EMC/Accutone Hearing
Services/BDI/The Headache Center
NOTICE OF PRIVACY PRACTICES
This
notice describes how health information about you
may be
used and disclosed and how you can access
this
information. Please review it carefully.
Our
Pledge Regarding Your Health Information
We understand that information about you and your
health is personal. We are committed to protecting the
privacy of this information. Each time you visit us, we
create a record of the care and services you receive. We
need this record to provide quality care and to comply with
certain legal requirements. This notice applies to all of
the records of your care generated by us, or received by us
from you or others. Our primary responsibility is to
safeguard your personal health information. We must also
make available this notice of our privacy practices, and we
must follow the terms of the notice that is currently in
effect. This notice will tell you about the ways in
which we may use and disclose health information about
you. We also describe your rights of access,
amendment, control, and other rights concerning the use and
disclosure of your health information.
PLEASE NOTE: if you are the parent, legal guardian, or
personal representative of the patient we are treating, the
references herein such as "...your personal health
information..." shall be understood to refer to that
patient.
Complaints: If you believe your privacy rights have been
violated, you may file a complaint with any of our
facilities. This complaint can be filed in writing to our
Privacy Officer: Janilyn M. Welsh, Ear Medical Center, Inc
6527 Colerain Avenue Cincinnati, Ohio 45239 There will be no
retaliation for filing a complaint. You can also file a
complaint with to the Secretary of the Department of Health
and Human Services.
How We May Use and Disclose Your Health
Information
The following categories describe different
ways that we may USE your health information within The Ear
Medical Center, Inc., and DISCLOSE your health information
to persons and entities outside of The Ear Medical Center,
Inc. We have not listed every use or disclosure within the
categories, but give some examples for understanding.
Common Uses and Disclosures Allowed by Law
Treatment:
We may use your health information to provide you treatment
and services. We may disclose health information about you
to others who are involved in your care.
Payment: We may use and disclose your health information
so the treatment and services you receive at The Ear Medical
Center, Inc. may be billed to and payment collected from
you, an insurance company or a third party. We may also
disclose health information to your insurance plan to obtain
prior authorization for treatment and procedures.
Health Care Operations: We may use and disclose your
health information for health care operations and activities
such as: quality assurance; administration; The Ear Medical
Center, Inc. financial and business planning and
development; customer service (including investigation of
complaints); and certain marketing and fundraising. These
uses and disclosures are necessary to operate our health
care facility and make sure patients receive quality
care.
Business Associates: Some services may be provided to our
organization through contracts with business associates,
such as: accountants; consultants; quality assurance
reviewers; billing and transcription services. We may
disclose your health information to our business associates
so that they can perform the job we’ve asked them to do. We
require our business associates to sign a contract that
states they will appropriately safeguard your
information.
Appointment Reminders: We may use and disclose health
information to contact you as a reminder that you have an
appointment for treatment or care at The Ear Medical Center,
Inc..
Marketing or Fundraising: We may contact you as part of a
marketing or fundraising effort. We may, for instance, tell
you about The Ear Medical Center, Inc. health-related
products, services, or activities that may be of
interest.
Research That Doesn’t Involve Your Treatment: When a
research study does not involve any treatment, we may
disclose your health information to researchers when an
Institutional Review Board has established appropriate
protocols to ensure the privacy of your health information,
and has approved the research.
Individuals Involved in your care: We may disclose health
information about you to a friend or family member who is
involved in your care, unless you tell us in advance not to
do so.
Other Laws: At times there may be federal, state or local
laws that require us to use or disclose health information
in other ways, and we will obey those laws. Additionally,
when a state law about protecting your health information
gives you more protection than the federal laws, we will
follow those.
Special Situations Which Do Not Require Your
Authorization
The following disclosures of your health
information are permitted by law without any oral or written
permission from you:
Organ and Tissue Donation: If you are an organ donor, we
may release health information to organizations that handle
organ procurement or transplantation, as necessary to
facilitate the donation.
Military and Veterans: If you are a member of the armed
forces, we may release health information about you as
required by military command authorities.
Worker’s Compensation: We may release health information
about you for worker’s compensation or similar programs if
you have a work related injury.
Averting a Serious Threat to Health or Safety: We may use
and disclose your health information when necessary to avert
a serious threat to you or others. These disclosures would
be made only to someone able to intervene.
Public Health Activities: We may disclose health
information about you for public health activities,
including:
* To prevent or control disease, injury or
disability.
* To report births and deaths.
* To report
child abuse or neglect.
* To report reactions to
medications, problems with products or other adverse
events.
* To notify people of recalls of products they
may be using.
* To notify a person who may have been
exposed to a disease or may be at risk for contracting or
spreading a disease or condition.
