Effective Date of this Notice: 06/22/2018
Audiology Center, LLC d/b/a Audiology Center of Maine
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN RECEIVE ACCESS TO YOUR PROTECTED HEALTH INFORMATION.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important information:
- How we may use and disclose your PHI
- Your privacy rights in your PHI
- Our obligations concerning the use and disclosure of your PHI
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.
If you have any questions about this notice, please contact:
77 Beechland Rd
Ellsworth, ME 04605
B. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS:
- Treatment. Treatment means the provision, coordination, or management of your health care and related services by Audiology Center d/b/a Audiology Center of Maine and other health care providers involved in your care. It includes the coordination or management of health care by a provider with a third party, consultation between our practice and other health care providers relating to your care, or our practice’s referral of you to a specialist physician or other practitioner or facility, such as a laboratory.
- Payment. Our practice may use and disclose your PHI in order to bill and collect payment for services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
- Health Care Operations. Health care operations mean the business activities of our practice. These activities include, for example, quality assessment and improvement activities; fraud and abuse compliance; business planning and development; and business management and general administrative activities. For example, we may call you by name in the waiting room when we are ready to serve you; and we may leave a reminder of your appointment on your answering machine or voicemail. Also, we may send you mailings from our practice. When we involve third parties, such as billing services, we will have them sign a “business associate” agreement obligating them to safeguard your PHI according to the same legal standards we follow.
- Family and Close Friends Involved in Your Care. You have consented to the disclosure of PHI that, in Audiology Center of Maine’s judgment, is in your best interest to discuss with your family members and close friends who are involved in your health care.
- Disclosures Required By Law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.
C. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
- Judicial and Administrative Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order expressly directing disclosure and within certain limits in response to a subpoena, discovery request, or other lawful process.
- Emergencies. If you are incapacitated and require emergency medical treatment, we will use and disclose your PHI to ensure you receive the necessary medical services. We will attempt to obtain your consent as soon as practical following your treatment.
- Communication Barriers. If we try but cannot obtain your consent to use or disclose your PHI because of substantial communication barriers and your provider, using his or her professional judgment, infers that you consent to the use or disclosure, we will make the use or disclosure.
- Law Enforcement Activities. We may disclose your PHI to a law enforcement officer for law enforcement purposes.
- Coroners, medical examiners, and funeral directors. Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary we may disclose information to enable a funeral director to carry out his or her lawful duties.
- Research. We may disclose your PHI for certain medical or scientific research where the researchers have a protocol to ensure the privacy of your PHI.
- Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent serious threat to your health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat.
- Military. Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
- National Security. We may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials for lawful intelligence, counterintelligence, and other national security activities.
- Inmates. We may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
- Workers’ Compensation. Our practice may disclose your PHI to the extent necessary to comply with the Maine Workers’ Compensation Act or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
- You and the Dept. of Health & Human Services (DHHS). We must disclose your PHI to you, upon request, and to the Secretary of the U.S. DHHS to investigate or determine Audiology Center d/b/a Audiology Center of Maine’s compliance with the privacy laws.
11) Health Oversight Activities.
We may disclose your PHI to a health oversight agency for audits, investigations, inspections, and other activities necessary for the appropriate oversight of the health care system and the government benefit programs such as MaineCare and Medicare.
12) Public Health Risks.
Audiology Center d/b/a Audiology Center of Maine may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
- preventing or controlling disease, injury or disability
- notifying a person regarding potential exposure to communicable disease
- notifying a person regarding a potential risk for spreading or contracting a disease or condition
- reporting child abuse or neglect
- reporting reactions to drugs or problems with products or devices
- notifying individuals if a product or device they may be using has been recalled
- notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
- notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
D. USE AND DISCLOSURES OF PHI BASED UPON YOUR WRITTEN AUTHORIZATION
From time to time, you may request that Audiology Center d/b/a Audiology Center of Maine disclose your PHI to specified individuals or companies for a defined purpose and/or timeframe. Also, you may authorize disclosures to individuals who are not involved in treatment, payment, or health care operations, such as attorneys, if you are involved in litigation either on your own or another’s behalf. If you wish us to make disclosures in these situations, we will ask you to sign an “Authorization to Use and Disclose Protected Health Information.”
