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Your Center for Hearing -
Complete Hearing Diagnostics ▪ Hearing Aid Dispensing &
Service |
BECKMAN AUDIOLOGY CENTER
Notice of Privacy Practices
As Required by the Privacy Regulations Created as a
Result of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
(AS A PATIENT OF THIS PRACTICE) MAY BE USED AND
DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR
INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy
of your individually identifiable health information (IIHI).
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 the
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 IIHI. By federal and state law, we must follow
the terms of the notice of privacy practices that we
have in effect at the time.
We realize that these laws are complicated, but we
must provide you with the following important
information:
§ How we may use and disclose your IIHI
§ Your privacy rights in your IIHI
§ Our obligations concerning the use and disclosure of
your IIHI
The terms of this notice apply to all records
containing your IIHI that are created or retained by
our practice. We reserve the right to revise or amend
this Notice of Privacy Practices. Any revision or
amendment to this notice will be effective for all of
your records that our practice has created or
maintained in the past, and for any of your records
that we may create or maintain in the future. Our
practice will post a copy of our current Notice in our
office in a visible location at all times, and you may
request a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT:
2501 Jimmy Johnson Blvd. • Regional Professional
Building • Suite 306 Port Arthur, TX 77640 (409)
722-3400
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY
IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE
FOLLOWING WAYS.
The following categories describe the different ways
in which we may use and disclose your IIHI.
1. Treatment. Our practice may use your IIHI to treat
you. Many of the people who work for our practice -
including, but not limited to, our doctors and nurses
- may use or disclose your IIHI in order to treat you
or to assist others in your treatment. Additionally,
we may disclose your IIHI to others who may assist in
your care, such as your spouse, children or parents.
Finally, we may also disclose your IIHI to other
health care providers for purposes related to your
treatment.
2. Payment. Our practice may use and disclose your
IIHI 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 IIHI to obtain payment
from third parties that may be responsible for such
costs, such as family members. Also, we may use your
IIHI to bill you directly for services and items. We
may disclose your IIHI to other health care providers
and entities to assist in their billing and collection
efforts.
3. Health Care Operations. Our practice may use and
disclose your IIHI 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 IIHI 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 IIHI to other health care providers and
entities to assist in their health care operations.
4. Appointment Reminders. Our practice may use and
disclose your IIHI to contact you and remind of an
appointment.
5. Treatment Options. Our practice may use and
disclose your IIHI to inform you of potential
treatment options or alternatives.
6. Health-Related Benefits and Services. Our practice
may use and disclose your IIHI to inform you of
health-related benefits or services that may be of
interest to you.
7. Release of Information to Family/Friends. Our
practice may release your IIHI to a friend or family
member that is involved in your care, or who assists
in taking care of you. For example, a parent or
guardian may ask that a babysitter take their child to
the pediatrician's office for treatment of a cold. In
this example, the babysitter may have access to this
child's medical information.
8. Disclosures Required By Law. Our practice will
use and disclose you IIHI when we are required to do
so by federal, state or local law.
D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL
CIRCUMSTANCES
The following categories describe unique scenarios in
which we may use of disclose your identifiable health
information.
1. Public Health Risks. Our practice may disclose
your IIHI to public health authorities that are
authorized by law to collect information for the
purpose of:
· Maintaining vital records, such as births and deaths
· Reporting child abuse or neglect
· Preventing or controlling disease, injury or
disability
· Notifying a person regarding potential exposure to a
communicable disease
· Notifying a person regarding a potential risk for
spreading or contracting a disease or condition
· Reporting reactions to drugs or problems with
products or devices
· Notifying individuals if a product or device they
may be using has been recalled
· Notifying appropriate government agency(ies) and
authority(ies) regarding the potential abuse or
neglect of an adult patient (including domestic
violence); however, we will only disclose this
information if the patient agrees or we are required
or authorized by law to disclose this information
· Notifying your employer under limited circumstances
related primarily to workplace injury or illness or
medical surveillance.
