ErgoFit Consulting, Inc.

PLEASE REVIEW CAREFULLY.

This Notice of Privacy Practices describes how ErgoFit Consulting, Inc. may use and disclose your protected health information to for recommendations to your employer and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including 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.

ErgoFit Consulting, Inc. is not a health care provider and does not provide treatment but is required under HIPAA to provide terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, your employer will provide you with any revised Notice of Privacy Practices. You may request a revised version by contacting your Human Recourses Department.

Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you for so long as ErgoFit Consulting, Inc. maintains the protected health information. You may obtain your records that contain medical and billing records and any other records that your employer uses for making decisions about you from your Human Recourses Department. As permitted by federal or state law, your Employer may charge you a reasonable copy fee for a copy of your records.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and laboratory results that are subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact your Employer’s Privacy Officer if you have questions about access to your records.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of our recommendations to your employer. You may also 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 this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply, ErgoFit Consulting, Inc. may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.

You have the right to receive an accounting of certain disclosures ErgoFit Consulting, Inc. have made, if any, of your protected health information. This right applies to disclosures for purposes other than our recommendations as described in this Notice of Privacy Practices. It excludes disclosures ErgoFit Consulting, Inc. may have made to you if you authorized us to make the disclosure, for a facility directory, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, as part of a limited data set disclosure. You have the right to receive specific information regarding these disclosures that occur after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying us in writing of your complaint. ErgoFit Consulting, Inc. will not retaliate against you for filing a complaint.

You may contact our privacy officer, Deborah Read at [email protected] for further information about the complaint process.

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by ErgoFit Consulting, Inc. Consulting, Inc. and others outside of our offices who are involved in your case for the purpose of providing recommendations to your employer. Your protected health information may also be used and disclosed to perform the services set forth in Service Agreement between ErgoFit Consulting, Inc. (“ErgoFit”) and your Employer or as required by law.

Following are examples of the types of uses and disclosures of your protected health information that our office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

• Assessments: ErgoFit Consulting, Inc. will use and disclose your protected health information to provide, coordinate, or manage recommendations made to your employer. This includes the coordination or management of your employer with another provider. For example, obtaining approval for a new chair may require that your relevant protected health information be disclosed to your employer to obtain approval for the purchase. Another example, ErgoFit Consulting, Inc. would disclose your protected health information, as necessary, to an office furniture supplier that provides equipment to your employer. ErgoFit Consulting, Inc. will also disclose protected health information to physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, ErgoFit Consulting, Inc. may disclose your protected health information from time-to-time to another provider (e.g., a doctor, specialist or laboratory) who, at the request of your employer, becomes involved in your case by providing assistance with our recommendations.
• Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for services provided by us or by another business associate. This may include certain activities that your employer may undertake before it approves or pays for the equipment or services ErgoFit Consulting, Inc. recommend for you such as: reviewing services provided to you for medical necessity.
• Health Care Operations: ErgoFit Consulting, Inc. may use or disclose, as needed, your protected health information in order to support the business activities of our practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of interns, and conducting or arranging for other business activities.
  ErgoFit Consulting, Inc. will share your protected health information with third party “business associates” that perform various activities (for example, billing or subcontracted services) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, ErgoFit Consulting, Inc. will have a written contract that contains terms that will protect the privacy of your protected health information.
• ErgoFit Consulting, Inc. may use or disclose your protected health information, as necessary, to provide your employer with information about equipment alternatives or other benefits and services that may be of interest to your ergonomic health.

Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Agree or Object:

ErgoFit Consulting, Inc. may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object. These situations include, but are not limited to:

• Required By Law: ErgoFit Consulting, Inc. may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.
• Public Health: ErgoFit Consulting, Inc. may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. For example, a disclosure may be made for the purpose of preventing or controlling disease, injury or disability.
• Health Oversight: ErgoFit Consulting, Inc. may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
• Food and Drug Administration: ErgoFit Consulting, Inc. may disclose your protected health information to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including, to report adverse events, product defects or problems, biologic product deviations, to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
• Legal Proceedings: ErgoFit Consulting, Inc. may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request or other lawful process.
• Law Enforcement: ErgoFit Consulting, Inc. may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of our practice, and (6) medical emergency (not on our practice’s premises) and it is likely that a crime has occurred.
• Research: ErgoFit Consulting, Inc. may disclose your protected health information 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 protected health information.
• Military Activity and National Security: When the appropriate conditions apply, ErgoFit Consulting, Inc. may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. ErgoFit Consulting, Inc. may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
• Workers’ Compensation: ErgoFit Consulting, Inc. may disclose your protected health information as authorized to comply with workers’ compensation laws and other similar legally-established programs.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

• Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization in writing at any time. If you revoke your authorization, ErgoFit Consulting, Inc. will no longer use or disclose your protected health information for the reasons covered by your written authorization. Please understand that ErgoFit Consulting, Inc. are unable to take back any disclosures already made with your authorization.
• Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or Object ErgoFit Consulting, Inc. may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your Employer may, using professional judgement, determine whether the disclosure is in your best interest.
• Others Involved in Your Health Care or Payment for your Care: ErgoFit Consulting, Inc. may disclose to your Employer or any other person(s) you identify, your protected health information that directly relates to that person’s involvement in our recommendation. If you are unable to agree or object to such a disclosure, ErgoFit Consulting, Inc. may disclose such information as necessary if ErgoFit Consulting, Inc. determine that it is in your best interest based on our professional judgment.