YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
YOUR RIGHTS:
You have important rights regarding your health information. You have the right to obtain a copy of your medical record in paper or electronic form and to request corrections if you believe your information is inaccurate or incomplete. You may request confidential communications or ask us to limit how we use or share your information, although we are not always required to agree.
You also have the right to request a list of certain disclosures of your information, obtain a copy of this Notice, and designate someone to act on your behalf. If you believe your rights have been violated, you have the right to file a complaint without fear of retaliation.
YOUR CHOICES:
You have choices regarding how we share your information in certain situations. This includes sharing information with family members, close friends, or others involved in your care, as well as in disaster relief situations. If you are unable to communicate your preferences, we may use our professional judgment to determine what is in your best interest.
We will not use or disclose your information for marketing purposes, the sale of your information, or most uses of psychotherapy notes without your written authorization. If we contact you for fundraising purposes, you may opt out at any time.
OUR USES AND DISCLOSURES:
We may use and share your information to provide treatment, run our practice, and bill for services. We may also share your information for public health and safety purposes, research where permitted, compliance with the law, and certain legal or government functions, including responding to court orders or working with medical examiners.
OUR RESPONSIBILITIES: We are required by law to maintain the privacy and security of your protected health information and to provide you with this Notice. We will notify you if a breach occurs that may compromise your information. We must follow the duties and privacy practices described in this Notice and will not use or share your information other than as described unless you provide written authorization. You may change your authorization at any time in writing.
ABOUT THIS NOTICE
Coastal Sound Audiology, PLLC (“we,” “our,” or “the practice”) is dedicated to safeguarding the privacy of your health information. This Notice of Privacy Practices (“Notice”) is provided in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended by the HIPAA Omnibus Rule and other applicable federal and state regulations. This Notice explains how we may use and disclose your protected health information in order to provide treatment, obtain payment, and carry out healthcare operations, as well as for other purposes permitted or required by law. It also outlines your rights and our legal responsibilities regarding your protected health information.
Protected health information (“PHI”) refers to information that identifies you and relates to your past, present, or future physical or mental health condition, the provision of healthcare services to you, or payment for those services. We are required to follow the terms of this Notice while it remains in effect.
We are required by law to make certain disclosures of your protected health information, including providing access to you upon request and disclosing information to the Secretary of the U.S. Department of Health and Human Services to determine our compliance with applicable privacy regulations.
If you have questions about this Notice, you may contact our Privacy Officer: Abigail Earliwine, Au.D. at Coastal Sound Audiology, PLLC.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories explain the circumstances under which we may use and disclose your protected health information. The examples included are meant to provide general guidance and are not intended to cover every possible situation.
1. Treatment
We may use and disclose your protected health information to provide, coordinate, or manage your audiological care and related services. This may include sharing information with physicians or other healthcare professionals involved in your care, such as specialists or laboratories, to ensure that they have the necessary information to diagnose or treat you appropriately.
2. Payment
We may use and disclose your protected health information to facilitate payment for services provided to you. This includes billing you, your insurance company, a government program, or other third-party payors. It may also involve activities undertaken by your health plan prior to approving or paying for services, such as determining eligibility or coverage, reviewing services for medical necessity, and conducting utilization review activities.
3. Healthcare Operations
We may use and disclose your protected health information for purposes related to the operation of our practice. These activities are necessary to ensure that you receive quality care and that our practice functions effectively. Examples include evaluating the quality of care provided, reviewing the performance of staff members, conducting training and educational activities, and managing administrative operations.
4. Treatment Communications
We may contact you with information about treatment alternatives or other health-related products or services that may be relevant to your care. In situations where we or one of our business associates receives financial remuneration for making such communications, we will obtain your written authorization unless the communication occurs face-to-face or involves a promotional item of nominal value. If you prefer not to receive such communications, you may submit a written request to our Privacy Officer.
5. Individuals Involved in Your Care
Unless you object, we may disclose your protected health information to a family member, relative, close friend, or other person you identify as being involved in your healthcare or payment for your care. This may include information directly related to that person’s involvement, such as allowing someone to pick up your hearing instruments, supplies, or records on your behalf.
If you are unable to agree or object to such disclosures, we may determine, based on our professional judgment, that it is in your best interest to share relevant information. We may also disclose information to notify individuals of your location, general condition, or death, and may coordinate with disaster relief organizations for such purposes.
6. Required by Law
We may use or disclose your protected health information when required to do so by federal, state, or local law. Any such disclosure will be limited to the requirements of the applicable law.
7. Public Health
We may disclose your protected health information to public health authorities authorized by law to collect such information for the purpose of preventing or controlling disease, injury, or disability. This may include reporting to government agencies or, when directed, to foreign authorities collaborating with public health agencies.
8. Business Associates
We may disclose your protected health information to third-party service providers who perform functions on our behalf or provide services necessary to operate our practice. These entities are required to protect your information and may only use it for the purposes for which it was disclosed.
9. Communicable Diseases
We may disclose your protected health information, when authorized by law, to individuals who may have been exposed to a communicable disease or who may otherwise be at risk of contracting or spreading a disease or condition.