2. Health Oversight Activities. Our practice may
disclose your IIHI to a health oversight agency for
activities authorized by law. Oversight activities
can include, for example, investigations, inspections,
audits, surveys, licensure and disciplinary actions;
civil, administrative, and criminal procedures or
actions; or other activities necessary for the
government to monitor government programs, compliance
with civil rights laws and the health care system in
general.
3. Lawsuits and Similar Proceedings. Our practice may
use and disclose your IIHI in response to a court or
administrative order, if you are involved in a lawsuit
or similar proceeding. We also may disclose your IIHI
in response to a discovery request, subpoena, or other
lawful process by another party involved in the
dispute, but only if we have made an effort to inform
you of the request or to obtain an order protecting
the information the party has requested.
4. Law Enforcement. We may release IIHI if asked to
do so by a law enforcement official:
· Regarding a crime victim in certain situations, if
we are unable to obtain the person's agreement
· Concerning a death we believe has resulted from
criminal conduct
· Regarding criminal conduct at our offices
· In response to a warrant, summons, court order,
subpoena or similar legal process
· To identify/locate a suspect, material witness,
fugitive or missing person
· In an emergency, to report a crime (including the
location or victim(s) of the crime, or the
description, identity or location of the perpetrator)
5. Deceased Patients. Our practice may release IIHI
to a medical examiner or coroner to identify a
deceased individual or to identify the cause of
death. If necessary, we also may release information
in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practice may
release your IIHI to organizations that handle organ,
eye or tissue procurement or transplantation,
including organ donation banks, as necessary to
facilitate organ or tissue donation and
transplantation if you are an organ donor.
7. Research. Our practice may use and disclose your
IIHI for research purposes in certain limited
circumstances. We will obtain your written
authorization to use your IIHI for research purposes
except when an Institutional Review Board or Privacy
Board has determined that the waiver of your
authorization satisfies the following: (i) the use of
disclosure involves no more than a minimal risk to
your privacy based on the following: (A) an adequate
plan to protect the identifiers from improper use and
disclosure; (B) an adequate plan to destroy the
identifiers at the earliest opportunity consistent
with the research (unless there is a health or
research justification for retaining the identifiers
or such retention is otherwise required by law); and
(C) adequate written assurances that the PHI will not
be re-used or disclosed to any other person or entity
(except as required by law) for authorized oversight
of the research study, or for other research for which
the use of disclosure would otherwise be permitted;
(ii) the research could not practicably be conducted
without the waiver; and (iii) the research could not
practicably be conducted without access to and use of
PHI.
8. Serious Threats to Health or Safety. Our practice
may use and disclose your IIHI when necessary to
reduce or prevent a serious threat to your health and
safety or the health and safety or another individual
or the public. Under these circumstances, we will
only make disclosures to a person or organization able
to help prevent the threat.
9. Military. Our practice may disclose your IIHI if
you are a member of U.S. or foreign military forces
(including veterans) and if required by the
appropriate authorities
10. National Security. Our practice may disclose your
IIHI to federal officials for intelligence and
national security activities authorized by law. We
also may disclose you IIHI to federal officials in
order to protect the President, other officials or
foreign heads of state, or to conduct investigations.
11. Inmates. Our practice may disclose your IIHI to
correctional institutions or law enforcement officials
if you are an inmate or under the custody of a law
enforcement official. Disclosure for these purposes
would be necessary: (a) for the institution to provide
health care services to you, (b) for the safety and
security of the institution, and/or (c) to protect
your health and safety or the health and safety of
other individuals.
12. Workers' Compensation. Our practice may release
your IIHI for workers' compensation and similar
programs.
E. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that
we maintain about you:
1. Confidential Communications. You have the right to
request that our practice communicate with you about
your health and related issues in a particular manner
or at a certain location. For instance, you may ask
that we contact you at home, rather than work. In
order to request a type of confidential communication,
you must make a written request to Dr. J. T. Beckman
409-722-3400 specifying the requested method of
contact, or the location where you wish to be
contacted. Our practice will accommodate reasonable
requests. You do not need to give a reason for your
request.
