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. If you have
any questions about this Notice please contact us at customerservice@myhearpod.com.
We respect your privacy and will never provide your email address to any other company and will only send you information you specifically request. In keeping with the right of privacy, we have changed the names of patients who have graciously sent their testimonials to us. However, the statements we attribute to our clients are the actual statements they have made.
This Notice of Privacy Practices describes how we may use and disclose your
protected health information to carry out treatment, payment, or health care
operations and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health information. “Protected
health information” is information about you, including demographic information,
that may identify you and that relates to your past, present or future physical
or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice at any time. The new notice will be effective
for all protected health information that we maintain at that time. Upon your
request, we will provide you with any revised Notice of Privacy Practices by
accessing our website www.hearlikenew.com, calling the office and requesting
that a revised copy be sent to you in the mail or asking for one at the time
of your next appointment.
1. Uses and Disclosures of Protected Health
Information
Uses and Disclosures of Protected Health Information Based Upon Your Written
Consent
You will be asked by your Health Care Provider to sign a consent form. Once
you have consented to use and disclosure of your protected health information
for treatment, payment and health care operations by signing the consent form,
your Health Care Provider will use or disclose your protected health information
as described in this Section 1. Your protected health information may be used
and disclosed by your Health Care Provider, our office staff and others outside
of our office that are involved in your care and treatment for the purpose
of providing health care services to you. Your protected health information
may also be used and disclosed to pay your health care bills and to support
the operation of the Health Care Provider’s practice.
Following are examples of the types of uses and disclosures of your protected
health care information that the Health Care Provider’s office is permitted
to make once you have signed our consent form. These examples are not meant
to be exhaustive, but to describe the types of uses and disclosures that may
be made by our office once you have provided consent.
We will use and disclose
your protected health information to provide, coordinate, or manage
your health care and any related services. This includes the coordination
or management of your health care with a third party that has already
obtained your permission to have access to your protected health
information. For example, we would disclose your protected health
information, as necessary, to a home health agency that provides
care to you. We will also disclose protected health information
to other physicians who may be treating you when we have the necessary
permission from you to disclose your protected health information.
For example, your protected health information may be provided
to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time
to another physician or health care provider (e.g., a specialist or laboratory)
who, at the request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
Your protected health
information will be used, as needed, to obtain payment for your
health care services. This may include certain activities that
your health insurance plan may undertake before it approves or
pays for the health care services we recommend for you such as;
making a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical necessity,
and undertaking utilization review activities. For example, obtaining
approval for a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain approval
for the hospital admission.
Healthcare Operations: We may use or disclose, as-needed, your protected health
information in order to support the business activities of your Health Care
Provider’s practice. These activities include, but are not limited to,
quality assessment activities, employee review activities, training of medical
students, licensing, marketing and fundraising activities, and conducting or
arranging for other business activities.
For example, we may disclose your protected health information to medical school
students that see patients at our office. In addition, we may use a sign-in
sheet at the registration desk where you will be asked to sign your name and
indicate your Health Care Provider. We may also call you by name in the waiting
room when your Health Care Provider is ready to see you. We may use or disclose
your protected health information, as necessary, to contact you to remind you
of your appointment. We will share your protected health information with third
party “business associates” that perform various activities (e.g.,
billing, transcription services) for the practice. Whenever an arrangement
between our office and a business associate involves the use or disclosure
of your protected health information, we will have a written contract that
contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other health-related
benefits and services that may be of interest to you. We may also use and disclose
your protected health information for other marketing activities. For example,
your name and address may be used to send you a newsletter about our practice
and the services we offer. We may also send you information about products
or services that we believe may be beneficial to you. You may contact our Privacy
Contact to request that these materials not be sent to you. We may use or disclose
your demographic information and the dates that you received treatment from
your Health Care Provider, as necessary, in order to contact you for fundraising
activities supported by our office. If you do not want to receive these materials,
please contact our Privacy Contact and request that these fundraising materials
not be sent to you.