* To notify the
appropriate government authority if we believe a patient has
been the victim of abuse (including child abuse), neglect or
domestic violence.
* To Disaster Relief agencies (such as
the Red Cross) for notification as to your location and
condition.
Health Oversight Activities: We may disclose health
information to a health oversight agency for activities
authorized by law. These include audits, investigations,
inspections and licensure. These activities are necessary
for the government to monitor the health care system,
government programs and compliance with civil rights
laws.
Lawsuits and Disputes: If you are involved in a lawsuit
or a dispute, we may be required to disclose your health
information in response to a court order, administrative
order, subpoena, discovery request or other lawful process
by someone involved in the dispute.
Law Enforcement: We may disclose health information to
law enforcement officials for reasons such as:
* In
response to a court order, subpoena, warrant, summons or
similar process.
* To identify or locate a suspect,
fugitive, material witness or missing person.
* About the
victim of a crime if, under certain circumstances, we are
unable to obtain the person’s agreement.
* About a death
we believe may be the result of criminal conduct.
* About
criminal conduct at our facility.
* In emergency
circumstances to report a crime, the location of the crime
or victims, or the identity, description or location of the
person who committed the crime.
Coroners, Medical Examiners and Funeral Home Directors:
We may disclose health information to a coroner or medical
examiner, to identify a deceased person or determine the
cause of death. We may also release health information about
patients to funeral home directors as necessary to carry out
their duties.
National Security and Intelligence Activities: We may
disclose health information about you to authorized federal
officials for intelligence, counterintelligence and other
national security activities authorized by law.
Legal Requirements: We will disclose health information
about you without your permission when required to do so by
federal, state or local law.
Other Uses and Disclosures with Your
Authorization
Other uses and disclosures of health
information not covered by this notice or applicable laws
will be made only with your written permission (called
“authorization”). If you give authorization to do so, you
may revoke that authorization in writing at any time. Some
typical disclosures that require your authorization are as
follows:
Research Involving Your Treatment: When a research study
involves your treatment, we may disclose your health
information to researchers only with your authorization. For
any such research study, an Institutional Review Board will
often have already have established appropriate protocols to
ensure the privacy of your health information, and approved
the research. You do not have to sign the authorization in
order to get treatment from The Ear Medical Center, Inc.,
but without your authorization, you cannot be part of the
research study.
Drug and Alcohol Abuse, and Mental Health Treatment
Disclosures: We will disclose drug and alcohol abuse, and
mental health treatment information about you only in
accordance with state and federal laws. In general, your
authorization is required for such disclosures.
Disclosures Requested by The Ear Medical Center, Inc.: We
may give you the option of authorizing us to use or disclose
your health information for specific purposes such as
notifying you of future educational events that might
benefit you.
Your Health Information Rights
You have the following
rights concerning your health information:
1. Request a restriction on certain uses and disclosures
of your information. We are not required by law to agree to
your request.
2. Obtain a copy of this Notice of Patient Privacy
Practices upon request.
3. Inspect and/or request a copy of your health record.
We may deny your request under very limited circumstances.
If denied, you may request that the denial be reviewed by
another health care professional chosen by our health care
team. We will abide by the outcome of that review.
4. Request an amendment to your health record if you feel
the information is incorrect or incomplete. We may deny your
request if: (1) it is not in writing; (2) it does not
include a valid reason; (3) the information was not created
by or kept by The Ear Medical Center, Inc.; (4) is not
information which you would be permitted to access; (5) if
the information is accurate and complete; or (6) it would
require us to delete information from your health
record.
5. Obtain an accounting of disclosures of your health
information. The accounting will not include the allowed
common uses and disclosures, or uses and disclosures that
you authorized.
6. Request communication of your health information by
alternative means or locations.
7. Revoke your authorization except to the extent that
action has already been taken.
8. File a complaint about any aspect of our health
information practices to us or to the Department of Health
and Human Services of the United States. You can complain to
us and expect an investigation and explanation by calling or
writing our Privacy Officer: Janilyn M. Welsh, Ear Medical
Center, Inc 6527 Colerain Avenue Cincinnati, Ohio 45239. You
can make a complaint to the Dept. of Health and Human
Services by addressing your written complaint to: Secretary,
Dept. of Health and
Human Services in an email to OCRComplaint@hhs.gov,
or to: The Office for Civil Rights, U.S. Department of
Health and Human Services, 233 N. Michigan Ave.,
Suite
240, Chicago, Ill. 60601. Voice Phone (312) 886-2359. FAX
(312) 886-1807. TDD (312) 353-5693.
We reserve the right to change this notice, and to make
the revised or changed notice effective for health
information we already have about you as well as any
information we receive in the future. A copy of the current
notice in effect will be available at The Ear Medical
Center, Inc.. Effective Date:
04-08-03
