Notice of Privacy Practices for Harbor Audiology & Hearing Services

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.

This Notice of Privacy describes how Harbor Audiology & Hearing Services 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 ( PHI) 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. You may call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment.

Uses and Disclosures of Protected Health Information

The following are examples of the uses and disclosures of your protected health care information that Harbor Audiology and Hearing Services, Inc. is permitted to make once you have signed our consent form.

Treatment : We may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. For example, your protected health information may be provided to a physician to or from whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your protected health information may be used, as needed, to obtain payment for your health care services.

Healthcare Operations : We may use or disclose your protected health information in order to support our business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training programs, licensing or credentialing and marketing activities.

We may share protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services, hearing aid sales, repairs and insurance) for our office. 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.

Others involved in Your Healthcare: 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.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders such as voicemail messages, postcards or letters.

Marketing Services: Occasionally we will use your health information for marketing communications such as newsletters and product information. These mailings will only come form Harbor Audiology and Hearing Services.

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 when we are required to do so by law. You will be notified, as required by law, of any such uses or disclosures.

Abuse or Neglect: We may disclose your protected health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety of the health or safety of others. 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.

National Security & Law Enforcement: We may use or disclose protected health information of Armed Forces personnel to appropriate military authorities; under certain circumstances. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities. We may disclose protected health information, as long as applicable legal requirements are met, for law enforcement purposes.

Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.

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.

Patient Rights

Access : You have the right to inspect and get copies of your protected health information. You must make a request in writing to obtain access to your health information. We will charge a reasonable fee for expenses such as copier and staff time.

Restriction: You have the right to request a restriction of your protected health information. 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. Harbor Audiology & Hearing Services is not required to agree to a restriction that you may request, but if we do, we will abide by our agreement (except in any emergency). You may request a restriction by contacting our Privacy Coordinator.

Alternative Communication: You have the right to request to receive confidential communications from us by alternative means or at any 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 Coordinator.

Amendment: You may have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.

Disclosure Accounting: 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, 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. The right to receive this information is subject to certain exceptions, restrictions and limitations.

Questions and Complaints

Please contact us if you want more information about our privacy practices or have questions or concerns.

If you believe your privacy rights have been violated by us, you may complain to us or to the Secretary of Health and Human Services. You may file a complaint with us by notifying our Privacy Coordinator of your complaint.

We support your right to the privacy of your health information. We will not retaliate against you for filing a complaint.

You may contact our Privacy Coordinator, at (253) 851-3932 for further information about the complaint process.

This notice becomes effective on April 14, 2003