Uses and Disclosures of Protected Health Information Based upon Your Written
Authorization
Other uses and disclosures of your protected health information will be made
only with your written authorization, unless otherwise permitted or required
by law as described below. You may revoke this authorization, at any time,
in writing, except to the extent that your Health Care Provider or the Health
Care Provider’s practice has taken an action in reliance on the use or
disclosure indicated in the authorization.
We may use and disclose your protected health information in the following
instances. You have the opportunity to agree or object to the use or disclosure
of all or part of your protected health information. If you are not present
or able to agree or object to the use or disclosure of the protected health
information, then your Health Care Provider may—using his/her professional
judgment—determine whether the disclosure is in your best interest. In
this case, only the protected health information that is relevant to your health
care will be disclosed.
Unless you
object, we will use and disclose in our facility directory your
name, the location at which you are receiving care, your condition
(in general terms), and your religious affiliation. All of this
information, except religious affiliation, will be disclosed to
people that ask for you by name. Members of the clergy will be
told your religious affiliation.
Unless
you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your protected
health information that directly relates to that person’s
involvement in your health care. If you are unable to agree or
object to such a disclosure, we may disclose such information as
necessary if we determine that it is in your best interest based
on our professional judgment. We may use or disclose protected
health information to notify or assist in notifying a family member,
personal representative or any other person that is responsible
for your care of your location, general condition or death. Finally,
we may use or disclose your protected health information to an
authorized public or private entity to assist in disaster relief
efforts and to coordinate uses and disclosures to family or other
individuals involved in your health care.
We may use or disclose
your protected health information in an emergency treatment situation.
If this happens, your Health Care Provider shall try to obtain
your consent as soon as reasonably practicable after the delivery
of treatment. If your Health Care is required by law to treat you
and the Health Care Provider has attempted to obtain your consent
but is unable to obtain your consent, he or she may still use or
disclose your protected health information to treat you.
Communication Barriers: We may use and disclose your protected health information
if your Health Care Provider or another Health Care Provider in the practice
attempts to obtain consent from you but is unable to do so due to substantial
communication barriers and the Health Care Provider determines, using professional
judgment, that you intend to consent to use or disclosure under the circumstances.
We may use or disclose your protected health information in the following situations
without your consent or authorization. These situations include:
Required By Law: We may use or disclose your protected health information to
the extent that law requires the use or disclosure. The use or disclosure will
be made in compliance with the law and will be limited to the relevant requirements
of the law. You will be notified, as required by law, of any such uses or disclosures.
We may disclose
your protected health information for public health activities
and purposes to a public health authority that is permitted by
law to collect or receive the information. The disclosure will
be made for the purpose of controlling disease, injury or disability.
We may also disclose your protected health information, if directed
by the public health authority, to a foreign government agency
that is collaborating with the public health authority.
We may disclose
your protected health information, if authorized by law, to a person
who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or condition.
We may disclose
protected health information to a health oversight agency for activities
authorized by law, such as audits, investigations, and inspections.
Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit
programs, other government regulatory programs and civil rights
laws.
We may disclose
your protected health information to a public health authority
that is authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose your protected health information
if we believe that you have been a victim of abuse, neglect or
domestic violence to the governmental entity or agency authorized
to receive such information. In this case, the disclosure will
be made consistent with the requirements of applicable federal
and state laws.
Food and Drug Administration: We may disclose your protected health information
to a person or company required by the Food and Drug Administration to report
adverse events, product defects or problems, biologic product deviations, track
products; to enable product recalls; to make repairs or replacements, or to
conduct post marketing surveillance, as required.
We may disclose
protected health information in the course of any judicial or administrative
proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized),
in certain conditions in response to a subpoena, discovery request
or other lawful process.
We may also disclose
protected health information, so long as applicable legal requirements
are met, for law enforcement purposes. These law enforcement purposes
include (1) legal processes and otherwise required by law, (2)
limited information requests for identification and location purposes,
(3) pertaining to victims of a crime, (4) suspicion that death
has occurred as a result of criminal conduct, (5) in the event
that a crime occurs on the premises of the practice, and (6) medical
emergency (not on the Practice’s premises) and it is likely
that a crime has occurred.
