Notice of Privacy Practices
Last Updated: September 2008
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice describes the legal obligations of DexCom, Inc. ("DexCom") and your
legal rights regarding your protected health information held by DexCom under the
Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). Among other
things, this Notice describes how your protected health information may be used
or disclosed to carry out treatment, payment, healthcare operations, or for any
other purposes that are permitted or required by law. We are required to provide
this Notice of Privacy Practices ("Notice") to you pursuant to HIPAA.
HIPAA protects certain medical information known as "protected health information."
Generally, protected health information is information that may identify you, that
is collected from you or created or received by a healthcare provider (or other
"covered entity" under HIPAA), that relates to:
- your past, present, or future physical or mental health or condition;
- the provision of healthcare services to you; or
- the past, present, or future payment for the provision of healthcare services to
you.
If you have any questions about this Notice or about our privacy practices, please
contact our designated Privacy Officer — Steven R. Pacelli, Senior Vice President
of Corporate Affairs at 1-858-200-0255, or send an email to
privacy@dexcom.com.
EFFECTIVE DATE
This Notice is effective September 2008.
DEXCOM'S RESPONSIBILITIES
DexCom is required by law to:
- maintain the privacy of your protected health information;
- provide you with certain rights with respect to your protected health information;
- provide you with a copy of this Notice of DexCom's legal duties and privacy practices
with respect to your protected health information; and
- follow the terms of the Notice that is currently in effect.
We reserve the right to change the terms of this Notice and to make new provisions
regarding your protected health information that we maintain, as allowed or required
by law. If we make any material change to this Notice, we will provide you with
a copy of our revised Notice of Privacy Practices by first-class mail to your last-known
address on file.
WRITTEN AUTHORIZATION POLICY
We will generally obtain your written authorization before using your protected
health information or disclosing it to outside persons or organizations. You may
revoke any written authorization you have provided to us at any time, except to
the extent that we have made any use(s) or disclosure(s) of your protected health
information in reliance on the authorization. To revoke an authorization, please
send your request in writing with a copy of the authorization being revoked (or,
if not available, a detailed description of the authorization including the date)
to our Privacy Officer at the address below.
HOW DEXCOM MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR WRITTEN
AUTHORIZATION?
Under the law, we may use or disclose your protected health information under certain
circumstances without your permission. The following categories describe the different
ways that we may use and disclose your protected health information. For each category
of uses or disclosures we will provide examples. Not every use or disclosure in
a category will be listed; the examples are given only for purposes of illustration,
since we cannot describe every possible use or disclosure of protected health information.
For Treatment. We may use or disclose your protected health information
to help deliver, coordinate, manage and facilitate your healthcare and related services.
For example, we may consult with or disclose medical information about you to providers
such as your physician or other doctors, nurses, technicians, or other personnel
who are involved in taking care of you.
For Payment. We may use or disclose your protected health information
to obtain payment for the healthcare products we provide to you. For example, prior
to providing you with such products, we may contact your insurance carrier, your
HMO or your employer's health plan regarding your treatment, including your diagnosis
and product needs, to ensure that such products will be covered. We may also disclose
information to your insurance carrier or other payer that is necessary to submit
claims for payment, or to resolve any questions such carrier or payer may have regarding
quality assurance or utilization review.
For Healthcare Operations. We may use and disclose your protected
health information in order to support our business activities, such as quality
assessment and improvement activities, business planning, management and general
administrative activities. For example, we may use your protected health information
to determine how to improve our products, resolve complaints, and assess staff performance.
To Business Associates. We may contract with individuals or entities
known as Business Associates to perform various functions on our behalf or to provide
certain types of services. In order to perform these functions or to provide these
services, Business Associates will receive, create, maintain, use and/or disclose
your protected health information, but only after they agree in writing with us
to implement appropriate safeguards regarding your protected health information.
For example, we may disclose your protected health information to a Business Associate
to administer claims or to provide support services, but only after the Business
Associate enters into a Business Associate Agreement with us.
As Required by Law. We will disclose your protected health information
when required to do so by federal, state, or local law. For example, we may disclose
your protected health information when required by national security laws or public
health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose
your protected health information when necessary to prevent a serious threat to
your health and safety, or the health and safety of the public or another person.
Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation and Procurement. We may release your
protected health information to organizations that handle organ procurement or organ,
eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces,
we may release your protected health information as required by military command
authorities. We may also release protected health information about foreign military
personnel to the appropriate foreign military authority.
Workers' Compensation. We may release your protected health information
for workers' compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
Public Health Risks. As required by law, we may disclose your protected
health information to public health or legal authorities under the following circumstances:
- to prevent or control disease, injury, or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to track FDA-regulated products;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition.
Victims of Abuse. We may disclose your protected health information
to notify the appropriate government authority if we believe that an individual
has been the victim of abuse, neglect, or domestic violence. We will only make this
disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your protected health
information to a health oversight agency for activities authorized by law. These
oversight activities include audits; civil, administrative, or criminal investigations,
proceedings or actions; inspections; licensure or disciplinary actions; and other
activities necessary for the appropriate oversight of the healthcare system, government
programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings, Lawsuits and Disputes.
We may disclose your protected health information in the course of any judicial
or administrative proceeding; if you are involved in a lawsuit or a dispute, we
may disclose your protected health information in response to a court or administrative
order. We may also disclose your protected health information in response to a subpoena,
discovery request, or other lawful process by someone else involved in the dispute,
but only if efforts have been made to tell you about the request or to obtain an
order protecting the information requested.
Law Enforcement. We may disclose your protected health information
if asked to do so by a law enforcement official in response to a court order, subpoena,
warrant, summons or similar process:
- to identify or locate a suspect, fugitive, material witness, or missing person;
- about the victim of a crime if, under certain limited circumstances, we are unable
to obtain the victim's agreement;
- about a death that we believe may be the result of criminal conduct;
- about criminal conduct; and
- in emergency circumstances to report a crime; the location of the crime or victims;
or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners, and Funeral Directors. We may release
protected health information to a coroner or medical examiner. This may be necessary,
for example, to identify a deceased person or determine the cause of death. We may
also release medical information about patients to funeral directors as necessary
to carry out their duties.
National Security and Intelligence Activities. We may release your
protected health information to authorized federal officials for intelligence, counter-intelligence,
and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or
are in the custody of a law enforcement official, we may disclose your protected
health information to the correctional institution or law enforcement official if
necessary (1) for the institution to provide you with healthcare; (2) to protect
your health and safety or the health and safety of others; or (3) for the safety
and security of the correctional institution.
Research. We may disclose your protected health information to
researchers when:
- the individual identifiers have been removed; or
- when an institutional review board or privacy board has (a) reviewed the research
proposal; and (b) established protocols to ensure the privacy of the requested information,
and approves the research.
Personal Representatives. We will disclose your protected health
information to individuals authorized by you, or to an individual designated as
your personal representative, attorney-in-fact, etc., so long as you provide us
with a written notice/authorization and any supporting documents (i.e., power of
attorney). NOTE: We do not have to disclose information to a personal representative
if we have a reasonable belief that:
- you have been, or may be, subjected to domestic violence, abuse or neglect by such
person;
- treating such person as your personal representative could endanger you; or
- in the exercise or professional judgment, it is not in your best interest to treat
the person as your personal representative.
Reminders. We may contact you to provide reminders or information
about appointments, product refills, treatment alternatives or other health-related
benefits and services that may be of interest to you.
REQUIRED DISCLOSURES
The following is a description of disclosures of your protected health information
we are required to make.
Government Audits. We are required to disclose your protected health
information to the Secretary of the United States Department of Health and Human
Services when the Secretary is investigating or determining our compliance with
the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose
to you the portion of your protected health information that contains medical records,
billing records, and any other records used to make decisions regarding your healthcare
benefits. We are also required, when requested, to provide you with an accounting
of most disclosures of your protected health information if the disclosure was for
reasons other than for payment, treatment, or healthcare operations, and if the
protected health information not disclosed pursuant to your individual authorization.
YOUR RIGHTS
You have the following rights with respect to your protected health information:
Right to Inspect and Copy. You have the right to inspect and copy
certain protected health information that may be used to make decisions about your
healthcare benefits. To inspect and copy your protected health information, you
must submit your request in writing to DexCom, Inc., ATTN. Privacy Officer, 6340
Sequence Drive, San Diego, CA 92121, or by sending an email to
privacy@dexcom.com. If you request a copy of the information, we may charge
a reasonable fee for the costs of copying, mailing, or other supplies associated
with your request.