10. Health Oversight
We may disclose your protected health information to government agencies authorized to oversee the healthcare system, government benefit programs, regulatory compliance, and civil rights laws. These activities may include audits, investigations, and inspections.
11. Abuse or Neglect
We may disclose your protected health information to appropriate authorities if we believe that you have been a victim of abuse, neglect, or domestic violence. Such disclosures will be made in accordance with applicable legal requirements.
12. Food and Drug Administration
We may disclose your protected health information to individuals or organizations subject to the authority of the Food and Drug Administration for purposes such as reporting adverse events, tracking products, facilitating product recalls, or conducting post-marketing surveillance.
13. Legal Proceedings
We may disclose your protected health information in the course of judicial or administrative proceedings, including in response to a court order, subpoena, discovery request, or other lawful process, as permitted by law.
14. Law Enforcement
We may disclose your protected health information to law enforcement officials for purposes permitted or required by law, including in response to legal processes or to report certain types of injuries or incidents.
15. Coroners, Funeral Directors, and Organ Donation
We may disclose your protected health information to coroners or medical examiners for identification purposes, to determine cause of death, or to carry out other authorized duties. We may also disclose information to funeral directors as necessary and, where applicable, for organ, eye, or tissue donation purposes.
16. Research
We may disclose your protected health information for research purposes when such research has been reviewed and approved in accordance with applicable legal standards designed to protect your privacy.
17. Serious Threat to Health or Safety
We may use or disclose your protected health information when necessary to prevent or reduce a serious and imminent threat to your health or safety or to the health or safety of others, consistent with applicable laws.
18. Military Activity and National Security
If applicable, we may disclose your protected health information to authorized federal officials for military, national security, or intelligence activities, or if you are in law enforcement custody.
19. Workers’ Compensation
We may disclose your protected health information as authorized by laws relating to workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
20. Data Breach Notification
We may use or disclose your protected health information to provide legally required notifications in the event of unauthorized access to or disclosure of your information. We are required to notify you in the event of a breach of your unsecured PHI.
21. Required Disclosures
We are required to disclose your protected health information to you upon request and to the Secretary of the U.S. Department of Health and Human Services for purposes of determining our compliance with applicable privacy regulations.
22. Fundraising Communications
We may use limited contact information to inform you about practice-related news or events. You have the right to opt out of receiving such communications at any time. Coastal Sound Audiology, PLLC does not sell your protected health information.
SPECIAL PROTECTIONS FOR CERTAIN INFORMATION
Certain federal and state laws provide additional protections for specific types of information, including HIV-related information, substance use records, mental health information, and genetic information. In such cases, we will comply with the more stringent requirements.
USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION
Certain uses and disclosures of your protected health information will only be made with your written authorization. These include uses and disclosures for marketing purposes where financial remuneration is involved and disclosures that constitute the sale of your protected health information. Other uses and disclosures not described in this Notice will also require your written authorization unless otherwise permitted or required by law. You may revoke your authorization at any time in writing, except to the extent that we have already relied on it.
Certain types of information, such as psychotherapy notes, will not be used or disclosed without your written authorization except as permitted by law.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the right to be notified in the event of a breach of your unsecured protected health information. You have the right to inspect and obtain a copy of your protected health information maintained in your medical and billing records, subject to certain limitations and reasonable fees.
You may request restrictions on the use or disclosure of your information for treatment, payment, or healthcare operations, although we are not required to agree to all requested restrictions. However, we must comply with a request to restrict disclosure to a health plan if the information pertains solely to a service for which you have paid out-of-pocket in full.
You have the right to request confidential communications by alternative means or at alternative locations, and we will accommodate reasonable requests. You may also request amendments to your information if you believe it is inaccurate or incomplete, subject to applicable legal limitations.
You have the right to request an accounting of certain disclosures of your protected health information, excluding disclosures made for treatment, payment, and healthcare operations, and subject to applicable limitations. You also have the right to receive a paper copy of this Notice at any time.
You have the right to make decisions regarding how your protected health information is shared in certain situations. This includes the ability to request that we share information with family members, close friends, or others involved in your care, as well as in disaster relief situations. If you are unable to communicate your preferences, we may use our professional judgment to determine whether sharing information is in your best interest.
In situations involving marketing, the sale of information, or other uses requiring authorization, we will not share your information without your written permission.
We will generally provide access to your requested information within 30 days of receiving your request, although certain circumstances may allow for an extension as permitted by law.
If your request for amendment is denied, we will provide you with a written explanation of the reason for the denial within 60 days, along with information on how you may respond. You have the right to submit a written statement of disagreement, which will be included with your record.
COMPLAINTS OR QUESTIONS
If you believe your privacy rights have been violated, you may file a complaint with Coastal Sound Audiology, PLLC by contacting the Privacy Officer, Abigail Earliwine, Au.D., at 14057 US Hwy 17, Suite 200, Hampstead, NC 28443. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. You will not be retaliated against for filing a complaint.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice at any time. Any changes will apply to all protected health information we maintain. The updated Notice will be made available upon request, in our office, and on our website.
Coastal Sound Audiology, PLLC
Attn: Privacy Officer
14057 US Hwy 17, Suite 200
Hampstead, NC 28443