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.
Uses and disclosures
Treatment. Your protected health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members. In addition, after a hearing aid has been ordered, hearing testing results may be disclosed to hearing aid manufacturers to assist the manufacturer in making an appropriate hearing aid for your particular hearing loss. Copies of your testing, including hearing testing, may be released to your primary care physician or other health care providers for their records. Your protected health information may be disclosed to a third-party administrator (Amplifon, EPIC Hearing, Tru Hearing, etc.) to access certain health insurance benefits, other family members (i.e. spouse, children) and/or residential facilities (i.e. nursing homes, retirement communities, etc.) who may call our office on your behalf.
Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service provided, and the medical condition being treated.
Health care operations. Your health information may be used as necessary to support day-to-day activities and management of South City Hearing & Audiology, LLC. For example, information on the services you received may be used for budgeting and financial reporting, and activities to evaluate and promote better quality.
Law enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.
Public health reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department. We are also required to report suspected abuse, neglect, or domestic violence to the appropriate government facility.
Appointment reminders/recall cards/promotions. Your health information will be used by our staff to send you appointment reminders and promotional offers. For example, our offices may send out a recall notice or postcard for follow-up exams (3-mos, 6 mos, etc.) We may also contact you by email for appointments or when an order is received or when we have been unsuccessful in reaching you by telephone.
Information about treatments. Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. We may also send you information describing other health-related goods and services provided by us that we believe may interest you.
Other Disclosures. Your health information may be utilized for worker’s compensation claims, health research, to respond to organ and tissue donation requests, or to work with a medical examiner or funeral director.
Other uses of Information. Disclosure of your health information or its use for any purpose other than those listed above requires specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified us of your decision. This includes the following:
- The right and choice to tell us to share information with your family, close friends, or others involved in your care.
- The right and choice to tell us to share information in a disaster relief situation.
- The right and choice to tell us to share your information in a hospital directory.
- The choice to have us contact you for fundraising efforts.
- The choice to share your information for marketing purposes.
- The choice to sell your information.
- The choice to share psychotherapy notes.
Individual Rights: You have certain rights under the federal privacy standards which include the following:
- The right to request restrictions on the use and disclosure of your protected health information.
- The right to receive confidential communication concerning medical conditions and treatment.
- The right to inspect and copy your protected health information.
- The right to amend or submit corrections to your protected health information.
- The right to receive an accounting of how and to whom your protected health information has been disclosed.
- The right to receive a printed copy of this notice.
- The right to choose someone to act for you.
- The right to ask, but not require, to limit what we share for treatment, payment, or normal business operations.
South City Hearing & Audiology, LLC Duties. We are required by law to maintain the privacy of your protected health information and to let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We are also required to provide you with this notice of privacy practices and to abide by the terms that are outlined in this notice. Additional information can be found at: www.hs.gov/ocr/privacy/hipa/understanding/consumers/noticepp.html.
Right to Revise Privacy Practices. As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.
Request 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. You may obtain a form requesting access to your records by contacting our Privacy Officer.
Complaints. If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
Privacy Compliance Officer
South City Hearing & Audiology, LLC 3915 Watson Rd., Ste. 201
St. Louis, MO 63109
If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.
You have the right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Ave, S.W.
Washington, DC 20201
1-877-696-6775
www.hhs.gov/ocr /privacy /hi paa/complaints/
Contact Person. The name and address of the person you can contact for further information concerning our privacy practices is:
Nancy M. Richman, Au.D., CCC-A