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West Newton
Hearing Center
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.
West Newton Hearing Center is required by law to maintain
the privacy of your health information and to provide you
with notice of its legal duties and privacy practices with
respect to your health information. If you have questions
about any part of this notice or if you want more information
about the privacy practices at West Newton Hearing Center
please contact:
Office Manager, West Newton Hearing Center, 1298 Washington
St., P0 Box 650038, West Newton MA 02465 (telephone 617-332-7244)
Effective Date of This Notice: April
1, 2003
I. How West Newton Hearing Center may
Use or Disclose Your Health Information
West Newton Hearing Center collects health information from
you and stores it in a chart and on a computer. This is your
medical record. The medical record is the property of West
Newton Hearing Center, but the information in the medical
record belongs to you. West Newton Hearing Center protects
the privacy of your health information. The law permits West
Newton Hearing Center to use or disclose your health information
for the following purposes:
1. Treatment. Information obtained
by the audiologist is recorded in your record and used to
determine the course of treatment that should work best for
you. Reports are sent to referring physicians and other specialists
who participate in your hearing health care. These physicians
are also asked to sign medical concurrence forms prior to
hearing aid fittings.
2. Payment. A bill may be sent to
you or a third-party payer. The information on or accompanying
the bill may include information that identifies you as well
as your diagnosis, procedures, and supplies used.
3. Regular Health Care Operations.
We may also use and disclose Personal Health Information for
our internal operations. These may include such activities
as the coordination of materials to be sent to our billing
agent, and the review of charts by our audiologic staff to
monitor the quality and effectiveness of the care we provide.
4. Business Associates. There may
be some services provided in our organization through participation
of outside companies, here referred to as Business Associates.
For example, billing is done by a medical billing service
with which we contract. Orders for hearing aids, earmolds,
and other related supplies may be sent to a hearing aid manufacturer
or earmold laboratory. We may disclose hearing health information
so that these companies can perform the job that we've asked
them to do. To protect your health information, however, we
require any Business Associate to appropriately safeguard
your information.
5. Information provided to you. We
have procedures for you or your authorized representative
to have access to the personal information that we collect.
6. Required by law. As required by
law, we may use and disclose your health information.
7. Notification and communication with
family. We may disclose to a family member, other relatives,
close personal friends or any other person you identify, health
information relevant to that person's involvement in your
care or payment related to your care. If you are able and
available to agree or object, we will give you the opportunity
to object prior to making this notification. If you are unable
or unavailable to agree or object, our health professionals
will use their best judgment in communication with your family
and others.
8. Public health. As required by
law, we may disclose your health information to public health
authorities for purposes related to: preventing or controlling
disease, injury or disability; reporting child abuse or neglect;
reporting domestic violence; reporting to the Food and Drug
Administration problems with products and reactions to medications;
and reporting disease or infection exposure.
9. Health oversight activities. We
may disclose your health information to health agencies during
the course of audits, investigations, inspections, licensure
and other proceedings.
10. Judicial and administrative proceedings.
We may disclose your health information in the course of any
administrative or judicial proceeding.
11. Law enforcement. We may disclose
your health information for law enforcement purposes as required
by law or in response to a valid subpoena.
12. Public safety. We may disclose
your health information to appropriate persons in order to
prevent or lessen a serious and imminent threat to the health
or safety of a particular person or the general public.
13. Worker's compensation. We may
disclose your health information as necessary to comply with
worker's compensation laws.
14. Marketing. We may contact you
to provide appointment reminders or to give you information
about other treatments or health-related benefits and services
that may be of interest to you.
15. Specialized government functions.
We may disclose your health information for military and national
security purposes.
16. Fund-raising. We may contact
you to participate in fund-raising activities sponsored by
the West Newton Hearing Center.
17. Change of Ownership. In the event
that the West Newton Hearing Center is sold or merged with
another organization, your health information/record will
become the property of the new owner.
II. When the West Newton Hearing Center
May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices,
the West Newton Hearing Center will not use or disclose your
health information without your written authorization. If
you do authorize us to use or disclose your health information
for another purpose, you may revoke your authorization in
writing at any time.
Ill. Your Health Information Rights
1. You have the right to request restrictions on certain
uses and disclosures of yqur health information. West Newton
Hearing Center is not required to agree to the restriction
that you requested.
2. You have the right to receive your health information
through a reasonable alternative means or at an alternative
location. Requests must be made in writing, and you may be
asked to pay a fee to cover staff time, duplicating and mailing
expenses.
3. You have the right to inspect and copy your health information.
4. You have a right to request that the West Newton Hearing
Center amend your health information that is incorrect or
incomplete. West Newton Hearing Center is not required to
change your health information and will provide you with information
about the organization's reason for denial and how you can
disagree with the denial.
5. You have a right to receive an accounting of disclosures
of your health information made by the West Newton Hearing
Center, except those disclosures described in parts I (treatment),
2 (payment), 3 (health care operations), and 4 (information
provided to you) of section I of this Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy
Practices.
If you would like to have a more detailed explanation of
these rights or if you would like to exercise one or more
of these rights, contact the office manager, West Newton Hearing
Center, 1298 Washington St., P0 Box 650038, West Newton MA
02465 (telephone 617-332-72~).
IV. Changes to this Notice of Privacy
Practices
West Newton Hearing Center reserves the right to amend this
Notice of Privacy Practices at any time in the future, and
to make the new provisions effective for all information that
it maintains, including information that was created or received
prior to the date of such amendment. Until such amendment
is made, West Newton Hearing Center is required by law to
comply with this Notice.
If there are revisions to this Notice, our
current patients will be notified by mail. Changes will also
be posted on our website www.newtonhearing.com.
V. Complaints
Complaints about this Notice of Privacy Practices or how
West Newton Hearing Center handles your health information
should be directed to: Deborah M. Guthermann, Au.D., Director,
West Newton Hearing Center.
If you are not satisfied with the manner in which this office
handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your complaint to one
of the regional Offices for Civil Rights. A list of these
offices can be found online at http://www.hhs.gov/ocr/regmail.html.
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