HIPAA Policy

We at Craft Wheel Chair Repair practice all of HIPAA Privacy Security rules and regulations at
all times.
If you would like to have a copy of this publication please contact atwc@att.net Shay Moore at
(323) 931-6164/65 Office, and (866) 931-6164 Toll Free.

CRAFT WHEELCHAIR REPAIR
5515 WEST SAN VICENTE BLVD.
Los Angeles, CA 90019
Phone (323) 931-6164/65
Toll Free (866) 931-6164
Fax (323) 931-2907
Notice of Privacy Practices
Effective April 14, 2003

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

INFORMATION.

Please Review This Notice Carefully

Craft Wheelchair Repair is required to maintain the privacy of your Protected Health Information (“PHI”) and
to provide you with a notice of our legal duties and privacy practices with respect to PHI. PHI is information
about you, including basic demographic information that may identify you and that relates to your past, present
or future physical or mental health or condition and related health care services. This Notice of Privacy
Practices (“Notice”) describes how we may use and disclose your PHI to carry out treatment, payment, or health
care operations and for other specified purposes that are permitted by law. The Notice also describes your rights
with respect to your PHI.
Craft Wheelchair Repair is required to follow the terms of this Notice. We will use your PHI for purposes of
treatment, payment or health care operations. We will not use or disclose your PHI for any other purposes about
you without your written authorization, except as described in this Notice. We reserve the right to change our
practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will
provide a revised Notice to you.
For Treatment
How Craft Wheelchair Repair May Use or Disclose Your Health Information
Craft Wheelchair Repair may use your health information to provide, coordinate ‘and manage your health care
and related services. For example, information obtained by a health care provider, such as a physician, nurse or
pharmacist providing health services to you will record information in your record that is related to your
treatment. This information is necessary for health care providers to determine what treatment you should
receive. Health care providers will also record actions taken by them in the course of your treatment and note
how you respond to the actions. Craft Wheelchair Repair for example, will use this information to confer with
your physician or dentist regarding your prescription needs.

This notice is effective in its entirety as of April 14, 2003.

For Payment
Craft Wheelchair Repair may use and disclose your health to others for purposes of receiving payment for
treatment and services that you receive. For example, Craft Wheelchair Repair will contact your insurer,
pharmacy benefit manager, or other third-party payors to determine whether it will pay for your prescription and
the amount of your co-payment responsibility. Craft Wheelchair Repair will bill you or a third-party payor for
the cost of prescription medication dispensed to you. The information on or accompanying the bill may include
information that identifies you, as well as the prescriptions that you are taking.

For Health Care Operations
Craft Wheelchair Repair may use and share information about you for operational purposes. For example,
your health information may be used by members of the Craft Wheelchair Repair staff to:
• evaluate the performance of technicians or other staff
• assess the quality of care and outcomes in your cases and similar cases
• learn how to improve our facilities and services
• determine how to continually improve the quality and effectiveness of the health care and services we provide
to you
Craft Wheelchair Repair Will Use or Disclose PHI in Its Regular Course of Business for The Following
Reasons:
Communication With You
Craft Wheelchair Repair will use your information to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may be of interest to you (if applicable to
provider).
Communication With Individuals Involved In Your Care or Payment For Your Care
Craft Wheelchair Repair using our professional judgment, may disclose to other healthcare professional such
as physicians and pharmacists, a family member, other relative, close personal friend or any person you identify,
PHI relevant to that person’s involvement in your care or payment related to your care.
Notification
Craft Wheelchair Repair may use or disclose PHI about you to notify or assist in notifying a family member,
personal representative, or another person responsible for your care, your location and general condition.
Required By Law
Craft Wheelchair Repair may use and disclose information about you as required by
law. For example, Craft Wheelchair Repair may disclose information for the following purposes:
• for judicial and administrative proceedings pursuant to legal authority
• to report information related to victims of abuse, neglect or domestic violence
• to assist law enforcement officials in their law enforcement duties

This notice is effective in its entirety as of April 14, 2003.

