EARS & HEARING
DIZZINESS & BALANCE
In accordance with the law and in consideration of your rights, we are committed to protecting your health information (PHI). It is our duty, unless expressly permitted by the law or by your authorization, to deidentify or anonymize your health information thereby assuring that it cannot be associated with elements of your identity which include your name, other data that could be used to personally identify you, or financial and insurance information which could be used to associate you with it.
According to HIPAA, the documentation created at Blue Water Ear Nose & Throat with Balance and Therapy by FYZICAL, including your medical and financial records, are our property; however, you have certain rights with regards to their use and disclosure. We will ask you to sign a form stating that you have received this notice, have read it, and were given the opportunity to execute your rights and ask questions about it.
Your Rights Under HIPAA
- You may request a copy of this notice.
- You may permit or prohibit disclosure of your PHI by indicating those preferences on the form you must sign. These can be changed at any time by filling out a new form.
- You may indicate how we can contact you about appointments and leave you messages about your care. Please consider who else may receive or hear these messages.
- You may restrict certain uses and disclosures of your PHI to a health plan or health care corporation regarding services or treatment for which you paid directly. This can be accomplished by making a written request. Other requests to restrict use and disclosure will be reviewed.
- You may request a copy of your PHI (medical record) by filling out and signing a form.
- You have the right to request that we change your health information by means of a written request. If this is not granted, you may still request that we keep a copy of your written statement on record.
- We will keep records of our disclosures of your information. With a written request, we will provide these records to you for the previous 12 months at no charge or we will notify you of the charge for older records. These are exclusive of disclosures for treatment, payment, or health care operations.
- You may cancel your authorization to use or disclose PHI that has not already been released by means of a written request.
If you have questions about your rights, please contact our Client Care Supervisor by mail at 4917 South Croatan Hwy Unit 1C, Nags Head, NC 27959 or by phone at (252) 489-4682.
In general, we do not need specific permissions to use your PHI for your care. In fact, there are many misperceptions about when and how we can use or disclose your protected health information. A good, general rule is that we do not require your permission to disclose your health information when it involves your health care or payment for your health care. The following outlines to whom we may release your information without specific permissions.
- For treatment purposes — within our facility or to other providers to help coordinate your care.
- For payment — to health insurers unless you are paying directly.
- For health care operations — including for quality improvement, quality review, audit functions and accounting, legal, or risk management services.
- As required by local, state, or federal law.
- To business associates when they have signed a business agreement to protect any information that is shared.
Furthermore, there are many situations in which disclosure will occur when that disclosure is appropriate, including but not limited to times necessary facilitate public health and safety, research, coroners, organ procurement organizations, the Food and Drug Administration (FDA), correctional institutions, law enforcement, disaster relief, national security, the Veterans Administration (VA), military or Department of State, or to facilitate workplace injury or illness cases, and government health and oversight activities. Whenever feasible, your identifying information will be removed. We are happy to share how we decide with you on our long form.
On the other hand, we will only disclose information to those who are not vital in your care with your written permission or after it has been anonymized. For that reason, we ask that you let us know of any family, friends, or other associates to whom you explicitly give us permission or withhold permission from informing or disclosing your information. We also reserve the right to leave messages at any phone number you have given us that will identify that you are or will be receiving care at Blue Water Ear Nose & Throat and Balance by FYZICAL unless you have otherwise informed us in writing.
Lastly, we may change this policy by making updates. All updates will be posted on our website or may be obtained at our office. We will ask you to sign a form that you have seen or been given our most current notice of your rights on a yearly basis if you continue to be seen in our office.
If you have any questions or concerns, or wish to report a problem please contact our Client Care Supervisor. If you believe your privacy rights have been violated you may discuss this with any member of our staff, send a written complaint, or report your concern to the Department of Health and Human Services (DHHS) Office for Civil Rights (OCR).
April 14, 2017