We may disclose protected health information to
a coroner or medical examiner for identification purposes, determining
cause of death or for the coroner or medical examiner to perform
other duties authorized by law. We may also disclose protected
health information to a funeral director, as authorized by law,
in order to permit the funeral director to carry out their duties.
We may disclose such information in reasonable anticipation of
death. Protected health information may be used and disclosed for
cadaver organ, eye or tissue donation purposes.
We may disclose your
protected health information to researchers when their research
has been approved by an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy
of your protected health information.
Consistent with
applicable federal and state laws, we may disclose your protected
health information, if we believe that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or the public. We may also disclose
protected health information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply,
we may use or disclose protected health information of individuals who are
Armed Forces personnel (1) for activities deemed necessary by appropriate military
command authorities; (2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits, or (3) to foreign military
authority if you are a member of that foreign military services. We may also
disclose your protected health information to authorized federal officials
for conducting national security and intelligence activities, including for
the provision of protective services to the President or others legally authorized.
Your
protected health information may be disclosed by us as authorized
to comply with workers’ compensation laws and other similar
legally-established programs.
We may use or disclose
your protected health information if you are an inmate of a correctional
facility and your Health Care Provider created or received your
protected health information in the course of providing care to
you.
Required Uses and Disclosures: Under the law, we must make disclosures to you
and when required by the Secretary of the Department of Health and Human Services
to investigate or determine our compliance with the requirements of Section
164.500 et. seq.
2. Your Rights
Following is a statement of your rights with respect to your protected health
information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This
means you may inspect and obtain a copy of protected health information about
you that is contained in a designated record set for as long as we maintain
the protected health information. A “designated record set” contains
medical and billing records and any other records that your Health Care Provider
and the practice uses for making decisions about you. Under federal law, however,
you may not inspect or copy the following records; psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding, and protected health information that is subject to law
that prohibits access to protected health information. Depending on the circumstances,
you may have a right to have this decision reviewed. Please contact our Privacy
Contact if you have questions about access to your medical record.
You have the right to request a restriction of your protected health information.
This means 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 disclosed to family members or friends who may be involved in your care
or for notification purposes as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested and to whom you
want the restriction to apply. Your Health Care Provider is not required to
agree to a restriction that you may request. If physician believes it is in
your best interest to permit use and disclosure of your protected health information,
your protected health information will not be restricted. If your Health Care
Provider does agree to the requested restriction, we may not use or disclose
your protected health information in violation of that restriction unless it
is needed to provide emergency treatment. With this in mind, please discuss
any restriction you wish to request with your Health Care Provider. You may
request a restriction by contacting us at customerservice@myhearpod.com.
You have the right to request to receive confidential communications from us
by alternative means or at an alternative location. We will accommodate reasonable
requests. We may also condition this accommodation by asking you for information
as to how payment will be handled or specification of an alternative address
or other method of contact. We will not request an explanation from you as
to the basis for the request. Please make this request in writing to our Privacy
Contact.
You may have the right to have your Health Care Provider amend your protected
health information. This means you may request an amendment of protected health
information about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request for an amendment.
If we deny your request for amendment, you have the right to file a statement
of disagreement with us and we may prepare a rebuttal to your statement and
will provide you with a copy of any such rebuttal. Please contact our Privacy
Contact to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have
made, if any, of your protected health information. This right applies to disclosures
for purposes other than treatment, payment or healthcare operations as described
in this Notice of Privacy Practices. It excludes disclosures we may have made
to you, for a facility directory, to family members or friends involved in
your care, or for notification purposes. You have the right to receive specific
information regarding these disclosures that occurred after April 14, 2003.
You may request a shorter timeframe. The right to receive this information
is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request,
even if you have agreed to accept this notice electronically.
3. Complaints
You may complain to us or to the Secretary of Health and Human Services if
you believe your privacy rights have been violated by us. You may file a complaint
with us by notifying our privacy contact of your complaint. We will not retaliate
against you for filing a complaint. You may contact us at customerservice@myhearpod.com.
Effective as of April 14,
2003
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