Effective
June 15, 2005
HIPAA NOTICE OF PRIVACY PRACTICES
FOR PERSONAL HEALTH INFORMATION
WE
MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION
FOR THE FOLLOWING PURPOSES:
For
Treatment: We 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 we must disclose
such information to the manufacturer
of your device. We may also disclose
your health information to another
physician or health care provider
involved in your care.
For
Payment: We may use and disclose
medical information about you so that
we obtain payment for the treatment
and services we provide to you from
you, an insurance company or another
third party if applicable.
For
Health Care Operations: We
may use and disclose medical information
about you for our health care operations.
Health care operations are activities
that are necessary to run our offices,
maintain licenses, and to make sure
that our patients receive quality
care, services and products. For example,
we may use your medical information
to review our treatment of you and
the services we provided and to evaluate
the performance of our staff in caring
for you.
Appointment
Reminders/Order Status: 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. We 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: We 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: 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. Disclosure would only be to
someone able to help prevent the threatened
harm.
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.
Health
Oversight Activities: We
may disclose your medical information
to a health oversight agency such
as licensing boards for activities
authorized by law.
Lawsuits
and Disputes: We 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:
We will disclose medical information
about you when required to do so by
federal, state or local law.
Law
Enforcement: Under certain
circumstances, we may release medical
information about you if asked to
do so by a law enforcement official.
Government
Purposes: We 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: We
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: We 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
We must obtain your authorization
to use or disclose health information
in those situations not otherwise
described in this Notice. If you do
authorize us 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 we maintain
about you:
Right
to Inspect and Copy: You
have the right to inspect and copy
your medical information that is in
our 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 our corporate office. If you request
a copy of the information, 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 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 us to amend that information.
You have the right to request an amendment
for as long as the information is
kept by or for our office. To request
an amendment, your request must be
made in writing and submitted to our
corporate office. You must explain
why you believe that the medical information
is incorrect or incomplete. If we
deny your request, you have a right
to give us a short statement to be
placed with you medical information
or to have us 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
we are required to provide to you.
We 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 our 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, 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 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 our corporate
office. We are not required, however,
to agree to your request.
Right
to Request Confidential Communication:
You have the right to request that
we 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 our corporate
office. We will not ask you the reason
for your request, and we will accommodate
all reasonable requests.
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 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 us or with the Secretary
of the United States Department of
Health and Human Services. To file
a complaint with us, contact our corporate
office in writing. You will not be
penalized for filing a complaint.
Aidright.com
Privacy Officer
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, AidRight
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 our Privacy
Officer at the address listed 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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