Effective
October 8, 2008
HIPAA NOTICE OF PRIVACY PRACTICES
FOR PERSONAL HEALTH INFORMATION
OUR
CLINICS MAY USE OR DISCLOSE YOUR MEDICAL
INFORMATION FOR THE FOLLOWING PURPOSES:
For
Treatment: Our clinics may
use and disclose medical information
about you, including hearing test
findings, in order to ensure that
you receive proper medical treatment.
To order your hearing aid our clinics
must disclose such information to
the manufacturer of your device. Our
clinics may also disclose your health
information to another physician or
health care provider involved in your
care.
For
Payment: Our clinics may
use and disclose medical information
about you so that they can obtain
payment for the treatment and services
that they provide to you from you,
an insurance company or another third
party if applicable.
For
Health Care Operations: Our
clinics may use and disclose medical
information about you for their health
care operations. Health care operations
are activities that are necessary
to run their offices, maintain licenses,
and to make sure that their patients
receive quality care, services and
products. For example, they may use
your medical information to review
their treatment of you and the services
they provided and to evaluate the
performance of their staff in caring
for you.
Appointment
Reminders/Order Status: Our
clinics may contact you or your personal
representative with a reminder postcard,
email or telephone message that it
is time for you to call their office
and schedule an appointment. They
may also contact you by telephone
or email with regard to the status
of your hearing aid, ear mold, repair
or assistive device order.
Individuals
Involved in Your Care or Payment for
Your Care: Our clinics may
discuss your medical care with family
members or close personal friends
who are involved in your medical care
or payment for that care. You have
the right to restrict or refuse any
of these uses or disclosures.
To
Avert a Serious Threat to Health or
Safety: Our clinics 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. Disclosure would
only be to someone able to help prevent
the threatened harm.
Workers'
Compensation: Our clinics
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.
Health
Oversight Activities: Our
clinics may disclose your medical
information to a health oversight
agency such as licensing boards for
activities authorized by law.
Lawsuits
and Disputes: Our clinics
may disclose medical information about
you in response to a court or administrative
order, a subpoena, discovery request
or other lawful process, but only
if efforts have been made to tell
you about the request or to obtain
an order protecting the information
requested.
As Required By Law:
Our clinics will disclose medical
information about you when required
to do so by federal, state or local
law.
Law
Enforcement: Under certain
circumstances, our clinics may release
medical information about you if asked
to do so by a law enforcement official.
Government
Purposes: Our clinics may
release your medical information under
limited circumstances if you are a
member of the armed forces or foreign
military personnel, or for intelligence,
counterintelligence and other national
security activities authorized by
law.
Incidental
Uses and Disclosures: Our
clinics may use or disclose your medical
information if it is a by product
of any of the uses or disclosures
described above and it could not be
reasonably prevented.
Unidentifiable
Information: Our clinics
may use or disclose certain information
that does not directly identify you
for research, public health or health
care operations if the recipient of
that information agrees to protect
the information.
DISCLOSURES
WITH YOUR AUTHORIZATION
Our clinics must obtain your authorization
to use or disclose health information
in those situations not otherwise
described in this Notice. If you do
authorize them to use or disclose
your medical information, you have
the right to revoke that authorization
at anytime.
YOUR
RIGHTS IN CONNECTION WITH YOUR MEDICAL
INFORMATION
You have the following rights in connection
with the medical information they
maintain about you:
Right
to Inspect and Copy: You
have the right to inspect and copy
your medical information that is in
our clinics possession. 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
medical information, you must submit
your request in writing to their corporate
office. If you request a copy of the
information, they may charge a fee
for the costs of copying, mailing
or other supplies associated with
your request. They may deny your request
to inspect or copy your health information
in certain very limited circumstances.
If you are denied access to your medical
information, you may be able to request
that the denial be reviewed.
Right
to Request Amendment: If
you feel that your medical information
is incorrect or incomplete, you may
ask them to amend that information.
You have the right to request an amendment
for as long as the information is
kept by or for their office. To request
an amendment, your request must be
made in writing and submitted to their
corporate office. You must explain
why you believe that the medical information
is incorrect or incomplete. If they
deny your request, you have a right
to give them a short statement to
be placed with you medical information
or to have them include your request
for amendment with your medical information.
Right
to an Accounting of Disclosures:
You have the right to request disclosures
of your medical information, which
they are required to provide to you.
Our clinics are not required to include
on that, disclosures to carry out
your treatment, payment for your care,
and other health care operations and
certain other disclosures. To request
this list or accounting of disclosures,
you must submit your request in writing
to their corporate office. Your request
must state a time period covered by
your request. That time period may
not be longer than six years and may
not include dates before June 1, 2005.
Your request should indicate in what
form you want the list (for example
on paper or electronically). The first
list you request within a 12 month
period will be free. For additional
lists, they may charge you for the
costs of providing the list. They
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. Your request must be
submitted in writing to their corporate
office. Our clinics are not required,
however, to agree to your request.
Right
to Request Confidential Communication:
You have the right to request that
our clinics communicate with you about
medical matters in a certain way or
at a certain location. Your request
must be specific as to how or where
you wish to be contacted. To request
confidential communications, you must
make your request in writing to their
corporate office. We will not ask
you the reason for your request, and
they will accommodate all reasonable
requests.
Right
to a Paper Copy of this Notice:
You may ask our clinics to give you
a copy of this notice at any time
by asking for it in person or in writing.
Even if you have agreed to receive
this notice electronically, you are
still entitled to a paper copy.
COMPLAINTS
If you believe your privacy rights
have been violated; you may file a
complaint with the office we sent
you to or with the Secretary of the
United States Department of Health
and Human Services. To contact AidRight
Hearing Aids for information on the
clinic that we referred you to, please
write us at:
AidRight
Hearing Aids
Re: Privacy Rights
3220 Northlake Parkway
Atlanta, GA. 30345
Or
send an e mail to: service@aidright.com
Complaints
or requests for information shall
be the object of an investigation
or response within 30 business days.
If the complaint is justified, our
clinics will take the appropriate
measures to address the complaint,
including access to the requested
information, by proceeding with rectification
or, as the case may be, by amending
its Policy and practices.
If
you have any questions about this
notice, please contact the office
we sent you to, or you can write to
us at the address above.
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 OUR MEDICAL INFORMATION.
IF WE CHANGE OUR NOTICE, YOU MAY OBTAIN
A COPY OF THE REVISED NOTICE BY NOTIFYING
US IN WRITING OR BY EMAIL TO THE ABOVE
ADDRESS.
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