Incidental Disclosures
Craft Wheelchair Repair may disclose PHI incidental to our provision of treatment, payment or health care
operations. For example, in our telephone discussions with physicians, PHI might be overheard by a member of
our staff other that the staff member placing the call.
Public Health
Your health information may be used or disclosed for public health activities such as assisting public health
authorities or other legal authorities to prevent or control disease, injury or disability or for other health
oversight activities.
Food and Drug Administration (FDA)
Craft Wheelchair Repair may disclose to the FDA or its agents PHI adverse events with respect to drugs, foods,
supplements, products and product defects or post marketing surveillance information to enable product recalls,
repairs or replacement (if applicable to provider).
Health Oversight Activities

Craft Wheelchair Repair may disclose PHI about you to an oversight agency for activities authorized by law.
These oversight activities include audits, investigations, inspections, as necessary for our licensure and for the
government to monitor the health care system, government programs, and compliance with civil rights laws.
Business Associates
These are some services provided by us through contracts with business associates. Examples may include,
from time to time, mailing or delivery services. When these services are contracted for, we may disclose PHI
about you to our business associate only to the extent necessary so that they can perform the job we have asked
them to do. To protect the PHI about you, we require the business associate to appropriately safeguard the PHI.
Worker’s Compensation
Your health information may be used or disclosed in order to comply with laws and regulations related to
Worker’s Compensation.
Craft Wheelchair Repair Is Further Permitted To Use Or Disclose PHI About You For The Following Purposes
Coroners, Medical Examiners and Funeral Directors
Craft Wheelchair Repair may release PHI about you to a coroner or medical examiner. This may be necessary,
for example, to identify a deceased person or determine the cause of death. Craft Wheelchair Repair may also
disclose PHI to funeral directors consistent with applicable law to carry out their duties.
Organ or Tissue Procurement Organizations
Consistent with applicable law, Craft Wheelchair Repair may disclose PHI about you to organ procurement
organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose
of tissue donation and transplant.

This notice is effective in its entirety as of April 14, 2003.

Correctional Institution
If you are or become an inmate of a correctional institution, Craft Wheelchair Repairmay disclose to the
institution or its agents PID necessary for your health and the health and safety of others.
Threat to Health or Safety
Craft Wheelchair Repair may use and disclose PHI about you when necessary to prevent a serious threat to your
health and safety or the health and safety of another person.
Military and Veterans
If you are a member of the Armed Forces, Craft Wheelchair Repair may release PHI about you as required by
military command authorities. Craft Wheelchair Repair may also release PHI about foreign military personnel
to the appropriate military authority.
National Security and Intelligence Activities
Craft Wheelchair Repair may release PHI about you to authorized federal officials for intelligence,
counterintelligence, or other national security activities authorized by law.
Protective Government Functions
Craft Wheelchair Repair may disclose PHI about you to authorized federal officials so they provide protection
to the President, other authorized persons, or foreign heads of state or conduct special investigations.
Victims of Abuse, Neglect or Domestic Violence
Craft Wheelchair Repair may disclose PHI about you to a government authority, such as a social service or
protective services agency if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We
will only disclose this type of information to the extent required by law, if you agree to the disclosure or if the

disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or
the law enforcement or public official that is to receive the report represents that it is necessary and will not be
used against you.
Research
Craft Wheelchair Repair may disclose PHI about you to researchers when their research has been approved by
an institutional review board that has reviewed the research proposal and established protocols to ensure the
privacy of your information (if applicable to provider).
Other Uses and Disclosures of PHI
Other uses and disclosures, other than those described above or otherwise permitted or required by law, will
only be made with your written authorization. You may revoke such a written authorization in writing at any
time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the
extent that we have already taken action in reliance on your authorization.

This notice is effective in its entirety as of April 14, 2003.

Your Privacy Rights
You have the following rights with respect to PHI about you:
Obtain a Paper copy of the Notice Upon Request
You may request a copy of the most current version of this Notice at any time. Even if you have agreed to
receive the notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact Shay
Moore Chief Privacy Officer.
Inspect and Obtain a Copy of PHI
You have the right to inspect and obtain a copy of the PHI about you contained in a designated record set forth
as long as Craft Wheelchair Repair maintains the PHI. The “designated record set” usually will include
prescription, physician orders and billing records. To inspect or receive a copy of your PHI for your inspection,
you must send a written request to Privacy Officer, Shay Moore. Under federal law, however you may not
inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected health information that is subject to law that
prohibits access to protected health information. We may charge you a fee for the costs of copying, mailing or
other supplies that are necessary to grant your request. We may deny your request to inspect and copy in certain
limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an Amendment of PHI
If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You
may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a
written request to the Chief Privacy Officer, Shay Moore. In addition, you must include a reason that supports
your request. In certain cases, we may deny your request for amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement with the decision and we will reply to your
statement.
Request a Restriction on Certain Uses and Disclosures if PHI
You have the right to request restrictions on our use and disclosure of PHI about you by sending a written
request to the Chief Privacy Officer, Shay Moore. You may request that any part of your protected health
information not be disclosed to family members or friends who may be involved in your care or for notification
purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction and to
whom you want the restriction to apply. We are not required to agree to those restrictions.

