ZYGO-USA NOTICE OF PRIVACY PRACTICES
Effective May 1, 2014

The privacy of your medical information is important to ZYGO. Although we are required by law to maintain the privacy of your protected health information and provide you with this notice, we are sincere in our pledge to ensure the confidentiality of your nonpublic personal information, including your medical records.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

We may share a client’s personal information for the purpose of providing and repairing durable medical equipment (DME). By signing a consent form, the client acknowledges that personal information can be shared for that express purpose.

We may use and disclose medical information as follows:

Treatment

We may share your information with speech therapists, doctors, or case managers to help them recommend appropriate medical equipment. For example, we might send a copy of your speech evaluation to your doctor to obtain a prescription for a speech generating device.

Payment

We may use and disclose medical information to process your medical claims or coordinate your benefits with other health plans. For example, we may need to disclose medical information to determine your eligibility for benefits.

Healthcare Operations

We may use and disclose medical information for regular healthcare operations. For example, we may disclose medical information to obtain prior authorization for your DME, ensure proper claims processing, cooperate with case management, and provide you with excellent customer service.

Business Associates

Business associates provide necessary services to our organization through contracts. Some examples of business associates are billing services and medical equipment dealers. We may disclose medical information to our business associates so they can perform the job we have asked them to do. To protect your medical information, we require our business associates to appropriately safeguard your information. We will not share your information with these outside groups unless there is a business need to do so and they agree to keep it protected. We require our business associates to treat your private information with the same high degree of confidentiality that we do.

Marketing

We will never sell information about you to any third party for marketing or any other purpose. Further, we do not use personal information for investigative consumer research or reporting.

Individuals Involved in Your Care or Payment for Your Care

We may disclose your medical information to a family member, friend, or other person that you indicate is involved in your care or payment for your care. This only pertains to your medical information that is directly relevant to their involvement. We will only make this disclosure if you agree or when required or authorized by law. In the event of your incapacity or in an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest.

As Required By Law and For Law Enforcement

We may use or disclose your medical information when required or permitted by federal, state, or local law, or by a court order.

Public Health and Safety

We may disclose medical information about you to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others.

State and Federal Agencies

We may be required to report information to state and federal agencies such as the United States Department of Health and Human Services.

Lawsuits and Disputes

If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We will only make such disclosures if efforts have been made to tell you about the request.

Military and National Security

Under certain circumstances, we may disclose to military authorities the medical information of armed forces personnel. We may disclose to authorized federal officials medical information required for lawful intelligence, counterintelligence, and other national security activities.

Workers’ Compensation

We may disclose medical information to coordinate benefits with Workers’ Compensation insurance carriers.

Other Uses and Disclosures

If we use or disclose your information for any reason other than those listed above, we will first obtain your written authorization. State laws may prohibit us from disclosing the following types of sensitive personal information without your authorization: chemical dependency, mental health, psychotherapy, genetic, or HIV/AIDS records. If you give us written authorization, you may revoke it at any time. This will not affect information that has already been shared.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

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

Right to Inspect and Copy

You have the right to inspect and obtain a copy of most information we maintain about you. You must request to do so in writing and you may be charged a fee for the cost of copying your records.

Right to Request a Correction

If you feel that medical information we have about you is incorrect or incomplete, you have the right to ask us to change or amend the information. Your request must be in writing.

Right to an Accounting of Disclosures

You have the right to request a list of disclosures we have made of your medical information for purposes other than treatment, payment, healthcare operations, and limited other activities. Your request must be in writing. Your request may not be for a record of more than six years and may not include dates before May 1, 2011.

Right to Request Restrictions

You have the right to ask us to restrict how we use or disclose your information for treatment, payment, or healthcare operations. You also have the right to ask us to restrict information we may give to persons involved in your care, such as a family member or friend. You must make this request in writing. While we may honor your request for restrictions, we are not required to agree to these restrictions.

Right to Request Confidential Communications

You have the right to ask that we communicate with you about health matters in a certain way or at a certain location. We will attempt to accommodate all reasonable requests and may require that you make your request in writing.

Right to Receive a Paper Copy of This Notice

You have the right to ask for a paper copy of this notice at any time, and it will always be available on our Web site at www.zygo-usa.com/privacy.htm.

If you wish to exercise any of these rights, please contact ZYGO. You will find our contact information in the box at the bottom.

HOW TO REPORT A PROBLEM OR FILE A COMPLAINT

You may contact any of the people listed to the right to report a problem or file a complaint. You must do so in writing. We will not take any action against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe is unlawful.

CHANGES TO THIS NOTICE

This Notice of Privacy Practices takes effect on May 1, 2011, and will remain in effect until we update or replace it. In the future, we may change our Notice of Privacy Practices. Any changes will apply to medical information we already have about you as well as any information we receive in the future.

You may request that this notice be mailed to you at any time, and it will always be available on our Web site at www.zygo-usa.com/privacy.htm.