The terms of this Notice of Privacy Practices apply to the
Youngtown Hearing and Speech Center operating as a clinically
integrated health care arrangement composed of Speech Pathologists,
Audiologists, Social Workers, Physical Therapists and Occupational
Therapists. The members of this clinically integrated health care
arrangement work and practice at 6614 Southern Blvd. Youngstown Oh
44512. All of the entities and persons listed will share personal
health information of patients as necessary to carry out treatment,
payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients'
personal health information and to provide patients with notice of
our legal duties and privacy practices with respect to your personal
health information. We are required to abide by the terms of this
Notice so long as it remains in effect. We reserve the right to
change the terms of this Notice of Privacy Practices as necessary
and to make the new Notice effective for all personal health information maintained
by us. You may receive a copy of any revised notices at 6614
Southern Blvd. Youngstown, Oh 44512 or a copy may be obtained by
mailing a request to Privacy Manager – Youngstown Hearing & Speech
Center – 6614 Southern Blvd. Youngstown Oh 44512. USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization. Except as outlined below, we will not
use or disclose your personal health information for any purpose
unless you have signed a form authorizing the use or disclosure. You
have the right to revoke that consent or authorization in writing
unless we have taken any action in reliance on the consent or
authorization.
Uses and Disclosures for Treatment. We will make uses and
disclosures of your personal health information as necessary for
your treatment. For instance, other professionals involved in your
care will use information in your medical record and information
that you provide to plan a course of treatment for you. We may also
release your personal health information to another health care
facility or professional who is not affiliated with our practice but
who is or will be providing treatment to you.
Uses and Disclosures for Payment. We will make uses and disclosures
of your personal health information as necessary for payment
purposes of those health professionals and facilities that have
treated you or provided services to you. For instance, we may
forward information regarding your medical procedures and treatment
to your insurance company to arrange payment for the services
provided
to you or we may use your information to prepare a bill to send to
you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations. We will
use and disclose your personal health information as necessary, and
as permitted by law, for our health care operations, which include
clinical improvement, professional peer review, business management,
etc. For instance, we may use and disclose your personal health
information for purposes of improving the clinical treatment and
care of our patients. We may also disclose your personal health
information to another health care facility, health care
professional, or health plan for such things as quality assurance
and case management, but only if that facility, professional, or
plan also has or had a
patient relationship with you.
Family and Friends Involved In Your Care. With your
approval, we may from time to time disclose your personal health
information to designated family, friends, and others who are
involved in your care or in payment of your care in order to
facilitate that person’s involvement in caring for you or paying for
your care.
Business Associates. Certain aspects and components of our
services are performed through contracts with outside persons or
organizations, such as auditing, accreditation, legal services, etc.
At times it may be necessary for us to provide certain of your
personal health information to one or more of these outside persons
or organizations who assist us with our health care operations. In
all cases, we require these business associates to appropriately
safeguard the privacy of your information.
Appointments and Services. We may contact you to provide appointment
reminders or test results. You have the right to request and we will
accommodate reasonable requests by you to receive communications
regarding your personal health information from us by alternative
means or at alternative locations. For instance, if you wish
appointment reminders to not be left on voice mail or sent to a
particular address, we will accommodate reasonable requests. You may
request such confidential communication in writing and may send your
request to the Privacy Manager – 6614 Southern Blvd. – Youngstown,
Oh 44512
Other Uses and Disclosures. We are permitted or required
by law to make certain other uses and disclosures of your personal
health information without your consent or authorization.
- We may release your personal health information for any purpose
required by law;
- We may release your personal health information for public health
activities, such as required reporting of disease, injury, and
birth and death, and for required public health investigations;
- We may release your personal health information as required by law
if we suspect child abuse or neglect; we may also release
your personal health information as required by law if we believe
you to be a victim of abuse, neglect, or domestic violence;
- We may release your personal health information to your employer
when we have provided health care to you at the request
of your employer; in most cases you will receive notice that
information is disclosed to your employer;
- We may release your personal health information if required by law
to a government oversight agency conducting audits,
investigations, or civil or criminal proceedings;
- We may release your personal health information if required to do
so by a court or administrative ordered subpoena or
discovery request; in most cases you will have notice of such
release;
- We may release your personal health information to law enforcement
officials as required by law to report wounds and
injuries and crimes;
- We may release your personal health information if you are a
member of the military as required by armed forces services; we
may also release your personal health information if necessary for
national security or intelligence activities; and
- We may release your personal health information to workers'
compensation agencies if necessary for your workers'
compensation benefit determination.
Access to Your Personal Health Information. You have the
right to copy and/or inspect much of the personal health information
that we retain on your behalf. All requests for access must be made
in writing and signed by you or your representative. You may obtain
an access request form from the Privacy Manager at the Youngtown
Hearing and Speech Center
Amendments to Your Personal Health Information.You have the
right to request in writing that personal health information that we
maintain about you be amended or corrected. We are not obligated to
make all requested amendments but will give each request careful
consideration. All amendment requests, in order to be considered by
us, must be in writing, signed by you or your representative, and
must state the reasons for the amendment/correction request. If an
amendment or correction you request is made by us, we may also
notify others who work with us and have copies of the uncorrected
record if we believe that such notification is necessary. You may
obtain an amendment request form from the Privacy Manager at the
Youngtown Hearing and Speech Center.
Accounting for Disclosures of Your Personal Health Information.
You have the right to receive an accounting of certain disclosures
made by us of your personal health information after April 14, 2003.
Requests must be made in writing and signed by you or your
representative. Accounting request forms are available from the
Privacy Manager at the Youngtown Hearing and Speech Center
Restrictions on Use and Disclosure of Your Personal Health
Information. You have the right to request restrictions on certain
of
our uses and disclosures of your personal health information for
treatment, payment, or health care operations. A restriction request
form can be obtained from the Privacy Manager at the Youngtown
Hearing and Speech Center. . We are not required to agree to your
restriction request but will attempt to accommodate reasonable
requests when appropriate and we retain the right to terminate an
agreed-to restriction if we believe such termination is appropriate.
In the event of a termination by us, we will notify you of such
termination. You also have the right to terminate, in writing or
orally, any agreed-to restriction to sending such termination notice
to
the Privacy Manager at the Youngtown Hearing and Speech Center
Complaints. If you believe your privacy rights have been violated,
you can file a complaint, in writing, with the Privacy Manager at
the Youngtown Hearing and Speech Center. You may also file a
complaint with the Secretary of the U.S. Department of Health and
Human Services in Washington D.C. in writing within 180 days of a
violation of your rights. There will be no retaliation for filing a
complaint.
Acknowledgment of Receipt of Notice. You will be asked to sign an
acknowledgment form that you received this Notice of Practice
Practices.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this
Notice, you may contact the Privacy Manager at the Youngtown Hearing
and Speech Center. As a patient you retain the right to obtain a
paper copy of this Notice of Privacy Practices, even if you have
requested such copy by e-mail or other electronic means.
EFFECTIVE DATE
This Notice of Privacy Practices is effective April 14, 2003.
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