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.
ABOUT THIS NOTICE
Milwaukee Ear, Nose, & Throat Clinic, Ltd. and Milwaukee Ear,
Nose, Throat Clinic Speech and Hearing Aid Center, Inc. of
Milwaukee, Wisconsin, is committed to protecting your health
information. This Notice of Privacy Practices (“Notice”) is
provided pursuant to the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”) as revised in the 2013
HIPAA Omnibus Rule. This Notice describes how we may use and
disclose your protected health information to carry out treatment,
payment, or health care operations and for other purposes that are
permitted or required by law. This Notice also describes your rights
and duties with respect to your protected health information.
“Protected health information” is information about you that may
identify you and that relates to your past, present or future physical
or mental health/condition and related health care services. We
must follow the privacy practices that are described in this Notice
while it is in effect. If you have any questions about this Notice,
please contact our Privacy Officer at 262-241-8000.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED
HEALTH INFORMATION
The following categories described the different ways that we may
use and disclose your protected health information. These examples
are not meant to be exhaustive, but to illustrate the types of uses and
disclosures that may be made.
- Treatment
We may use and disclose your protected health information to
provide, coordinate, or manage your audiological treatment and any
related services. We may also disclose your protected health
information to other third party providers involved in your medical
and hearing/ health care. For example, your protected health
information may be provided to a physician, or other medical and
hearing/health care provider (e.g. specialist or laboratory) to whom
you have been referred to ensure that the physician or other
audiological/ health care provider has the necessary information to
diagnose or treat you. - Payment
We may use and disclose your protected health information so that
the treatment and health care services you receive may be billed to
you, your insurance company, a government program, or third party
payors. This may include certain activities that your health
insurance plan may undertake before it approves or pays for the
health care services we recommend for you, such as making a
determination of eligibility or coverage for insurance benefits,
reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, we may
provide your health plan with medical information about the health
care services at Milwaukee Ear, Nose, and Throat Clinic, Ltd., and
Milwaukee Ear, Nose, & Throat Clinic Speech and Hearing Aid
Center of Milwaukee, Wisconsin, rendered to you for
reimbursement purposes. - Medical and Hearing/Health Care Operations
We may use and disclose your protected health information for
medical and hearing/ health care operation purposes. These uses
and disclosures are necessary to make sure that all of our patients
receive quality care and for our operation and management
purposes. For example, we may use your protected health
information to review the quality of the treatment and services you
receive and to evaluate the performance of our team members in
caring for you. We also may disclose information to audiologists,
physicians, nurses, technicians’, medical students, and other
personnel for educational and learning purposes. - Appointment Reminders
We may use and disclose medical information to contact and remind
you about appointments. If you are not home, we may leave this
information on your answering machine or in a message left with
the person answering the phone. - Check-in Sheet
We may use and disclose medical information about you by having
you check in when you arrive at our office. We may also call out
your name when we are ready to see you. - Notification and Communication with Family or Others
Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your
protected health information that directly relates to that person’s
involvement in your health care. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary
if we determine that it is in your best interest based on our
professional judgment. Also, for example, if you are brought into
this office and are unable to communicate normally with your
clinician for some reason, we may find it is in your best interest to
give your hearing instrument and other supplies to the friend or
relative who brought you in for treatment. We may also use and
disclose protected health information to notify such persons of your
location, general condition, or death. We also may use professional
judgment and our experience with common practice to make
reasonable decisions about your best interests in allowing a person
to act on your behalf to pick up your supplies, records, or other
things that contain protected health information about you. - Marketing
We may provide treatment communications concerning treatment
alternatives or other health related products or services, or to direct
or recommend other treatments, therapies, health care providers or
settings of care that may be of interest to you. For communications
for which we or a business associate may receive financial
remuneration in exchange for making the communication, we must
obtain written authorization unless the communication is made face-to-face and/or involving promotional gifts of nominal value. The
authorization will disclose whether we receive any compensation
for any marketing activity you authorize, and we will stop any
future marketing activity to the extent you revoke that authorization.
If you do not wish to receive these communications please submit a
written request to our Privacy Officer.
We may similarly describe products or services provided by this
practice and tell you which health plans this practice participates in.
