NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
This Notice of Privacy Practices 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 strive to provide the best service to our visitors. The more we know about our visitors, the more we can customize the information for their needs. As we assist you with your hearing, we ask for some mandatory and some optional information, this Notice provides information about our commitment to protect this information and ensure that it remains confidential.
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 a patient's, or authorized personal representative's rights to access and control protected health information. “Protected health information” is information that may identify the patient and that relates to the patient's past, present or future physical or mental health or condition and related healthcare services or payment for such services. This Notice describes the privacy practices of Connect Hearing, its personnel and business associates (collectively, “we” or “us”). It applies to services provided to you at clinics within the Connect Hearing Network as well as through internet inquiries and our call center. 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. Connect Hearing clinic locations may share protected health information with each other for the treatment, payment or health care operation purposes described in this Notice.
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 patient information, including rights to access or authorize the disclosure of patient information, “you” and “your” may refer to a patient's personal representative.
We are required by law to maintain the privacy of your protected health information and provide individuals with this Notice of our legal duties and privacy practices. We are also required to abide by the terms of the Notice currently in effect. If you have questions about this Notice, please contact our Privacy Office as described below.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe different purposes for which we may use and disclose your protected health information without specific written authorization by you (or your personal representative). We explain each category below and include examples, but we do not list every possible use or disclosure in a category.
For Treatment: We may use and disclose protected health information about you, 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 protected health information about you 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.
Appointment Reminders: We may 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.
Individuals Involved in Your Care or Payment for Your Care: With your written approval, we may discuss your hearing care with family members or close protected friends who are 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 health information to a company that helps us mail important health communications to you. These business associates are required to adhere to the federal and state laws regarding the protection of your protected health information; they are also under a contractual obligation to Connect Hearing to maintain the privacy and security of your protected health information.
Workers' Compensation: We may release medical information about you 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.
Uses and Disclosures Where Authorized or Required by Law, for Public Health and Similar Activities: We are also permitted to disclose your 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. Other examples include:
- 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 if the HIPAA Privacy Rule and any applicable state law requirements.
- To public health or appropriate authorities as Required By Law, when there is a reason to suspect abuse, neglect, or domestic violence;
- To the Military if the individual is a member of the military and disclosure is required by the armed forces;
- To avert a serious threat to someone's health or safety, including the disclosure of protected health information to government or disaster relief or agencies to allow such agencies to carry out their responsibilities to specific disaster situations; and
- To federal authorities for intelligence, counterintelligence and other national security activities as authorized by law;
- For research purposes, when such research is approved by an institutional review board with established rules to ensure privacy;
- To a coroner, medical examiner or funeral director to assist in identifying a deceased individual or to determine a cause of death;
- We must also disclose your protected health information when required to investigate or determine our compliance with the HIPAA Privacy law.
DISCLOSURES WITH YOUR AUTHORIZATION
We must obtain your authorization to use or disclose your protected health information in those situations not otherwise described in this Notice. If you do authorize us to use or disclose your protected health information, you have the right to revoke that authorization, in writing, at any time, except to the extent that we have taken action in reliance on the use or disclosure indicated in that authorization. Connect Hearing does not generally receive copies of or access to any psychotherapy notes, however if copies are obtained, they cannot and will not be released without an authorization.
Communications, such as contacting you for appointment reminders, case management, treatment alternatives or other health related products or services are not considered marketing and your authorization is not required. However, if a communication is made that does not contribute to your current or future treatment directly and as defined by the law, thereby considered “marketing,” we will request your specific authorization. Further, without your specific authorization, we will not sell or lease your information to a third party for marketing purposes. You have the right to opt out of any such marketing at any time.
YOUR RIGHTS IN CONNECTION WITH YOUR PROTECTED HEALTH INFORMATION
You have the following rights as a consumer under HIPAA regarding the protected health information we have about you in our records. 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 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 your protected health information in the 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 make your request in writing, 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 list or 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 Receive Notice of a Breach: You have the right to be notified and we will notify you if there is a breach of your unsecured protected health information (i.e. impermissibly used or shared).
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, 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 personal information.
CONCERNS OR COMPLAINTS
Please tell us about any problems or concerns you have regarding your privacy rights or how Connect Hearing uses or shares your medical information. If you have a concern, please contact the Connect Hearing Privacy Office as described below.
If for some reason Connect Hearing cannot resolve your concern, you may also file a complaint with the Director of the Office for Civil Rights of the United States Department of Health and Human Services. We will not retaliate against you or end our services to you if you file a complaint, in good faith, with us or the Office for Civil Rights.
If you have any questions about this Notice, please contact our Privacy Office by calling (630) 303-5380, extension 106, or through the email address 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
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 MEDICAL 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 of this Notice: September 20, 2013