NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The terms of this Notice of Privacy Practices apply to Akron E.N.T. Associates, Inc. We will share protected 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 patients’ protected health information and to provide patients with notice of its legal obligations and privacy practices. We are required to abide by the terms of this Notice so long as it is in place. We reserve the right to change the terms of this Notice as necessary. You may get a copy of any revised notices at our office or by mailing a request to: Jacqueline Hamilton, Privacy Manager — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Authorization. Except for uses and disclosures described later in this Notice, we will not use or disclosure your protected health information unless you have signed a written authorization giving us permission. You have the right to revoke an authorization in writing except to the extent that we have already taken action based on the authorization.

Uses and Disclosures Required or Permitted by Law. The law permits and in some case requires us to use and/or disclose your protected health information without your authorization. We may use or disclose your protected health information for:

  • Any purpose required by law
  • Public health activities (for example, where required for reporting disease, injuries, births, and death), and for required public health investigations.
  • Reporting suspected child abuse or neglect; or if you may be a victim of abuse, neglect, or domestic violence.
  • Reporting to the Food and Drug Administration to report adverse events, product defects, or to participates in product recalls.
  • Your employer if we have provided health care to you at your employer’s request.
  • Reporting to a health oversight agency conducting audits, investigations, or for civil or criminal proceedings.
  • A court or administrative ordered subpoena or discovery request.
  • Law enforcement officials to report wounds, injuries and crimes.
  • Preventing or lessening a serious and imminent threat to the health or safety of a person or the public.
  • County coroners.
  • Arrangement of an organ or tissue donation from you or a transplant for you.
  • Military purposes, if you are a member of the military, or for national security or intelligence activities.
  • Your workers’ compensation claim to workers’ compensation agencies.

    Uses and Disclosures for Treatment, Payment or Health Care Operations. We will use and disclose your protected health information as needed for treatment, payment and health care operations purposes. Examples of such uses and disclosures include: nurses, doctors and other professionals involved in your care will use information in your medical record to put in place a treatment plan and to carry out that plan; and in some situations to other health care facilities or providers who will be treating you; sending information about you and your treatment to insurance companies, governmental agencies and programs and other entities or individuals who will pay for your care; and in meeting and as part of other actions our practice takes to make sure our doctors and other professionals involved in our facility have proper credentials and in many other activities designed to make sure of, and improve upon, the quality of care our practice provides.

    Business Associates.As part of the services our practice provides, it sometimes seeks the help of outside person or businesses. These outside entities help in a number of ways like giving us legal help, accrediting our facilities or auditing our records, just to list some examples. In order to get their help in making Akron E.N.T.’s care available, we must often give them your protected health information. At times it may be necessary for us to provide certain of your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. Before we give out any protected health information to these outside parties, we require them to protect the privacy of your information.

    Others Involved in Your Care. We may disclose your protected health information to people (typically family and friends or any person you designate), who are involved in your care or in payment of your care, to help with your care or paying for your care, unless you object to such disclosure or request a restriction on such disclosure pursuant to your right to ask for a restrictions as provided herein. If you are not available or are incapacitated, and we determine that a limited disclosure may be in your best interest, we may disclose protected health information with the people involved in your care or paying for your care unless you object to such disclosure or request a restriction on such disclosure pursuant to your right to ask for restrictions as provided herein. If you have a health emergency we will exercise our professional judgment to determine whether disclosure is in your best interest. In some cases, we may also disclose your protected health information to parties involved in disaster relief to help them find your family member or other persons involved in your care or paying for your care.

    Marketing. We may use your protected health information to contact you about health products and services necessary for your care, about new products and services we offer, and to give you general health and wellness information.

    Services/Communications. We may contact you to provide appointment reminders, or test results, or other information regarding your care. You can ask and we will accommodate reasonable requests to receive communications about your protected health information from us in a different way or at a different place. You must make the request in writing to: Jacqueline Hamilton, Privacy Manger — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304.

    Research. Sometimes we may use and disclose your protected health information for research purposes where, for example, an entity may compare outcomes of patients taking a medicine. If we do not get your specific authorization, your privacy will be protected by strict confidentiality requirements used by an Institutional Review Board that oversees the research or by representations of the researchers that limit their use and disclosure of your information.

    YOUR RIGHTS

    Right to Receive Notice. You have the right to receive a copy of this Notice on paper even if you have requested the Notice by e-mail or in some other electronic transmission.

    Access to Your Protected Health Information. You have the right to copy and/or inspect the protected health information that we have about you. You have to ask us in writing and sign the request. You send the written request to Jacqueline Hamilton, Privacy Manager – Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304. You can get a form for making the request from: Jacqueline Hamilton, Privacy Manager — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304. There are charges for our costs to provide this information.

    Amendments to Protected Health Information. You have the right to request that we amend your protected health information. We do not have to make your amendments but will carefully consider your request. All amendment requests must be in writing, signed and state the reason for the amendment. You can get a form for making the request from Jacqueline Hamilton, Privacy Manger – Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304.

    Accounting for Disclosures of Protected Health Information. You have the right to get an accounting of certain disclosures we make after April 14, 2003 of your protected health information. To get this accounting, you have to sign and complete a written accounting request form that you can get from: Jacqueline Hamilton, Privacy Manager — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304. It will not cost you anything for one accounting in a 12-month period, but for each subsequent accounting within a 12-month period we will charge you a fee.

    Restrictions on Uses and Disclosures. You have the right to ask for restrictions on certain uses and disclosures we make of your protected health information for treatment, payment of health care operations. You can get a restriction request form from: Jacqueline Hamilton, Privacy Manager — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304. We do not have to agree to any restriction, but we will review it and if we consider it appropriate allow the restriction. We reserve the right to stop any restriction at any time by giving you written notice. You can also stop a restriction by giving your written notice. You can also stop a restriction by giving written notice to: Jacqueline Hamilton, Privacy Manager — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304.

    Complaints. If you believe your privacy rights have been violated, you can file a complaint with us on a complaint form. You can get the form from Jacqueline Hamilton, Privacy Manager – Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304. We will review it and respond to you. You may also file a complaint, in writing, within 180 days of a violation of your rights. There will be no retaliation for filing a complaint. Complaints should be sent to:

    Region V
    Office for Civil Rights
    U.S. Department of Health and Human Services
    233 N. Michigan Avenue
    Suite 240
    Chicago, IL 60601
    Telephone: (312) 886-2359
    Fax: (312) 886-1807
    TDD: (312) 353-5693

    Acknowledgement of Receipt of Notice. You will be asked to sign an acknowledgement that you received this Notice of Privacy Practices.

    FOR FURTHER INFORMATION

    If you have any questions about this Notice, you can talk to: Jacqueline Hamilton, Privacy Manager — Akron E.N.T. Associates, Inc. 395 East Market Street, Akron, OH 44304.

    EFFECTIVE DATE

    This Notice of Privacy Practices is effective April 14, 2003.