This notice describes the practices of the clinic of Hearts for Hearing and that of:
Any healthcare professionals authorized to enter information into your file or record.
Any employee, staff, and other personnel.
Any member of a volunteer group we allow to help you while you are at the clinic.
All business associates with whom we contract to provide services on our behalf.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at our clinic. We need this record to provide you with quality care and to comply with certain legal requirements. Your record is accessible to our staff and members of our personnel. Proper safeguards are in place to discourage improper use or access. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
Make sure that medical information that identifies you is kept private;
Give you this notice of our legal duties and privacy practices with respect to medical information
Notify you if there is a breach of your information; and
Follow the terms of the notice that is currently in effect.
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, technicians, medical students, or clinicians who are involved in therapy. For example, multidisciplinary clinic staff meet regularly to review and to make further recommendations regarding your care.
This information may be shared with other Hearts for Hearing staff for the purpose of supervision and coordination of services. If you are receiving any additional services outside of our providers, we may disclose that information with your consent.
We may use and disclose information about you so that treatment and services you receive at the clinic may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you have received so your health plan will pay us or reimburse you. We will also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover treatment.
Wemayuseanddiscloseyourinformationforhealthcareoperationpurposes. Forexample,wemayuse your information for quality improvement activities, business planning, compliance plan purposes, or to fulfill our legal obligations.
Subject to your opportunity to object, we may release medical information about you to your family, friends, or other individuals who are involved in your medical care to the extent of that person’s involvement. We may also give information to someone who is listed on your Authorization to Release Information Form.
With regards to behavioral health, PHI will not be released to others unless a signed release allows us to disclose information and the service provider feels it is appropriate to do so.
We may use and disclose your protected health information to contact you as a reminder that you have an appointment for treatment or medical care.
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
In certain cases, we will provide your information to contractors, agents, and other parties who need the information in order to perform a service for us. Prior to sharing your information with our business associates, we will obtain reasonable assurances that they will safeguard your information consistent with this Notice.
We will disclose medical information about you when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety
We may use and disclose medical information about you 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 prevent the threat.
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
We may release medical information about you for worker’s compensation or similar programs. These programs provide benefits for work-related injuries or illness.
We may disclose medical information about you for public health activities. These activities generally include the following:
To prevent or control disease, injury, or disability;
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;
To notify the appropriate government authority if we believe a patient, sibling, or family member
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.
We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in a response to a court or administrative order. We may also disclose medical information about you 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.
We may release medical 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
About a death we believe may be the result of criminal conduct;
About criminal conduct involving our clinic; 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.
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.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for this practice to provide you with health care; (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.
You have the right to inspect and request a copy of your protected health information contained in our designated record set, except as prohibited by law.
This includes treatment documents and billing records but does not include psychotherapy notes or information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative proceeding.
To inspect and/or request a copy of your protected health information, you must submit your request to our office in writing. If you request a copy of the information, we may charge a fee to offset the costs associated with the request.
If you feel that the medical 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 Hearts for Hearing.
To request an amendment, your request must be made in writing and submitted to the Compliance Officer. 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 and submitted to the Compliance Officer. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
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 medical information kept by or for the clinic;
or is accurate and complete.
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we have made of medical information about you. However, this accounting is not required to include disclosures:
To carry out treatment, payment, or health care operations;
Incident to a use or disclosure otherwise permitted under HIPAA;
Pursuant to your written authorization;
To individuals involved in your care or for notification purposes;
For national security or intelligence purposes;
To correctional institutions or law enforcement officials in certain situations; or
As part of a limited data set.
You have the right to request one free accounting of this list every 12 months. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, paper, email, or fax). For more than one list in a 12-month period, we may charge you for the costs of providing the additional list(s). 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.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you have had.
We are not required to agree to this request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
To request restrictions, you must make your request in writing to the Compliance Officer. 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.
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. We will not ask you the reason for the request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
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.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our office. The notice will contain the effective date.
Other uses and disclosures of protected health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you have provided us authorization to use or disclose protected health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.
If you believe your privacy rights have been violated, you may file a written complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact:
To file a written complaint with the Secretary of the Department of Health and Human Services, contact:
The complaint must be in writing, either on paper or electronically, name the entity that is the subject of the complaint and describe the acts or omissions believed to be in violation of the standards.