Hearing Services of Kentucky, Inc

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Privacy Notice

HEARING SERVICES OF KENTUCKY, INC
NOTICE OF PRIVACY PRACTICES

For Your Protection	This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Protected Health Information	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 to you. We are required by law to maintain confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.
Use and Disclosure of PHI	The following categories describe the different ways in which we may use and of disclose your PHI. Treatment. Our practice may use your PHI to treat you. Many of the people who work for our practice - including, but not limited to, our audiologists - may use or disclose your PHI in order to treat you or to assist others in your treatment. We may disclose your PHI to ear mold manufacturers and hearing aid manufacturers. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the 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 or banks. Also, we may use your PHI to bill you directly for services and items. We may disclose PHI to our collection agency and /or its agents for purposes of collecting delinquent or unpaid bills. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts. Health Care Operations. Our practice may use and disclose your PHI to operate our business, as examples of the ways in which we may use and disclose your information for our operations; our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your PHI to other health care providers and entities to assist in their health care operations. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment. We may call your home or send you a post card, requesting that you contact our office for follow-up visits. Disclosure Required By Law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.
May I See My Medical Information?	You are allowed to see your medical information, unless it is the private notes taken by a mental health provider or is part of a legal case. Most of the time you can receive a copy, if you ask. You may be charged a small amount for the copying costs.
Can I Amend My PHI?	If for some reason you think some of the information is wrong, you may ask in writing that it be changed or new information be added. You may also ask that the changes be sent to others who have received your PHI. If we deny your request for this amendment to your medical information, you have the right to file a statement of disagreement with us, and we may prepare a rebuttal to your statement. You may ask for a list of any places where medical information may have been sent if it was not sent as part of your provider’s care or used to be sure that you received quality care and that all laws about medical care are met.
What if My Information Needs to Go Somewhere Else?	You will be asked to sign an authorization form allowing your medical Medical information to be shared if: Your healthcare provider needs to send it to other places. You want us to send it to another healthcare provider. You want it sent to another person for you, or obtain a copy for yourself. The form tells us what, where and to whom the information must be sent. You may be charged a small amount for the copying costs. Your authorization is good for 6 months or until the date you put on the form. You can cancel or limit the amount of information sent at any time by letting us know in writing. Note: If you are less than 18 years old, your parents or guardians will receive your private medical information, unless you are able to consent for your own healthcare treatment. If you are, then it will not be shared with your parents or guardians unless you sign an authorization form. You may also ask to have your information sent to a different person.
Could Medical Information Be Released Without My Authorization?	There are laws that tell us when we have to release private information, even if you do not sign an authorization form. We always report: contagious diseases; to the police when they are investigating a crime, when child or elder abuse may be occurring, or when the court orders us to; work related injuries to workers compensation; to the U.S. military or foreign military (if you are a member of that military service) and to the Department of Veterans Affairs; to the federal government when they are investigating something important to protect our country, the President and other government workers.
May I Restrict the Use of My PHI?	You have the right to request that we restrict the use or disclosure of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for disaster relief notification purposes. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to your request. If we do agree to the restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment or its use or disclosure is required by law. If you want to request a restriction, it must be made in writing to our Privacy Officer at our office. Your request must describe in clear and concise fashion: the information you wish restricted, whether you are requesting to limit our practice’s use, or disclosure or both to whom you want the limits to apply.
May I Have a Copy of this Notice?	This notice is yours. If you have any questions about this notice, please ask the person who gave or sent it to you. We reserve the right to make modifications and changes to this Notice and to make the new Notice provisions effective for all protected health information that we maintain. If we change our Notice of Privacy Practices, we will post the revised Notice in a clear and prominent place in our office and make a copy available to you upon request. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services at: The Secretary of the Department of Health and Human Services 200 Independence Ave. SW Washington, DC 20201 404-562-7886 TDD 404-331-2867 To file a complaint with our practice we request that you mail your complaint to our office at: Hearing Services of Kentucky, Inc. 1717 High Street, Suite 2C Hopkinsville, KY 42240 You will not be penalized for filing a complaint.
Effective Date	The effective date of this Notice is April 1, 2003.