We may also encourage you to maintain a healthy lifestyle and get
recommended tests, participate in a disease management program,
provide you with small gifts, tell you about government sponsored
health programs or encourage you to purchase a product or service
when we see you, for which we may be paid. Finally, we may
receive compensation which covers our cost of reminding you to
take and refill your medication, or otherwise communicate about a
drug or biologic that is currently prescribed for you. - Sale of Health Information
We will not sell your health information without your prior written
authorization. The authorization will disclose that we will receive
compensation for your health information if you authorize us to sell
it, and we will stop any future sales of your information to the extent
that you revoke that authorization. - Required by Law
As required by law, we will use and disclose your health
information, but we will limit our use or disclosure to the relevant
requirements of the law. When the law requires us to report abuse,
neglect or domestic violence, or respond to judicial or
administrative proceedings, or to law enforcement officials, we will
further comply with the requirement set forth below concerning
those activities. - Public Health
We may, and are sometimes required by law, to disclose your health
information to public health authorities for purposes related to:
preventing or controlling disease, injury or disability; reporting
child, elder or dependent adult abuse or neglect, reporting domestic
violence, reporting to the Food and Drug Administration problems
with products and reactions to medications; and reporting disease or
infection exposure. When we report suspected elder or dependent
adult abuse or domestic violence, we will inform you or your
personal representative promptly unless in our best professional
judgment, we believe the notification would place you at risk of
serious harm or would require informing a personal representative
we believe is responsible for the abuse or harm. - Health Oversight
We may, and are sometimes required by law, to disclose your health
information to health oversight agencies during the course of audits,
investigations, inspections, licensure and other proceedings, subject
to the limitations impose by law. - Judicial and Administrative Proceedings
We may, and are sometimes required by law, to disclose your health
information in the course of any administrative or judicial
proceeding to the extent expressly authorized by a court oradministrative order. We may also disclose information about you
in response to a subpoena, discovery request or other lawful process
if reasonable efforts have been made to notify you of the request and
you have not objected, or if your objections have been resolved by
a court or administrative order. - Law Enforcement
We may, and are sometimes required by law, to disclose your health
information to a law enforcement official for purposes such as
identify or locating a suspect, fugitive, material witness or missing
person, complying with a court order, warrant, grand jury subpoena
and other law enforcement purposes. - Coroners, Funeral Directors, and Organ Donation
We may disclosed your protected health information to a coroner or
medical examiner for identification purposes, determining cause of
death or for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose your protected health
information to a funeral director, as authorized by law, in order to
permit the funeral director to carry out its duties. We may disclosed
such information in reasonable anticipation of death. Protected
health information may be used and disclosed for cadaveric organ,
eye or tissue donation purposes. - Serious Threat to Health or Safety
Consistent with applicable federal and state laws, we may disclose
your protected health information to prevent or lessen a serious
threat to your health and safety or to the health and safety of another
person or the public. - Military Activity and National Security
If you are involved with military, national security or intelligence
activities or if you are in law enforcement custody, we may disclose
your protected health information to authorized officials so they
may carry out their legal duties under the law. - Workers’ Compensation
We may disclose your protected health information as authorized for
workers’ compensation or other similar programs that provide
benefit for a work-related illness. - Change of Ownership
In the event that this medical practice is sold or merged with another
organization, your health information/record will become the
property of the new owner, although you will maintain the right to
request that copies of your health information be transferred to
another physician or medical group. - Breach Notification
In the case of a breach of unsecured protected health information,
we will notify you as required by law. If you have provided us with
a current e-mail address, we may use e-mail to communicate
information related to the breach. In some circumstances our
business associate may provide the notification. We may also
provide notification by other methods as appropriate. - Required Uses and Disclosures
Under the law, we must make disclosures to you and when requiredby the Secretary of the U.S. Department of Health and Human
Services to investigate or determine our compliance with the
requirements of Section 164.500 et Seq.
SPECIAL PROTECTIONS FOR HIV, ALCOHOL AND
SUBSTANCE ABUSE, MENTAL HEALTH AND GENETIC
INFORMATION
Certain federal and state laws may require special privacy
protections that restrict the use and disclosure of certain health
information, including HIV-related information, alcohol and
substance abuse information, mental health information, and genetic
information. Some parts of this Notice may not apply to these types
of information.