E. YOUR RIGHTS REGARDING YOUR PHI
- Right to request restriction of uses and disclosures. You have the right to request that we not use or disclose any part of your PHI unless it is a use or disclosure required by law. Please advise us of the specific PHI you wish restricted and the individual(s) who should not receive the restricted PHI. You do not need to give a reason for your request. We are not required to agree to your restriction request, but if we do agree to the request, we will not use or disclose the restricted PHI unless it is necessary for emergency treatment. In that case, we will ask that the recipient not further use or disclose the restricted PHI.
- Inspection and Copies. You have the right to inspect and obtain a copy of your PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Audiology Center of Maine d/b/a Audiology Center of Maine. We will respond to your request as soon as possible, but no later than 30 days from the date of your request. We have the right to charge a reasonable fee for providing copies of your PHI.
- Right to amend PHI. You have the right to request that we amend the PHI in your record for as long as we maintain the PHI in such format. Please make your request in writing to our Privacy Officer. We will respond to your request as soon as possible, but no later than 60 days from the date of your request. If we deny your request for amendment, you have the right to submit a written statement of reasonable length disagreeing with the denial and we have the right to submit a rebuttal statement. A record of any disagreement about the amendment will become part of your medical records and may be included in subsequent disclosures of your PHI.
- Accounting of Disclosures. Subject to certain limitations, you have the right to a written accounting of disclosures by us of your PHI for not more than 6 years prior to your request. Your right to an accounting applies to disclosures other than those for treatment, payment, or health care operations; to yourself; for a facility directory; to your family or close friends involved in your care; or for notification purposes. Please make your request in writing to our Privacy Officer. We will respond to your request no later than 60 days from the date of the request. We will provide you with one accounting every 12 months free of charge, and may charge a reasonable fee for any subsequent accounting requests.
- Right to a copy of our Notice of Privacy Practices. We will ask you to sign a written acknowledgment of receipt of our Notice of Privacy Practices. We may amend this Notice of Privacy Practices and you may obtain an updated Notice from our Privacy Officer at any time.
F. COMPLAINT PROCEDURE
- Filing a complaint with the practice. If you believe your privacy rights have been violated please make your complaint in writing to our Privacy Officer. We will respond to your complaint in writing within 60 days of the date of your complaint.
- Filing a complaint outside the practice. If you believe we are not complying with our legal obligations to protect the privacy of your PHI, you may file a complaint with the Secretary of U. S. Department of Health and Human Services. You must make your complaint to the Secretary in writing within 180 days of the act or omission forming the basis of your complaint.
Audiology Center, LLC d/b/a Audiology Center of Maine
NOTICE OF PRIVACY PRACTICES
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.
Each time you visit or call our office a record of this is made in your chart. Audiology Center, LLC d/b/a Audiology Center of Maine is committed to protecting the privacy of your health information. Federal laws now require us to put in place more formal policies and procedures to safeguard your medical records. This also includes other records, such as billing records that contain personal health information about you.
These laws give you certain rights, such as the right to receive this notice outlining our privacy practices and your right to ask us for a current copy of this notice at any time. You have the right to ask to see and copy your records, ask us to change your records if they are incorrect or not complete. You may ask us for a listing of certain disclosures we may have made about you. If you think we violated your privacy, you may complain to us and/or to the Department of Health and Human Services.
In addition to these basic rights, we will honor all reasonable requests you may have about when, where and how we may contact you.
You may request we make changes to our normal privacy practices. We will consider your requests, although the law does not require us to agree to every suggestion you have. We will, however, always tell you if we can make special arrangements to meet your needs.
The health information you give us, or that we create to treat you, is routinely used to bill you or your insurer and to operate our business in ways consistent with good patient care and sound practice management. Your records are seen, in whole or part, by staff members who need this information to do their jobs. When necessary, we may release your medical records to other health care providers involved in your care. We may also discuss some health information about you with relatives or friends who help with your care, if you agree.
We may work with individuals and businesses that help us run our practice (for example: answering services, accountants, or billing consultants). Personal information about you may be disclosed to these business associates if they need the information to do their jobs. To protect your health information, we always include a provision on our contracts with these associates requiring them to put procedures in place to safeguard your records.
We release personal health information about our patients when we are required to do so by federal, state or local laws. We may also release this information for a number of public policy reasons including public health reporting, law enforcement activities, judicial proceedings, workers’ compensation, and certain types of records-based research. Whenever we release records for these reasons, we follow privacy safeguards suitable to the situation.
We will get a written authorization from you if we need to use or disclose your records for purposes other than those described above. You may revoke any authorizations you give us at any time, which must be done in writing.