HEARING AIDS IN SALT LAKE CITY, UT
Salt Lake Hearing Zone’s Notice of Privacy Practices
I. Salt Lake Hearing Zone’s Privacy Practices
II. Our Privacy Responsibilities
III. Uses and Disclosures of PHI Permitted by Law
The law permits us to use your PHI for treating you, billing for our services provided to you and for health care operations necessary to operate our clinics. Some health records, including confidential communications with mental health professionals, substance abuse treatment records, and genetic test results, may have additional restrictions for use and disclosure under state and federal laws. We may use and/or disclose your PHI for the following purposes:
1. Treatment. To provide treatment and other services to you. For example, diagnosing and treating your injury or illness, sending you appointment reminders or information about treatment alternatives or other health-related benefits, and services that may be of interest to you.
2. Payment. To obtain payment for services provided to you. For example, disclosures to submit claims to and obtain payment from your health insurer.
3. Health Care Operations. To conduct health care operations. For example, to conduct the business of and evaluate the quality of treatment and services provided by our physicians, nurses, and other health care workers.
4. Individuals Involved in Your Care or Payment for Your Care. To a family member, a close personal friend, or any other person identified by you if we obtain your consent. Please let us know if you would like to allow someone access to your PHI and we will provide you with the appropriate consent form to sign.
5. Immunization Records to Schools. If a state or other law requires a school to have immunization records on a student before the student can be enrolled, we can disclose the student’s immunization records to the school with a parent’s consent. We can obtain a parent’s consent over the phone or in writing.
6. Health Care Communications. To identify health-related services and products that may be beneficial to you, and then contact you about the services and products.
7. Public Health Activities. To report: (a) health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability; (b) child, adult, or elder abuse and neglect, domestic violence, to public health authorities, government authorities, or other services authorized by law to receive such reports; (c) information about products under the jurisdiction of the U.S. Food and Drug Administration; (d) communicable disease risks to a person who may have been exposed or be at risk of contracting or spreading a disease or condition; and (e) information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
8. Health Oversight Activities. To a health oversight agency that oversees the health care system and ensures compliance with the rules of government health programs, such as Medicare or Medicaid.
9. Judicial and Administrative Proceedings. In the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
10. Threat to Health and Safety. To reduce or prevent a serious threat to public health and safety.
11. Law Enforcement Officials; Specialized Government Functions. To: (a) the police or other law enforcement officials as required by law or in compliance with a court order; (b) military authorities for the personal and health information of armed forces personnel under certain circumstances; or (c) authorized federal officials for personal and health information required for lawful intelligence, counterintelligence, and other national security activities.
12. Decedents. To a coroner, medical examiner, or funeral director as authorized by law. We may also disclose a deceased patient’s PHI to close family members of the deceased if the disclosure is related to the treatment immediately prior to death or for payment purposes, and the disclosure is not inconsistent with any prior restriction requested by you.
13. Organ and Tissue Procurement. To organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.
14. Workers’ Compensation. To comply with workers’ compensation laws.
IV. Uses and Disclosures with Your Authorization
The Clinic cannot use your PHI for anything other than the reasons mentioned above, without your signed “Authorization.” An Authorization is a written document signed by you that permits the Clinic to use your PHI for a specific purpose. You may revoke your Authorization by delivering a written revocation statement to the Clinic. If you revoke your Authorization, the Clinic will no longer use or disclose your PHI as permitted by your Authorization. Of course, your revocation of Authorization will not reverse the use or disclosure of your PHI while your Authorization was in effect, nor will it disallow us from use or disclosure of your information as described in item III above. The following uses and disclosures of your PHI will be made only with your written authorization:
1. Most uses and disclosures of psychotherapy notes;
2. Uses and disclosures for marketing purposes;
3. Uses and disclosures that may constitute the sale of PHI; and
4. Other uses and disclosures not described in this Notice.
V. Your Individual Rights
Right to Access Your Protected Health Information. You may request access to our records that we use for decision-making purposes about you that contain your PHI. You may request access in order to inspect and ask for copies of the records. You may request an electronic copy of your PHI if it is maintained in an electronic format. Under limited circumstances, we may deny you access to a portion of your records. If your request is denied, you will receive a written response and may request that the denial be reviewed. If you desire access to your records, please ask the receptionist for the appropriate documentation. If you request copies of your records, we are allowed to charge a fee for the costs of copying, mailing, or other services associated with your request. Determination of the fee will be made at the time your request is processed. A period of time may be necessary to complete your request.
Right to Request Amendment to Your Records. You have the right to request an amendment to your PHI that we created and used for decision-making purposes. If you desire to amend your records, please ask the receptionist for the appropriate documentation. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other circumstances apply. In such cases, we are not required to grant your request.
Right to Receive Confidential Communications. You may request, and we will accommodate, any reasonable written request for you to receive PHI by alternative means of communication, or at alternative locations such as by mail to an address other than your home.
