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Notice of Privacy Practices
PURPOSE:
We respect your health information and our legal obligation to keep it
private. This notice describes how
we protect your health information and what rights you have regarding it.
Please review it carefully.
USES AND
DISCLOSURES:
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Treatment:
Your health information may be used by staff members or disclosed to
other health care professionals (such as your doctor) for the purpose of
evaluating your health, diagnosing medical conditions, coordinating
services, and providing treatment.
For example, we may send test results to the doctor who referred you to Fine
Hearing Care for your general medical records.
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Payment: Your health information
may be used to obtain payment for services rendered from you, a third party
payer such as your insurance company, or credit card company that you have
authorized. For example, a bill may
be sent to you or your insurance company.
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Health Care Operations: Your
health information may be used by our staff to assess your care and outcomes
in your case and others like it in effort to continually improve the
training of our employees and the quality of services we provide.
For example, you may receive a follow-up call or an appointment
reminder by mail or by phone. Unless
you tell us otherwise, we will leave minimal information on an answering
machine or with the person who answers the phone if you are not home.
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Business Associates: Your health
information may be used to communicate vital information for your care to
entities outside of our office. We
require these associates to protect your private health information as well.
For example, we may send your hearing test results to a hearing aid
manufacturer so that a new hearing aid can be custom-made for your use.
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Caregivers: Your health
information may be disclosed to a family member, other relative, personal
representative, guardian or another person you identify as necessary for
your care. For example, we may notify
a family member that you designate that a hearing aid is ready for you to
pick up and use.
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Other potential uses:
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Serious Threat to Health or Safety: We may use
and disclose your health information when necessary to prevent a serious threat
to your health and safety or the health and safety of the public or another
person. Any disclosure would only be
to someone able to help prevent the threat.
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Law Enforcement: Your health information may be
disclosed to law enforcement agencies to support government audits and
inspections, to facilitate law-enforcement investigations, and to comply with
government mandated reporting.
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As Required By Law: Your health information will
be disclosed when required to do so by federal, state, or local law.
INDIVIDUAL
RIGHTS: You have certain rights under federal privacy standards.
These include:
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The right to receive confidential communications concerning your medical
condition and treatment
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The right to inspect and copy your protected health information
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The right to amend or submit corrections to your protected health
information
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The right to receive an accounting of how and to whom your protected health
information has been disclosed
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The right to request restrictions on the use and disclosure of your
protected health information
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The right to receive a printed copy of this notice
TO INSPECT
PROTECTED HEALTH INFORMATION: As permitted by federal regulation, we
require that requests to inspect or copy protected health information be
submitted in writing to the person designated below.
We reserve the right to charge you $.25 per page.
We may deny your request to inspect and/or copy in certain very limited
events.
TO AMEND
PROTECTED HEALTH INFORMATION: If you feel the medical information we
have about you is incorrect or incomplete, you may ask us to amend the
information in writing to the person designated below.
We may deny your request for an amendment if it is not in writing or does
not include a reason to support the request.
Additionally, we may deny your request to amend information that was not
created by us, is not part of the information kept by us, is not part of the
information you would be permitted to inspect and copy, or is accurate and
complete.
TO REQUEST AN
ACCOUNTING OF DISCLOSURES: You may request in writing to the designated
person below of the disclosures we have made of your health information after April 14, 2003 for a period
not longer than six years. This
excludes disclosures we may have made to you and disclosures made for treatment,
payment, or healthcare operations.
This excludes disclosures made according to your written authorization or to
family members or caregivers involved in your care, for notification purposes,
and for national security purposes.
Our response to your request will be in writing.
The first list you request within a 12 month period will be free.
For additional lists, we reserve the right to charge $10 per additional
request.
TO REQUEST
RESTRICTIONS: You may request that we restrict disclosure of your health
information to the person designated below in writing.
In your request, you must tell us (1.) what information you want to
limit; (2.) whether you want to limit our use, disclosure, or both; (3.) to whom
you want the limits to apply.
We reserve the right to change our practices and to make
new provisions effective for all protected health information we maintain at any
time in compliance with and as allowed by law.
If we change this notice, the new privacy practices will apply to your
health information that we already have as well as to such information in that
we may generate in the future. If we
change our notice of privacy practices, we will have copies available in our
office. If you think that we have
not properly respected the privacy of your health information, you may write us
with your concern to the designated person below or to the U.S. Department of
Health and Human Services, Office of Civil Rights.
CONTACT PERSON:
Kris Watson
Fine Hearing Care
2801 S. Bryant
Edmond, OK 73013
Phone: 405-340-9191
Fax: 405-340-9185
Email: finehearingcare@coxinet.net
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