Hearing Care by Gina's
Notice of Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We, at Hearing Care by Gina, are required by law to maintain the privacy of your protected health information and provide individuals with the Notice of our legal duties and privacy practices. We are also required to abide by the terms of the Notice currently in effect. If you have questions about this Notice, please contact our office at 320-321-1551.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
For Treatment: We may use and disclose protected health information about you, including hearing test finding, to ensure that you receive proper medical treatment. For example, we may share your protected health information to another physician or health care provider involved in your care. We also may contact you about treatment alternatives and options.
For Payment: We may use and disclose your protected health information to obtain payment for services that were provided to you. For example, we may share your protected health information, so your health plan will pay us or reimburse you for your hearing care services. We may also contact your health plan about a treatment you may receive to determine whether your plan will pay part of the cost of your hearing care device.
Appointment Reminders: We may contact you or your personal representative with a reminder postcard, email or telephone message that it is time for you to call our office and schedule and appointment.
Individuals Involved in Your Care or Payment for Your Care: With your written approval, we may discuss your hearing care with family members of close protected friends who are involved in your medical care or payment for that care. We encourage you to identify persons involved in your care that you wish information to be shared with. You have the right to restrict or refuse any of these uses or disclosures.
Business Associates: At times, we must provide your protected health information to outside vendors (business associates) so they may help us operate more efficiently. For example, we may provide your name, address, and other health information to a company that helps us mail important health communications to you. These business associates are required to adhere to the federal and state laws regarding the protection of your protected health information; they are also under a contractual obligation to Hearing Care by Gina to maintain the privacy and security of your protected health information.
DISCLOSURES WITH YOUR AUTHORIZATION
We must obtain your authorization to use or disclose your protected health information in those situations not otherwise described in this Notice. If you do authorize us to use or disclose your protected health information, you have the right to revoke that authorization, in writing, at any time, except to the extent that we have acted in reliance on the use or disclosure indicated in that authorization. Hearing Care by Gina does not generally receive copies of or access to any psychotherapy notes, however, if copies are obtained, they cannot and will not be released without and authorization.
YOUR RIGHTS IN CONNECTION WITH YOUR PROTECTED HEALTH INFORMATION
You have the following rights as a consumer under HIPAA regarding the protected health information we have about you in our records. Any request to exercise your rights as described below should be made in writing and submitted to the Hearing Care by Gina office in Montevideo, MN. (Contact information at end of Notice.)
Right to Inspect and Copy: You have the right to inspect and copy your protected health information that is in our possession as a part of the “designated record set”. The designated record set is essentially the information used to make decisions about your care and payment of care. You may not, however, have access to information that is put together for use in a civil, criminal or administrative proceeding.
Right to Request Amendment: If you feel your protected health information in the designated record set is incorrect or incomplete, you may ask us to amend that information. You have to right to request amendment for as long as the information is kept by or for Hearing Care by Gina.
Right to a Paper Copy of this Notice: You may ask us to give you an additional copy of this notice at any time by asking for it at your next office visit or in writing as described below. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
If you have any questions about this Notice, please contact Hearing Care by Gina in Montevideo, by calling (320)321-1551, or through email at email@example.com. If you wish to submit your questions to us by mail, please address your correspondence to:
Hearing Care by Gina
Gina K./Tina E.
408 North 1st Street
Montevideo, MN 56265
WE MAY MAKE CHANGES TO THIS NOTICE IN THE FUTURE, AND ANY OF THE TERMS OF THIS NOTICE THAT ARE CHANGED WILL APPLY TO ALL OF YOUR MEDICAL INFORMATION. IF WE MAKE A MATERIAL CHANGE TO OUR NOTICE, YOU MAY OBTAIN A COPY OF THE REVISED NOTICE AT YOUR LOCAL HEARING CARE BY GINA CLINIC, ON OUR WEBSITE, OR UPON REQUEST TO THE HEARING CARE BY GINA OFFICE AS DESCRIBED ABOVE.
Effective date of the Notice: August 20th, 2018