Notice of Privacy Practices for Protected Health Information
THIS NOTICE DESCRIBES HOW HEARING HEALTHCARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice is effective starting June 12, 2019 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the updated version available upon request.
You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
Use And Disclosure Of Your Health Information
We use and disclose health information about you for treatment, payment and healthcare operations. For example:
We may use or disclose your health information to a physician or other healthcare provider who is treating you, including hearing aid manufacturers and other providers of hearing healthcare devices, and/or related supplies.
We may use and disclose your health information to obtain payment for services we provide you with.
We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
This authorization may be revoked at any time by sending written notice to the Compliance Officer at the below address, except to the extent that provider has already taken action in reliance on it. Authorizing the disclosure of this health information is voluntary and you do not need to sign this form in order to assure treatment, payment, enrollment or eligibility for benefits. You may inspect or obtain a copy of the information to be used or disclosed. Any disclosure of information carries with it the potential for an unauthorized re-disclosure and the information may not be protected by federal confidentiality rules. If you have questions about disclosure of your health information, contact the Compliance Officer at the below number.
To Your Family and Friends:
We must disclose your health information to you, as described in the “Patient Rights” section of this notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or payment for your healthcare, but only if you agree that we may do so.
We may use and disclose your PHI to business associates. A business associate is an individual or entity under contract with HearingLife to perform or assist HearingLife in a function or activity which requires the use and/or disclosure of the personal health information of patients.
Examples of business associates include, but are not limited to, copy services used by us to copy medical records, consultants, accountants, lawyers, and interpreters. We require business associates to enter into agreements to protect the confidentiality of your PHI.
Persons Involved In Care:
We may use your health information for marketing communications unless you choose to opt out. You may opt out by contacting the Compliance Officer. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up hearing aids, batteries, impressions, audiograms, or similar forms of health information.
Marketing Health-Related Services:
We may use your health information for marketing communications unless you choose to opt out. You may opt out by contacting the Compliance Officer.
Required by Law:
We may use or disclose your health information when we are required to do so by law.
We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmate or patient under certain circumstances.
We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, newsletters, or letters), as well as information about treatment alternatives.
Patient Rights Access:
You have the right to view or receive copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you requested unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this notice. You may also request access by sending us a letter to the address at the end of this notice.
Copying fees may be imposed. Actual postage costs will be added if you would like the information mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
You have the right to receive a list of instances in which we or our business associates have disclosed your health information for purposes, other than treatment, payment, healthcare operations and other activities, for the last 6 years, but not before June 12, 2006. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation about how payments will be handled under the alternative means and/or location you request.
You have the right to request that we amend your health information. Your request must be in writing and explain why the information should be amended. We may deny your request under certain circumstances.
If you receive this notice on our website or by electronic mail (e-mail), you are entitled to receive this notice in written form.
Abuse or Neglect:
We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence, or other crimes. We may disclose your health information to the extent necessary to avoid a serious threat to your health or safety and/or the health or safety of others.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may make us aware of your concern by using the contact information listed at the end of this notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
You also have the right to request the categories of sources from which the personal information is collected, as well as the business or commercial purpose for collecting or selling personal information. You have the right to edit this information or request its deletion. To submit an information request, please e-mail us at firstname.lastname@example.org or call us at (888) 878-3525.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or the U.S. Department of Health and Human Services.
Address: 580 Howard Avenue, Somerset, NJ 08873