inCourage RespirTech - Confidentiality of Health Information

6. Confidentiality of Health Information. Patients have the right to be advised
of RespirTech’s policies regarding the disclosure of patient’s records. The right to
communicate with RespirTech employees and representatives in confidence and
to have the confidentiality of their individually identifiable health care information
protected. Patients also have the right to review and copy their own medical
records and to request amendments to their records. Please contact the HIPAA
Privacy Official with any questions or concerns at: privacyofficial@respirtech.com,
or call the toll free number for assistance.
7. Alleged Grievances and Abuse. All patients have the right to a fair and
efficient process for resolving differences with RespirTech, including a rigorous
system of internal review. Differences can be resolved through respectful
discussion, written notification of the issues, and a thorough investigation
process. An alleged grievance or abuse violation should be directed to the
RespirTech Privacy/Compliance Officer via phone at 1-800-793-1261; e-mail
(privacyofficial@respirtech.com); or to the company address:
Respiratory Technologies, Inc.
Attn: Privacy Official
2896 Centre Pointe Drive
St. Paul, MN 55113
A Company representative will respond back to the patient within five (5) days to
confirm receipt of the notification of concern and will initiate an investigation of
the alleged grievance or abuse concern.
You may also submit a complaint to the U.S. Department of Health and Human
Services by contacting your state’s regional office at:
Region 1 — Boston
(Connecticut, Maine,
Massachusetts, New Hampshire,
Rhode Island, Vermont)
Office for Civil Rights
U.S. Department of Health and
Human Services Government Center
J.F. Kennedy Federal Building —
Room 1875
Boston, MA 02203
Voice phone (800) 368-1019
FAX (617) 565-3809
TDD (800) 537-7697
Region 2 — New York
(New Jersey, New York, Puerto
Rico, Virgin Islands)
Office for Civil Rights
U.S. Department of Health and
Human Services
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278
Voice Phone (800) 368-1019
FAX (212) 264-3039
TDD (800) 537-7697
PATIENT BILL OF RIGHTS AND RESPONSIBILITIES (cont’d)
33
inCourage
®
Airway Clearance Therapy | INSTRUCTION MANUAL