Notice of Privacy Practice
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
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.
At Connect Hearing, Inc. (“Connect Hearing”, “we”, “our”, or “us”), we strive to provide the best service to our patients. As participants in your health care we are required by applicable law to maintain the privacy of your “protected health information.” As used in this Notice, “protected health information” is information under our control that reasonably can be used to identify a patient and that relates to that patient’s physical or mental health condition, provision of health care, or payment for such health care.
This Notice describes how we may use and disclose protected health information for treatment, payment or healthcare operations and for other purposes that are permitted or required by law. It also describes your right to access and control your protected health information. This Notice describes the privacy practices of Connect Hearing and its workforce. Any hearing care professional authorized to enter information into your record with Connect Hearing and all employees, staff and other members of our workforce will follow the terms of this Notice. We are required to abide by the terms of this Notice currently in effect. We are also required by law to provide you with notice following a breach of your unsecured protected health information.
Generally, when this Notice uses the words, “you” or “your,” it is referring to the patient who is the subject of protected health information. However, when this Notice discusses rights regarding protected health information, including rights to access or authorize the disclosure of protected health information, “you” and “your” may refer to a patient's personal representative. If you have questions about this Notice, please contact our Privacy Office as described below.
HOW WE USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Uses of protected health information without your authorization
We may disclose your protected health information without your written authorization for the following purposes:
For Treatment: We may use and disclose your protected health information, including hearing test findings, in order to ensure that you receive proper medical treatment. For example, we may share your protected health information to another physician or health care provider involved in your care. We also may contact you about treatment alternatives and options.
For Payment: We may use and disclose your protected health information to obtain payment for services that were provided to you. For example, we may share your protected health information so your health plan will pay us or reimburse you for your hearing care services. We may also contact your health plan about a treatment you may receive to determine whether your plan will pay part of the cost of your hearing care device.
For Health Care Operations: We may use and disclose your protected health information for our health care operations. Health care operations are activities that are necessary to run our offices, maintain licensure, and to make sure that our visitors receive quality information on services and products. For example, we may:
- need to discuss your protected health information with companies and individuals necessary to complete your requests for information about hearing care devices and for the purpose of consultation and recommendation;
- contact you or your personal representative with a reminder postcard, email or telephone message that it is time for you to call our office and schedule an appointment; or
- use your protected health information to communicate with you about treatment alternatives and other health-related benefits and services that may be of interest to you.
We may also disclose your protected health information without your written authorization for other purposes, as permitted or required by law. This includes:
Individuals Involved in Your Care or Payment for Your Care: With your permission, we may discuss your hearing care with family members or other individuals involved in your medical care or payment for that care. We encourage you to identify persons involved in your care that you wish information to be shared with. You have the right to restrict or refuse any of these uses or disclosures.
Business Associates: At times, we must provide your protected health information to outside vendors (business associates) so they may help us operate more efficiently. For example, we may provide your name, address, and other information to a company that helps us mail important health communications to you. These business associates are required to adhere to federal and state laws regarding the protection of your protected health information; they are also under contractual obligations with us to maintain the privacy and security of your protected health information.
Workers' Compensation: We may release your protected health information for workers' compensation or similar programs that provide benefits for work related injuries or illness as required or permitted by law if you are injured at work.
Public Health Activities: We are also permitted to disclose your protected health information for certain purposes that have been determined to benefit the public as a whole. For example, we may:
- disclose your information to the United States Food and Drug Administration, to a state or local health department, or to law enforcement agencies if the disclosure will prevent or control disease, or prevent serious threat to the health and safety of an individual or the public;
- report child abuse or neglect, or adult abuse, including domestic violence, to a government authority authorized by law to receive such reports; or
- alert a person who may have been exposed to a communicable disease, if we are authorized by law to do so.
Judicial and Administrative Proceedings: We may disclose your protected health information pursuant to a court ordered subpoena or discovery request, or for law enforcement purposes as permitted by law once we have met all administrative requirements and any applicable state law requirements.
Government functions: We may disclose your protected health information to various departments of the government such as the U.S. military or the U.S. Department of State as required by law.
Research: We may disclose your protected health information for research purposes, when such research is approved by an institutional review board with established rules to ensure privacy.
Health or Safety: We may disclose your protected health information to avert a serious threat to someone's health or safety, including the disclosure of your protected health information to government or disaster relief or agencies to allow such agencies to carry out their responsibilities in response to specific disaster situations.
Compliance with Law: We may also disclose your protected health information when required to investigate or determine our compliance with law.
DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
We must obtain a signed authorization to use or disclose your protected health information in those situations not otherwise described in this Notice. The form will describe what information will be disclosed, to whom, for what purpose, and when. These situations can include:
- uses and disclosures of psychotherapy notes;
- uses and disclosures for marketing purposes, including marketing communications paid for by third parties;
- uses and disclosures specially protected by state and/or Federal law and regulations;
- uses and disclosures for certain research protocols; and
- disclosures that constitute a sale of protected health information.