Receive an Accounting of Disclosure PHI
You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14,
2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude
disclosures we have made directly to you, disclosures to friends or family members involved in your care,
incidental disclosures permitted by law, and disclosures for notification purposes. The right to receive an
accounting is subject to certain other exceptions, restrictions and limitations. To request an accounting, you
must submit your request in writing to

This notice is effective in its entirety as of April 14, 2003.

the Chief Privacy Officer, Shay Moore. You request must specify the time period, but may not be longer than
six years. The first accounting you request within a 12-month period will be provided free of charge, but you
may be charged for their cost of providing additional accountings. We will notify you of the cost involved and
you may choose to withdraw or modify your request at that time.
Request Communication of PHI By Alternative Means or At Alternative Locations
You may request that we communicate with you by alternative means or at an alternate location. For example,
you may request that we contact you about medical matters only in writing or at a different residence or post
office box. We will not request an explanation from you as to the basis for the request. To request confidential
communication of PHI about you, you must submit your request in writing to the Chief Privacy Officer, Shay
Moore. We will accommodate all reasonable requests.
Complaints

You may complain to Craft Wheelchair Repair and to the Department of Health and Human Services if you
believe your privacy rights have been violated. You will not be retaliated against for filling a complaint. If you
wish to file a complaint, please contact our Chief Privacy Officer at 5515 West San Vicente Blvd., Los Angeles,
CA 90019.

Contact Information

If you have any questions or other concerns, please contact Chief Privacy Officer, Shay Moore at 5515 West
San Vicente Blvd Los Angeles, CA 90019. We reserve the right to change this notice. Its effective date is at the
top of the first page and at the bottom of each consecutive page. We reserve the right to make the revised or
changed notice effective for health information about you that we already have and information we receive in
the future. We will post a copy of our current notice in our office in a prominent location. You may obtain any
revised Notice of Privacy Practices by calling our office and requesting a revised copy be sent to you in the
mail.

Sincerely,
Shay Moore

This notice is effective in its entirety as of April 14, 2003.

________________________________________________________________

Your Privacy Rights

You have the following rights with respect to PHI about you:
Obtain a Paper copy of the Notice Upon Request
You may request a copy of the most current version of this Notice at any time. Even if you have agreed to
receive the notice electronically, you are still entitled to a paper copy.

To obtain a paper copy, contact Shay Moore Chief Privacy Officer.

Inspect and Obtain a Copy of PHI

You have the right to inspect and obtain a copy of the PHl about you contained in a designated record set forth
as long as Craft Wheelchair Repair maintains the PHl. The “designated record set” usually will include
prescription, physician orders and billing records. To inspect or receive a copy of your PHI for your inspection,
you must send a written request to Privacy Officer, Shay Moore. Under federal law, however you may not
inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected health information that is subject to law that
prohibits access to protected health information. We may charge you a fee for the costs of copying, mailing or
other supplies that are necessary to grant your request. We may deny your request to inspect and copy in certain
limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.

Request an Amendment of PHI

If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You
may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a
written request to the Chief Privacy Officer, Shay Moore. In addition, you must include a reason that supports
your request. In certain cases, we may deny your request for amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement with the decision and we will reply to your
statement.

Request a Restriction on Certain Uses and Disclosures if PHI

You have the right to request restrictions on our use and disclosure of PHI about you by sending a written
request to the Chief Privacy Officer, Shay Moore. You may request that any part of your protected health
information not be disclosed to family members or friends who may be involved in your care or for notification
purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction and to
whom you want the restriction to apply. We are not required to agree to those restrictions.

Receive an Accounting of Disclosure PHI

You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14,
2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude
disclosures we have made directly to you, disclosures to friends or family members involved in your care,
incidental disclosures permitted by law, and disclosures for notification purposes. The right to receive an
accounting is subject to certain other exceptions, restrictions and limitations.
This notice is effective in its entirety as of April 14, 2003.