HIPAA 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.
Advanced Digital Hearing Aid Center (ADHAC) maintains a record of the health care services we provide to you. This includes your symptoms, or findings, test results, diagnoses and treatment, health information from other providers, and billing and payment information relating to these services. Federal and state laws allow us to use this information to provide care for you but require us to protect the privacy of this information.
ADHAC respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so. We are required by law to provide to you this notice of our privacy practices.
How your Health Information is Used
• Information will be used to help decide what care may be right for you.
• This information may be shared with other health care providers caring for you.
• Every patient has their pre op exam counseling, their anesthetic injection, along with any.
other private medical history taking in a private room. But the rest of the time including
teaching activities, administration of eye drops and waiting for eye drops to take effect,
patients are in a group setting, unless you prefer to be in a private setting for those phases.
Please advise us if you prefer a private setting, and we will accommodate you.
• Diagnoses, procedures performed, or recommended care is provided to your health insurance plan so that we may receive payment from them.
• You may opt to restrict disclosure of your personal health information to your health plan if
you pay for your services at Pacific Cataract and Laser Institute entirely out-of-pocket.
• If you ask us not to release any of your information to your insurance company(ies), we will respect that, and take special measures to be sure not to release your information to your insurance company(ies).
For health care operations:
• Information may be used to assess and improve the quality of care we provide.
• We may contact you to remind you about appointments.
• Information may be used to conduct or arrange for services, including:
• Medical quality review by your health plan;
• Accounting, legal, risk management, and insurance services;
• Audit functions, including fraud and abuse detection and compliance programs.
Your Health Information Rights
The health and billing records we create and store are the property of ADHAC. The protected health information in it, however, generally belongs to you. You have a right to:
• Receive, read, and ask questions about this Notice;
• Ask us to restrict certain uses and disclosures of your health information. You must deliver this request in writing to us. We are not required to grant your request, but if we can and do grant it, we will comply with your wishes;
• Receive from us a copy of this Notice;
• See and obtain a copy of your protected health information. You may request that this information is provided to you in written or electronic format. Please make this request in writing;
• Ask us to change your health information. Please make this request in writing;
• Receive a list of disclosures of your health information (excluding disclosures to third-party payers);
• Cancel prior authorizations to use or disclose health information. Again, please provide this request in writing.
Other Disclosures and Uses of Protected Health Information
Notification to Family and Others
• We will only release your health information directly to you and or your legal guardian.
• We may also give information to someone who helps pay for your care.
• We may disclose health information about you to assist in disaster relief efforts.
• We may release health, information about you to a friend or family member but only at your request or with your approval.
• Emergency situations may arise where it is necessary for us to inform your family of your location and general well-being. The person contacted will be, if at all possible, the individual you designate to contact in case of emergency.
If you are not comfortable with and do not agree with any of these policies and practices regarding your privacy please inform us and we will do our best to follow your wishes.
Other situations where your health information may be used without your authorization
• For Medical Researchers — if the research has been approved and has policies to protect
the privacy of your health information.
• To the Food and Drug Administration relating to problems with regulated products.
• To Comply With Workers' Compensation Laws
• For Public Health and Safety Purposes as Allowed or Required by Law, to prevent or reduce a serious threat to the health or safety of a person or the public.
• To Report Suspected Abuse or Neglect to public authorities.
• To Correctional Institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
• For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
• For Health and Safety Oversight Activities. For example, we may share health information with the Department of Health.
• For Work-Related Conditions that Could Affect Employee Health. For example, an employer may ask us to assess health risks on a job site.
• To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission.
• In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.
• For Specialized Government Functions. For example, we may share information for national security purposes.
• In the event of the patient's death we may disclose relevant PHI of the deceased patient to a family member, friend, or representative, if that family member, friend, or person had been involved in the patient's care or payment before death. Unless disclosure would be inconsistent with the patient's express wishes to the practice.
Other Uses and Disclosures of Protected Health Information will be made only as allowed or required by law or with your written authorization. This includes but is not limited to:
• The transfer of your records to a doctor who did not refer you to ADHAC, or you were not referred to by ADHAC. For example, if you move from the area, and see a new doctor, a signed release is required in order for ADHAC to release your records to that doctor.
• The transfer of your records in the course of judicial/administrative proceedings at your request as directed by a subpoena or court order.
Should There Be a Security Breach That Potentially Affects Patient Privacy and PHI
We are required to:
• Notify patients.
• Take steps to mitigate the damage.
• Notify the Department of Health and Human Services (HHS)
We are required to:
• Keep your protected health information private;
• Give you this Notice;
• Follow the terms of this Notice.
We may change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our facility to pick one up.
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact the ASC Manager at ADHAC office during regular business hours. You may also deliver a written complaint to our ASC Manager. You may also file a complaint with the U.S. Secretary of Health and Human Services. If you file a complaint, we will not retaliate against you.
Complaints should be sent to:
Attn: Privacy Officer
710 George Washington Way Suite CC
Richland, WA 99352
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Additional Information About This Notice
Changes to this Notice: We reserve the right to change the ADHAC privacy practices as described in this Notice. Any change may affect the use and disclosure of PHI already maintained by ADHAC, as well as any of PHI that ADHAC may receive or create in the future. If there is a material change to the terms of this Notice, revised Notices will be made available at ADHAC.
Acknowledgment: When first delivering this Notice to you, ADHAC will ask you to sign an acknowledgment that you were provided a copy of this Notice.
How to obtain an additional copy of this Notice: You can obtain a copy of the current notice by writing our Privacy Officer at the address or e-mail address set out in this Notice.
If you have any questions regarding this Notice, please contact:
710 George Washington Way Suite CC
Richland, WA 99352
Attention: Privacy Officer
Effective Date of this Notice: September 23, 2013
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