We may deny your request to inspect and copy in certain very limited circumstances.
If you are denied access to your medical information, you may request that the denial
be reviewed by submitting a written request to DexCom, Inc., ATTN. Chief Executive
Officer, 6340 Sequence Drive, San Diego, CA 92121.
Right to Amend. If you feel that the protected health information
we have about you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information is kept
by or for us.
To request an amendment, your request must be made in writing and submitted to DexCom,
Inc., ATTN. Privacy Officer, 6340 Sequence Drive, San Diego, CA 92121, or by sending
an email to privacy@dexcom.com. In addition,
you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may deny your request if you ask
us to amend information that:
- is not part of the medical information kept by or for us;
- was not created by us, unless the person or entity that created the information
is no longer available to make the amendment;
- is not part of the information that you would be permitted to inspect and copy;
or
- is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement
with us and any future disclosures of the disputed information will include your
statement.
Right to an Accounting of Disclosures. You have the right to request
an "accounting" of certain disclosures of your protected health information. The
accounting will not include (1) disclosures for purposes of treatment, payment,
or healthcare operations; (2) disclosures made to you; (3) disclosures made pursuant
to your authorization; (4) disclosures made to friends or family in your presence
or because of an emergency; (5) disclosures for national security purposes; and
(6) disclosures incidental to otherwise permissible disclosures.
To request this list or accounting of disclosures, you must submit your request
in writing to DexCom, Inc., ATTN. Privacy Officer, 6340 Sequence Drive, San Diego,
CA 92121, or by sending an email to privacy@dexcom.com.
Your request must state a time period of not longer than six years and may not include
dates before March 27, 2006. Your request should indicate in what form you want
the list (for example, paper or electronic). The first list you request within a
12-month period will be provided free of charge. For additional lists, we may charge
you for the costs of providing the list. We will notify you of the cost involved
and you may choose to withdraw or modify your request at that time before any costs
are incurred.
Right to Request Restrictions. You have the right to request a
restriction or limitation on your protected health information that we use or disclose
for treatment, payment; or healthcare operations. You also have the right to request
a limit on your protected health information that we disclose to someone who is
involved in your care or the payment for your care, such as a family member or friend.
For example, you could ask that we not use or disclose information about a surgery
that you had.
We are not required to agree to your request. However, if we do agree to the request,
we will honor the restriction until you revoke it or we notify you.
To request restrictions, you must make your request in writing to DexCom, Inc.,
ATTN. Privacy Officer, 6340 Sequence Drive, San Diego, CA 92121, or by sending an
email to privacy@dexcom.com. In your request,
you must tell us (1) what information you want to limit; (2) whether you want to
limit our use, disclosure, or both; and (3) to whom you want the limits to apply
— for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right
to request that we communicate with you about medical matters in a certain way or
at a certain location. For example, you can ask that we only contact you at work
or by mail.
To request confidential communications, you must make your request in writing to
DexCom, Inc., ATTN. Privacy Officer, 6340 Sequence Drive, San Diego, CA 92121, or
by sending an email to privacy@dexcom.com.
We will not ask you the reason for your request. Your request must specify how or
where you wish to be contacted. We will accommodate all reasonable requests if you
clearly provide information that the disclosure of all or part of your protected
information could endanger you.
Right to a Paper Copy of This Notice. You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice.
You may obtain a copy of this notice at our website,
www.dexcom.com.
To obtain a paper copy of this notice, please write to DexCom, Inc., ATTN. Privacy
Officer, 6340 Sequence Drive, San Diego, CA 92121, or send an email to
privacy@dexcom.com.
Complaints. If you believe that your privacy rights have been violated,
you may file a complaint with the Office for Civil Rights of the United States Department
of Health and Human Services. To file a complaint with DexCom, contact DexCom, Inc.,
ATTN. John Lister, Director of Legal Affairs, 6340 Sequence Drive, San Diego, CA
92121. All complaints must be submitted in writing.
You will not be penalized, or in any other way retaliated against, for filing a
complaint with the Office of Civil Rights, or with us.