THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU AND INFO THAT CAN BE IDENTIFIED WITH YOU MAY BE USED AND DISCLOSED, IN ADDITION TO HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE FOLLOWING CAREFULLY.
The practice of WILMINGTON AUDIOLOGY SERVICES is required, by law, to maintain the privacy and confidentiality of your protected health information (PHI) and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information. We may use and disclose your health care information in the following ways without authorization:
TREATMENT
The practice of WILMINGTON AUDIOLOGY SERVICES may disclose your PHI to other health care professionals within our practice for the purpose of treatment, payment or health care operations. Many of the people who work for us, including but not limited to our doctors and nurses, may use your PHI to treat you or to help others in your treatment. We may disclose your PHI to others who may assist in your care, such as health care providers outside of our practice, or a spouse, child or parent who is involved in your care. Examples are: We could disclose your PHI if it is necessary to seek consultation regarding your condition from other health care providers associated with our practice, in the event
of your primary health care provider’s absence due to vacation, sickness, or other emergency, without advance notice to you, we could disclose your PHI to a substitute health care provider for the purposes of assessment and treatment of our patients. We may disclose your PHI to a pharmacy when ordering a prescription for you or to a laboratory when ordering lab tests to help us reach a diagnosis.
PAYMENT
The practice of WILMINGTON AUDIOLOGY SERVICES may disclose your health information to your insurance provider for the purpose of payment or health care operation. For example, we may contact your health insurer to certify that you are eligible for benefits, and we may disclose your treatment plan to determine if your insurer will pay for your treatment. Our practice may submit an itemized billing statement to your insurance carrier for the purpose of payment for health care services rendered. If you pay for your health care services personally, we may provide an itemized billing to your insurance carrier for the purpose of reimbursement to you, unless you request otherwise. The billing statement contains medical information, including diagnosis, date of injury or condition and codes that describe the health care services received. If you request that your insurance company not be notified of services that you have paid for out-of-pocket, we take every reasonable precaution to avoid their notification.
OPERATIONS
The practice of WILMINGTON AUDIOLOGY SERVICES could use your PHI in our business operations. “Operations” are any activities that are necessary information. We understand that breaches of personal information have the potential to cause reputation, physical or financial harm. If there is a reason to believe that your PHI is breached, our practice will conduct a thorough investigation and risk assessment. If after considering all the factors our evaluation fails to demonstrate a low probability that your privacy has been comprises, we are required by law to notify you and the U.S. Department of Health and Human Services in writing. Information provided will include details of the breach, the correctional actions taken by the practice and any action that you should take to protect yourself further.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
The practice of WILMINGTON AUDIOLOGY SERVICES reserves the right to amend this Notice of Privacy Practices at any time in the future and will make the new provisions effective for all information that it maintains. Until such amendment is made, our practice is required by law to comply with this notice. We are required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice, or if you want more information about your privacy rights, please contact our practice’s Privacy Officer by calling this office at (302) 654-1011. If the Privacy Officer is not available, you may make an appointment for a personal conference in person of by telephone within two (2) working days.
COMPLAINTS
Complaints about your privacy rights or about how the practice of WILMINGTON AUDIOLOGY SERVICES has handled your health information should be directed to our Privacy Officer by calling his office at (302) 654-1011. If our Privacy Officer is not available, you may make a request for a personal conference in person or by telephone and receive an appointment within two (2) working days. There will be no retaliation for the filing of a complaint.
If you are not satisfied with the way the practice of WILMINGTON AUDIOLOGY SERVICES handles your complaint, you may submit a formal complaint to the Office of Civil Rights at the address below. Our Privacy Officer can provide you with the correct form to file. You will not be retaliated against if you file a complaint to use or to the Office of Civil Rights.
DHHS, Office of Civil Rights 200 Independence Avenue, S.W.
Room 509F HHH Building Washington, DC 20201
Revised January 2022