written permission.

Make a Request, Report a Concern, File a Complaint or Request More Information To obtain request forms for any of the above requests contact HME RELAY at (877)527-4633 If you have questions and would like additional information, or would like to report a concern please contact HME RELAY during normal business hours, at (877)527-4633 If you believe that your privacy rights have been violated, you can file a complaint with our Privacy Officer at 4305 Pineview Drive Suite 300 Commerce  MI 4832. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Do Not Use any of this information

HIPAA Notice

Notice of Privacy Practices

This notice describes how your protected health information (PHI) may be used and disclosed by HME RELAY Supplies, and how you can access this information. Please review this notice carefully and keep it for your records.

If you have any questions about this Notice, please contact our Compliance Department, HME RELAY

4305 Pineview Dr Suite300 Commerce MI 48390

This Notice of Privacy Practices describes how we HME RELAY may use and disclose your protected

Please remember that ‘we’ and ‘us’ means HME RELAY, and ‘you’ refers to the client receiving medical supplies.

HME RELAY is required by Federal and State laws, including the Health Insurance Portability and Accountability Act (HIPAA), to protect the privacy of your PHI. Protected health information includes your name, address, telephone number, date of birth, social security number, insurance information, and medical information. The law does allow us to use and / or disclose your PHI for purposes of treatment and payment.


For Treatment: We may use your PHI to provide and coordinate medical supplies and treatments. For example, information obtained by our nursing staff / customer service will be used to supply you with the products you need to take care of your medical condition.

For Payment: We will use your PHI to acquire payment for the medical supplies that are provided to you. For example, some insurance companies require us to give your primary diagnosis before they will pay us for supplies.


To communicate with individuals involved in your care or payment for your care We may disclose certain PHI to a family member, caregiver, case worker, physician, or any other person you identify in order to keep your account information current and active.

As Required By Law We will release your PHI when required by law to do so. For example, in the event of an audit or government investigation, we may have to provide records of shipments, billing, and / or prescription coverage.

If We Suspect Abuse or Neglect We may disclose your PHI to a government agency if we have reason to suspect that you are a victim of abuse or neglect. We will only disclose enough information to assist the government agency in preventing further abuse or neglect.

Other Uses / Disclosures We will obtain your written permission before using or disclosing your PHI for reasons not specified in this notice (or as permitted / required by law).


Paper Copy Of The Notice You may request a copy of our current Notice at any time. You may also request a copy of this notice via email by clicking on the above “Contact Us” button.

Obtain A Copy / Request Amendment Of PHI You have the right to obtain a copy of the PHI that we maintain about you. To do so, you must send a written request to the privacy officer. We may charge a small fee to cover the cost of copying and mailing the information to you. If you think the PHI we have is incorrect, you may request that we update it. To do so, you must send a written request to the privacy officer.

Request Communication Of PHI By Alternative Means For example, if you would prefer that we contact you on your cell phone, in writing at a certain address, etc. To request confidential communication of your PHI, please send a written request to the privacy officer.

Where To Obtain Forms For Submitting Written Requests You may obtain these forms by calling or writing the privacy officer.

If you have any questions or concerns, or do not understand this notice, please call, email, or write us ask to speak with our HIPAA Privacy Officer. If you feel your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services