You have the right to revoke your authorization, in writing, at any time, except to the extent we have taken action in reliance upon it. We do not generally receive copies of or access to any psychotherapy notes, however if copies are obtained, they cannot and will not be released without your authorization.
YOUR RIGHTS IN CONNECTION WITH YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding the protected health information we create, obtain, and/or maintain about you. Any request to exercise your rights as described below should be made in writing and submitted to the Connect Hearing Privacy Office as described below. If you have questions, you may contact the Privacy Office as described below.
Right to Inspect and Copy: You have the right to inspect and copy your protected health information that is in our possession as a part of the "designated record set." The designated record set is essentially the information used to make decisions about your care and payment of care. You may not, however, have access to information that is put together for use in a civil, criminal, or administrative proceeding.
To inspect or copy your protected health information in the designated record set, you must submit the details of your request in writing as described below. 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 or copy your designated record set in certain very limited circumstances. If you are denied access to your protected health information, you may be able to request that the denial be reviewed.
Right to Request Amendment: If you feel that protected health information in your designated record set is incorrect or incomplete, you may ask us to amend that information. You have the right to request an amendment for as long as the information is kept by or for Connect Hearing. To request an amendment, you must include the reason for your request and submit the request in writing as described below. We are not required to honor the request if the information in the designated record set is accurate and complete. If we deny your request, you have a right to give us a short statement to be placed with your protected health information or to have us include your request for amendment with your protected health information.
Right to an Accounting of Disclosures: You have the right to request, and we must provide you with a list of certain disclosures of your protected health information. We are not required to include on that list disclosures to carry out your care, payment for your care, and other health care operations and certain other disclosures. Examples of disclosures in the accounting would include those made to a court or government agency, research, or to the Department of Health and Human Services. To request this accounting of disclosures, you must submit your request in writing as described below.
Your request must state a time period covered by your request. That time period may not be longer than six years. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the information. 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 Additional Privacy Protections: You have the right to request additional restrictions from those detailed in this Notice. This means that you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be shared with family members or friends who may be involved in your care or for notification purposes described in this Notice. Your request must be submitted in writing as described below. We are not required, however, to agree to your request except if you request that we not disclose protected health information to your health plan with respect to health care for which you have paid in full.
Right to Request Confidential Communication: You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request must specify how or where you wish to be contacted. To request confidential communications, you must make your request in writing as described below. We will not ask you the reason for your request and we will accommodate all reasonable requests. However, please note that certain billing information through your insurance may continue to be mailed to the primary member of the coverage.
Right to a Paper Copy of this Notice: You may ask us to give you a copy of this Notice at any time by asking for it at your next office visit or in writing as described below. Even if you have agreed to receive this Notice electronically or otherwise already received a copy, you are still entitled to a paper copy of this Notice.
Some states provide additional privacy protections under state law. We are committed to complying with applicable laws when we use or disclose your medical information.
CONCERNS OR COMPLAINTS
Contact Connect Hearing: If you have questions about your privacy rights, believe that we may have violated your privacy rights, or disagree with a decision that we made about access to your protected health information, you may contact our Privacy Office by calling (630) 303-5380, extension 106, or emailing us at email@example.com. If you wish to submit your questions to us by mail, please address your correspondence to:
Attn: Compliance & Privacy Office
215 Shuman Blvd, Suite 401
Naperville, Illinois 60563
For certain types of requests, you may be required to complete and mail to us the applicable form, which we will make available to you.
Contact a Government Agency: If you believe we have violated your privacy rights, you may also file a complaint with the Office for Civil Rights of the United States Department of Health and Human Services (“OCR”). We will not retaliate against you or end our services to you if you file a complaint with us or OCR. Your complaint can be sent by email, fax, or mail to OCR. For more information, go to the OCR website (www.hhs.gov/ocr/privacy/hipaa/complaints).
WE MAY MAKE CHANGES TO THIS NOTICE IN THE FUTURE, AND ANY OF THE TERMS OF THIS NOTICE THAT ARE CHANGED WILL APPLY TO ALL OF YOUR PROTECTED HEALTH INFORMATION. IF WE MAKE A MATERIAL CHANGE TO OUR NOTICE, YOU MAY OBTAIN A COPY OF THE REVISED NOTICE AT YOUR LOCAL CONNECT HEARING CLINIC, ON OUR WEB SITE, OR UPON REQUEST TO THE CONNECT HEARING PRIVACY OFFICE AS DESCRIBED ABOVE.
Effective Date: This Notice is effective as of September 20, 2013, and updated as of 7/3/2017.