Right to Request Additional Restrictions. You may submit a written request for restrictions on our use and disclosure of PHI: (1) for treatment, payment, and health care operations; (2) to individuals (such as a family member, other relative, close personal friend, or any other person identified by you) involved with your care or with payment related to your care; or (3) to notify or assist in the notification of such individuals regarding your location and general condition. We will consider all requests for additional restrictions carefully but are not required to agree to a requested restriction. To request additional restrictions, please ask the receptionist for the appropriate documentation.
Right to Request Restriction on Uses and Disclosures Related to Treatment/Services Paid for by You Out-of-Pocket. If you paid in full for a specific treatment, item or service out-of-pocket, you have the right to ask that your PHI related to that specific treatment, item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor your request.
Right to Receive an Accounting of Disclosures. You may request in writing an accounting of certain disclosures of PHI made by us or by our business associates. Your request must state the period of time desired for the accounting, which must be within the six (6) years prior to the date of your request and exclude dates prior to April 14, 2003. If you desire to receive an accounting of disclosures, please ask the receptionist for the appropriate documentation. We may charge a fee based on the cost of fulfilling your request. You will be notified of the fee at the time of your request and will be given the opportunity to withdraw or modify your request.
Right to Receive a Notice of Breach of Your PHI. In the rare event that the security of your PHI is compromised or “breached,” we will notify you of the breach, provide you with information regarding the breach and what steps you can take to protect yourself from harm.
Right to Opt Out of Fundraising Communications. In the rare event that we contact you to solicit funds for the Clinic, you have the right to opt out of receiving any such communications. We will notify you of our intent to distribute any fundraising communications prior to their distribution to provide you with the opportunity to opt out.
Right to Complain About our Policy Practices. Please contact us if you desire further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to your PHI. You may also file written complaints with the Director of the Office of Civil Rights of the U.S. Department of Health and Human Services. Be assured that no retaliation or diminution of service will result if you file a complaint with the Director or the Clinic.
VI. Effective Date and Duration of This Notice
Right to Change Terms of This Notice. We may change this Notice at any time. If we do, the new Notice may apply to any information (including PHI) created or received prior to issuing the new Notice.
VII. Contact Information
Right to Access Your Protected Health Information. You may request access to our records that we use for decision-making purposes about you that contain your PHI. You may request access in order to inspect and ask for copies of the records. You may request an electronic copy of your PHI if it is maintained in an electronic format. Under limited circumstances, we may deny you access to a portion of your records. If your request is denied, you will receive a written response and may request that the denial be reviewed. If you desire access to your records, please ask the receptionist for the appropriate documentation. If you request copies of your records, we are allowed to charge a fee for the costs of copying, mailing, or other services associated with your request. Determination of the fee will be made at the time your request is processed. A period of time may be necessary to complete your request.
Right to Request Amendment to Your Records. You have the right to request an amendment to your PHI that we created and used for decision-making purposes. If you desire to amend your records, please ask the receptionist for the appropriate documentation. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other circumstances apply. In such cases, we are not required to grant your request.
Right to Receive Confidential Communications. You may request, and we will accommodate, any reasonable written request for you to receive PHI by alternative means of communication, or at alternative locations such as by mail to an address other than your home.
Right to Request Additional Restrictions. You may submit a written request for restrictions on our use and disclosure of PHI: (1) for treatment, payment, and health care operations; (2) to individuals (such as a family member, other relative, close personal friend, or any other person identified by you) involved with your care or with payment related to your care; or (3) to notify or assist in the notification of such individuals regarding your location and general condition. We will consider all requests for additional restrictions carefully but are not required to agree to a requested restriction. To request additional restrictions, please ask the receptionist for the appropriate documentation.
Right to Request Restriction on Uses and Disclosures Related to Treatment/Services Paid for by You Out-of-Pocket. If you paid in full for a specific treatment, item or service out-of-pocket, you have the right to ask that your PHI related to that specific treatment, item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor your request.
Right to Receive an Accounting of Disclosures. You may request in writing an accounting of certain disclosures of PHI made by us or by our business associates. Your request must state the period of time desired for the accounting, which must be within the six (6) years prior to the date of your request and exclude dates prior to April 14, 2003. If you desire to receive an accounting of disclosures, please ask the receptionist for the appropriate documentation. We may charge a fee based on the cost of fulfilling your request. You will be notified of the fee at the time of your request and will be given the opportunity to withdraw or modify your request.
Right to Receive a Notice of Breach of Your PHI. In the rare event that the security of your PHI is compromised or “breached,” we will notify you of the breach, provide you with information regarding the breach and what steps you can take to protect yourself from harm.
Right to Opt Out of Fundraising Communications. In the rare event that we contact you to solicit funds for the Clinic, you have the right to opt out of receiving any such communications. We will notify you of our intent to distribute any fundraising communications prior to their distribution to provide you with the opportunity to opt out.
Right to Complain About our Policy Practices. Please contact us if you desire further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to your PHI. You may also file written complaints with the Director of the Office of Civil Rights of the U.S. Department of Health and Human Services. Be assured that no retaliation or diminution of service will result if you file a complaint with the Director or the Clinic.