2. Requesting Restrictions. You have the right to
request a restriction in our use and disclosure of
your IIHI for treatment, payment or health care
operations. Additionally, you have the right to
request that we restrict our disclosure of your IIHI
to only certain individuals involved in your care or
the payment for your care, such as family members and
friends. We are not required to agree to your
request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in
emergencies, or when the information is necessary to
treat you. In order to request a restriction in our
use and disclosure of your IIHI, you must make your
request in writing to Dr. J. T. Beckman 409-722-3400.
Your request must describe in a clear and concise
fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice's
use, disclosure or both; and
(c) to whom you want the limits to apply.
3. Inspection and Copies. You have the right to
inspect and obtain a copy of the IIHI that may be used
to make decisions about you, including patient medical
records and billing records, but not including
psychotherapy notes. You must submit your request in
writing to Dr. J. T. Beckman 409-722-3400 in order to
inspect and/or obtain a copy of your IIHI. Our
practice may charge a fee for the costs of copying,
mailing, labor and supplies associated with your
request. Our practice may deny your request to
inspect and/or copy in certain limited circumstances;
however, you may request a review of our denial.
Another licensed health care professional chosen by us
will conduct reviews.
4. Amendment. You may ask us to amend your health
information if you believe it is incorrect or
incomplete, and you may request an amendment for a
long as the information is kept by or for our
practice. To request an amendment, your request must
be made in writing and submitted to Dr. J. T. Beckman
409-722-3400. You must provide us with a reason that
supports your request for amendment. Our practice
will deny your request if you fail to submit your
request (and the reason supporting your request) in
writing. Also, we may deny your request if you ask us
to amend information that is in our opinion: (a)
accurate and complete; (b) not part of the IIHI kept
by or for the practice; (c) not part of the IIHI which
you would be permitted to inspect and copy; or (d) not
created by our practice, unless the individual or
entity that created the information is not available
to amend the information.
5. Accounting of Disclosures. All of our patients
have the right to request an "accounting of
disclosures." An "accounting of disclosures" is a
list of certain non-routine disclosures our practice
has made of your IIHI for non-treatment, non-payment
or non-operations purposes. Use of your IIHI as part
of the routine patient care in our practice is not
required to be documented. For example, the doctor
sharing information with the nurse; or the billing
department using your information to file your
insurance claim. In order to obtain an accounting of
disclosures, you must submit your request in writing
to Dr. J. T. Beckman 409-722-3400. All requests for
an "accounting of disclosures" must state a time
period, which may not be longer that six (6) years
from the date of disclosure and may not include dates
before April 14, 2003. The first list you request
with a 12-month period is free of charge, but our
practice may charge you for additional lists within
the same 12-month period. Our practice will notify
you of the costs involved with additional requests,
and you may withdraw your request before you incur any
costs.
6. Right to a Paper Copy of This Notice. You are
entitled to receive a paper copy of our notice of
privacy practices. You may ask us to give you
a copy of this notice at any time. To obtain a
paper copy of this notice, contact Dr. J. T. Beckman
409-722-3400.
7. Right to File A Complaint. 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. To file
a complaint with our practice, contact Dr. J. T.
Beckman 409-722-3400. All complaints must be
submitted in writing. You will not be penalized for
filing a complaint.
8. Right to Provide an Authorization for Other Uses
and Disclosures. Our practice will obtain your
written authorization for uses and disclosures that
are not identified by this notice or permitted by
applicable law. Any authorization you provide to us
regarding the use and disclosure of your IIHI may be
revoked at any time in writing. After you revoke your
authorization, we will no longer use or disclose your
IIHI for the reasons described in the authorization.
Please note, we are required to retain records of your
care.
Again, if you have any questions regarding this
notice or our health information privacy
policies, please contact Dr. J. T. Beckman
409-722-3400.
2501 Jimmy Johnson Blvd.
▪ Regional Professional Building
▪ Suite 306 ▪ Port
Arthur, TX 77640 ▪ 409.722.3400
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