Pro2 LLC Professional Oxygen Services

Types and uses and disclosures that PRO2 might use for treatment, payment and health care operations include: Your name, address, telephone number, date of birth, social security number, diagnosis, health insurance number, type of equipment, date of treatment, medical records, physician name and address, authorization of release of medical information, assignment of medical benefits and email address.

PRO2 will contact you to make appointments as needed for equipment service, therapists' visits and to review billing information.

Other purposes for which disclosure is permitted under the privacy regulations include: Uses and disclosures required by law, for public health activities, for law enforcement purposes, for judicial proceedings and for specialized governmental function. (e.g. military, national security and intelligence).

Uses and disclosures will only be made with a written authorization and you have the right to revoke the authorization.

You have the right to request restrictions on certain uses and disclosures and PRO2 is not required to agree to your requested restriction. You also have the right to receive confidential communication of Protected Health Information (PHI), inspect and copy PHI, amend PHI, and receive an accounting of disclosure of PHI.

PRO2 is required by law to maintain the privacy of PHI and will abide by the terms of the privacy notice currently in effect. PRO2 reserves the right to change the terms of its practice and to make the new provisions effective for all PHI that it maintains.

You have the right to complain to the Secretary of Health and Human Services if you believe your rights have been violated. This complaint must be filed within 180 days of when the complainant knew or should have known that the act had occurred. You can file your complaint by documenting your issue, assembling related copies of your recorded PHI and forwarding it to the Secretary of Health and Human Services. You may contact the Secretary of Health and Human Services at 1-877-696-6775. If you file a complaint, you will not be retaliated against or treated any differently.

For further information, you may call PRO2 at 716-667-9600 and ask for the Privacy Officer.

Any request for PHI will be provided within 60 days of the request. The first accounting during any 12 month period will be provided with no charge to you. Additional requests will be billed at a reasonable cost based fee. PRO2 will maintain a record of all its accountings.