THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Notice of Privacy Practices Throughout this notice, the words “we” and “us,” mean The Hearing & Speech Center, and any other entity which we may include from time to time as a member of our organized health care arrangement. “You” refers to anyone who receives health care services or products from us. “Health information” means any information, whether oral, written or recorded in any form, that we create or receive relating to your past, present or future health or health care payment. How we may USE and DISCLOSE your HEALTH INFORMATION We are required by law to give you this Notice explaining that we use and disclose your health information for the following purposes:
Treatment: We will use your health information to provide you with health care services or products. We may shareyour health information with doctors and others who are involved in your care and who are part of the entity providingyour care. With your consent (or the consent of your legal representative), we may share certain health informationspecified by you with your family members or others involved in your care or other entities or individuals outsideLexington Hearing and Speech Center.
Payment: We may use and disclose health information about you so that we can bill any applicable payors or programsfor your health care services or products. If your insurer or health plan requires prior approval or other notice in orderto determine whether they will pay for those services or products, we may disclose your health information to them –unless you have asked that we not bill your insurer or plan.
Business Associates: We may disclose information about you within Lexington Hearing and Speech Center to manageand improve our business. This includes quality assessment activities, licensing and accreditation activities, obtaininglegal and accounting services, and business planning and management. Other people and companies who are notemployees or affiliates of Lexington Hearing and Speech Center may help us run our business. These people and/orcompanies are our “business associates.” We may give them limited access to your health information if they need it todo what we have hired them to do and they agree to safeguard your information.
Treatment Alternatives: We may use and disclose your health information to contact you to provide information abouttreatment alternatives.
Individuals Involved in Your Care: If you agree, we may give certain health information about you to a friend orfamily member involved in your care or obtaining payment related to your care. If you cannot agree because ofincapacity or emergency circumstances, we may disclose your health information as necessary if we determine that it isin your best interest, based on our professional judgment. We may disclose information about you to an organizationassisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research: We will not use or disclose any health information that identifies you or can be used to identify you for anyresearch purposes unless you agree in writing or we follow state law procedures for attempting to notify you of ourresearch request. If you want to participate in clinical research trials involving treatment, you will be asked to signadditional authorizations, either by us or by the entity or person conducting the research trials.
Workers’ Compensation: We may release health information about you for workers’ compensation or similarprograms to the extent authorized and necessary to comply with related laws. These programs provide benefits forwork-related injuries or illness.
Public Responsibilities: If you cannot agree because of incapacity or emergency circumstances and we need to use ordisclose your health information, we will do so without your authorization for the following purposes:
To the government for public health activities as permitted or required by law to report disease statistics,births and deaths, child or vulnerable adult abuse or neglect, domestic violence, reactions to medications,problems with products and disease exposures;
To a health oversight agency for audits, investigations, inspections, and licensure activities;
To prevent a serious and imminent threat to the health or safety of a person or the public, or to help the policeapprehend an individual involved in a violent crime which may have seriously harmed someone;
To organ procurement organizations to facilitate organ or tissue donation and transplantation, consistent withapplicable law;
To a law enforcement official in response to a court order, subpoena, warrant, summons or similar process; toidentify or locate a suspect, witness, or missing person; to identify a victim of crime if, under certain limitedcircumstances, we are unable to obtain the victim’s agreement; or in emergency circumstances to report thelocation and perpetrator of a crime;
To a court or party in litigation in response to a valid court or administrative order;
To a coroner or funeral director as permitted or required by law to identify a deceased person, determine thecause of death, or otherwise as necessary to carry out their duties;
If you are an inmate of a correctional institution, to the institution as necessary for your health and the healthand safety of other individuals;
For military, national security or lawful intelligence activities; or
As otherwise as permitted or required by law.
Uses and disclosures of your health information other than those described above, will be made only with your written or verbal authorization. You may revoke that authorization in writing at any time, but we cannottake back any disclosures we already made in reliance on a previous authorization.
YOUR RIGHTS TO YOUR HEALTH INFORMATION
You have the following rights regarding the health information we maintain about you:
Rights to Inspect and Copy: With some exceptions, you have the right to inspect and request a copy of your recordsif we have or use those records and they include health information about you. To inspect and request a copy ofrecords containing your health information, you must submit your request in writing to our Executive Director, at theaddress listed at the end of this Notice. If you request a copy of the information, we may charge a fee for the costs ofcomplying with your request. In some cases, we may deny your request to inspect and copy records; you may requestto inspect and copy records; you may request that the denial be reviewed. Another licensed health care professionalchosen by us will review your request and the denial; the person conducting the review will not be the person whodenied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that a record containing your health information is incorrect or incomplete, you may askus to amend the information. You must make the request in writing and submit it to the Executive Director at theaddress listed at the end of this Notice, and you must tell us why you think the information is wrong or incomplete. Wemay deny your request if (among other reasons) the information was not created by us, is not included in your medical,billing or other records used to make decisions about your care or is otherwise accurate and complete.
Right to an Accounting of Disclosures: With limited exceptions, you have the right to request a written accounting ofevery disclosure of your health information we have made for you up to six years prior to your request, other thandisclosures to you, disclosures authorized by you in writing, and disclosures for treatment, payment and health careoperations as described in this Notice. To request this accounting, you must submit your request in writing to theExecutive Director at the address listed at the end of this Notice. Your request must state a time period, which may notbe longer than six years and may not include dates before April 14, 2003. Your request should indicate in what formyou want the accounting (for example, on paper or by e-mail). The first accounting you request within a 12-monthperiod will be free. For additional accountings, we may charge you for the costs of providing the accounting; we willnotify you of the cost involved and you may choose to withdraw or modify your request at that time before any costsare incurred.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health information weuse or disclose about you for treatment, payment, health care operations, or to assist others’ involvement in your care.We are not required to agree to your request. If we do agree, we will comply with your request unless the informationis needed to provide you emergency treatment. To request a restriction, you must make your request in writing to theExecutive Director at the address listed at the end of this Notice. In your request, you must tell us (1) what informationyou want to limit; (2) whether and how you want to limit our use, disclosure or both; and (3) to whom you want thelimits to apply (for example, disclosures to your spouse).
Right to Request Confidential Communications: You have the right to request that we communicate healthinformation about you in a certain way or at a certain location. For example, you can ask that we only contact you atwork or by mail. To request confidential communications please submit a written request to the address listed at theend of this Notice. We will attempt to accommodate all reasonable requests.
OUR LEGAL DUTIES AND RIGHTS: We are required by law to protect the privacy of your health information and to provide this Notice about our legal duties and health information practices. We will comply with this Notice. We reserve the right to make the changed Notice effective for health information we already have about you as well as any information we receive after the change. The Notice will contain an effective date on the first page, in the top left-hand corner. We will post a copy of the current Notice on our website, www.hscky.org. COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with our Executive Director at the address listed immediately below. You may also file a complaint with the Secretary of the Department of Health and Human Services, Office of Civil Rights, HIPPA Complaint Division, 7500 Security Blvd., C5-24-04, Baltimore, MD 21244. For information on how to file, call 1-800-368-1019. All complaints must be submitted in writing. You will not be penalized for filing a complaint. If you have any questions, please contact our Executive Director at The Hearing and Speech Center, 350 Henry Clay Boulevard, Lexington, KY 40502.
