Patient Privacy Rights
This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Responsibilities of Newport-Mesa Audiology Balance and Ear Institute
The Institute is required to protect the privacy of your health information that may identify you. This health information includes health care services that are provided to you, payment for those health care services or other health care operations provided on your behalf.
This Institute is required by law to inform you of our legal duties and privacy practices with respect to your health information through this Notice of Privacy Practices. This Notice describes the ways we may share your past, present and future health information, ensuring that we use and/or disclose this information only as we have described in this Notice. We do, however, reserve the right to change our privacy practices and the terms of this Notice, and to make the new Notice provisions effective for all health information that we maintain. Any changes to this Notice will be posted. Copies of any revised Notices will be available to you upon request.
If at any time you have questions or concerns about the information in this Notice or about our Institute’s privacy policies, procedures and practices, you may contact our Institute's Privacy Official at (949) 274-8399.
Use and Disclosure of Health Information Without Authorization
The Institute may use or disclose your health information, as needed, in order to provide, coordinate, or manage your health care and related services. This includes sharing your health information with other health care providers, both within and outside this Institute, regarding your treatment when we need to coordinate and manage your health care.
Payment for Services
The Institute may use and give your health information to other staff and health plans you designate to bill and collect payment for the health care services received by you. We may share information with your health plan to determine coverage status prior to scheduled services. We will share adequate information with departments that prepare bills and manage client accounts in order to ensure payment for services rendered. We may share your health information with agents of your insurance company or health plan to confirm services that were provided to you. We may also share your health information with facility staff who reviews client services to make certain you have received appropriate care and treatment.
Health Care Operations
The Institute may use or disclose your health information in performing a variety of business activities that we call “health care operations”. These “health care operations” allow us to improve the quality of care we provide to you and our other clients and help us to reduce health care costs.
The Institute may use and/or disclose your health information for those circumstances that have been determined to be so important that your authorization may not be required. Prior to disclosing your health information, we will evaluate each request to ensure that only necessary information will be disclosed. Those circumstances include disclosures that are:
- Required by law
- For public health activities. For example, we may disclose health information to public health authorities if you have a communicable disease and we have reason to believe, based upon information provided to us, that there is a public health risk such as evidence of your noncompliance with your treatment plan. If you suffer from a communicable disease such as tuberculosis or HIV/AIDS, information about your disease will be treated as confidential. Other than circumstances described to you in other sections of this Notice, we will not release any information about your communicable disease except as required to protect public health or the spread of a disease, or at the request of the State or Local Health Director
- Regarding abuse, neglect or domestic violence
The Institute may use your health information to contact you to:
- Remind you of upcoming appointments
- Make you aware of alternative treatment, services, products or health care providers that may be of interest to you
- Contact you to conduct a Patient Survey to assess Instituteal outcomes.
Use and Disclosure of Health Information that Requires Your Authorization
The Institute will not use or disclose your health information without your authorization except as specified in the above examples where use or disclosure of your information is allowed or when required by State or Federal law. For all other uses or disclosures, we will ask you to sign a written authorization that allows us to share or request your health information. Before you sign an authorization, you will be fully informed of the exact information you are authorizing to be disclosed / requested and to/from whom the information will be disclosed/requested.
You may request that your authorization be cancelled by informing our Institute Privacy Official that you do not want any additional health information about you exchanged with a particular person/Institute. You will be asked to sign and date the Authorization Revocation section of your original authorization. Your authorization will then be considered invalid at that point in time; however, any actions that were taken on the authorization prior to the time you cancelled your authorization are legal and binding.
Your Rights Regarding Your Health Information
You have the following rights regarding your health information as created and maintained by this Institute.
Right to Receive a Copy of this Notice
You have a right to receive a copy of The Institute’s Notice of Privacy Practices. At your first treatment encounter with this Institute, you will be given a copy of this Notice and asked to sign acknowledgement that you have received it. In the event of emergency services, you will be provided the Notice as soon as possible after emergency services have been rendered.
Right to Request Different Ways to Communicate With You
You have the right to request to be contacted at a different location or by a different method. For example, you may request all written information be sent to your work address rather than your home address. We will agree with your request as long as it is reasonable to do so; however, your request must be made in writing and forwarded to our Institute Privacy Official.
Right to Request to See and Copy Your Health Information
You have the right to request and receive a copy of your health information in Instituteal, billing, and other records that are used to make decisions about you. Your request must be in writing and forwarded to our Institute Privacy Official. If your request is approved, you may be charged a fee to cover the cost of the copy, excluding labor costs.
Instead of providing you with a full copy of the health information, we may give you a summary or explanation of your health information, if you agree in advance to that format and to the cost of such information.
Your request may be denied under certain circumstances. If we do deny your request, we will explain our reason for doing so in writing, and describe any rights you may have to request a review of our denial.
Right to Request Amendment of Your Health Information
You have the right to request changes in your health information in Instituteal, billing, and other records used to make decisions about you. If you believe that we have information that is either inaccurate or incomplete, you may submit a request in writing to our Institute Privacy Official and explain your reasons for the amendment. We must respond to your request within 60 days of receiving your request.
We may deny your request if:
- The information was not created by this Institute (unless you prove the creator of the information is no longer available to change the information)
- The information is not part of the records used to make decisions about you
- We believe the information is correct and complete
- You do not have the right to see and copy the record.
If we deny your request to change your health information, we will tell you in writing the reasons for denial and describe your rights to give us a written statement disagreeing with the denial.
If we accept your request to change your health information, we will make reasonable efforts to inform others of the changes, including persons you name who have received your health information and who need the changes.
Right to Request a Listing of Disclosures We Have Made
You have the right to request and receive a written list of certain disclosures of your health information, made after April 14, 2003. You may ask for disclosures we made up to six years before your request. This listing will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed and the purpose of the disclosure.
This Institute is Not Required to Include on the List Disclosures for the Following:
- For your treatment;
- For billing and collection of payment for your treatment
- For our health care operations
- Requested by you, that you authorized, or which are made to individuals involved in your care
- Allowed by law
Your first request for a listing of disclosures will be provided to you free of charge. However, if you request a listing of disclosures more than once in a 12 month period, you may be charged a reasonable fee. We will inform you of the cost involved and you may choose to withdraw or modify your request at that time, before any costs are incurred.
Right to Request Restrictions on Uses and Disclosures of Your Health Information
You have the right to request that we limit our use and disclosure of your health information for treatment, payment, and health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment of your care, such as a family member or a friend. For example, you could ask that we not use or disclose the information about a previous condition you had.
We are not required to agree to such request. However, if we do agree, we must follow the agreed upon restriction (unless the information is necessary for emergency treatment or unless it is a disclosure to the U.S. Secretary of the Department of Health and Human Services).
You or your personal representative may cancel the restrictions at any time. In addition, this Institute may cancel a restriction at any time, as long as we notify you of the cancellation.
If you believe your privacy rights have been violated by us, or if you want to complain to us about our privacy practices, you may contact our Institute Privacy Official. All complaints should be submitted in writing.
You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. Contact information is as follows:
Office for Civil Rights
U.S. Department of Health and Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Voice Phone (404) 562-7886
FAX (404) 562-7881
TDD (404) 331-2867
If you file a complaint, we will not take any action against you or change our treatment of you, in any way.