USES AND DISCLOSURES OF PROTECTED HEALTH
INFORMATION BASED UPON YOUR WRITTEN
AUTHORIZATION
Except as described in this Notice of Privacy Practices, this medical
practice will, consistent with its legal obligations, not use or disclose
health information which identifies you without your written
authorization. If you do authorize this medical practice to use or
disclosed your health information for another purpose, you may
revoke your authorization in writing at any time.
The following uses and disclosures will be made only with your
written authorization: - Uses an disclosures of protected health information for
marketing purposes for which we or a business associate may
receive remuneration; and - Disclosures that constitute a sale of protected health
information. Other uses and disclosures of your protected health
information not described in this Notice will be made only with your
written authorization, unless otherwise permitted or required by law.
You make revoke this authorization, at any time, in writing, except
to the extent that Milwaukee Ear, Nose, and Throat Clinic, Ltd., and
Milwaukee Ear, Nose, and Throat Speech and Hearing Aid Center
of Milwaukee, Wisconsin, has taken an action in reliance on the use
or disclosure indicated in the authorization. Additionally, if a use or
disclosure of protected health information described above in this
Notice is prohibited or materially limited by other laws that apply to
sue, it is our intent to meet the requirements of the more stringent
law.
YOUR RIGHTS REGARDING YOUR PROTECTED
HEALTH INFORMATION
The following is a statement of your rights with respect to your
protected health information and a brief description of how you may
exercise these rights. - Right to be Notified If There is a Breach of Your Protected
Health Information
You have the right to be notified upon a breach of any of your
unsecured protected health information. - Right to Inspect and Copy
You have the right to inspect and copy your health information, with
limited exceptions. To access your medical information, you must
submit a written request detailing what information you want access
to, whether you want to inspect it or get a copy of it, and if you want
a copy, your preferred form and format. We will provide copies in
your requested form and format if it is readily producible, or we will
provide you with an alternative format you find acceptable, or if we
cannot agree and we maintain the record in an electronic format,
your choice of a readable electronic or hardcopy format. We will
also send a copy to any other person you designate in writing. We
will charge a reasonable fee which covers our costs for labor,
supplies, postage, and if requested and agreed to in advance, the cost
of preparing an explanation or summary. We may deny your request
under limited circumstances. If we deny your request to access your
child’s records of the records of an incapacitated adult you are
representing because we believe allowing access would be
reasonably likely to cause substantial harm to the patient, you will
have a right to appeal our decision. - Right to Request Restrictions (Special Privacy Protections)
You have the right to request restrictions on certain uses and
disclosures of your health information by a written request
specifying what information you want to limit, and what limitations
on our use or disclosure of that information you wish to have
imposed. If you tell us not to disclose information to your
commercial health plan concerning health care items or services for
which you paid for in full out-of-pocket, we will abide by your
request, unless we must disclose the information for treatment or
legal reasons. We reserve the right to accept or reject any other
request, and will notify you of our decision. - Right to Request Confidential Communications
You have the right to request that you receive your health
information in a specific way or at a specific location. For example,
you may ask that we send information to a particular e-mail account
or to your work address. We will comply with all reasonable
requests submitted in writing which specify how or where you wish
to receive these communications. - Right to Amend or Supplement
You have a right to request that we amend your health information
that you believe is incorrect or incomplete. You must make a
request to amend in writing, and include the reasons you believe the
information is inaccurate or incomplete. We are not required to
change your health information, and will provide you with
information about this medical practice’s denial and how you can
disagree with the denial. We may deny your request if we do not
have the information, if we did not create the information (unless
the person or entity that created the information is no longer
available to make the amendment), if you would not be permitted to
inspect or copy the information at issue, or if the information is
accurate and complete as is. If we deny your request, you may
submit a written statement of your disagreement with that decision,
and we may, in turn, prepare a written rebuttal. All information
related to any request to amend will be maintained and disclosed in
conjunction with any subsequent disclosure of the disputedinformation. - Right to an Accounting of Disclosures
You have a right to receive an accounting of disclosures of your
health information made by this medical practice, except that this
medical practice does not have to account for the disclosures
provided to you or pursuant to your written authorization, or as
described in treatment, payment, health care operations, notification
and communication with family, specialized government functions
of this Notice of Privacy Practices or disclosures for purposes of
research or public health which exclude direct patient identifiers, or
which are incident to a use or disclosure otherwise permitted or
authorized by law, or the disclosures to a health oversight agency or
law enforcement official to the extent this medical practice has
received notice from that agency or official that providing this
accounting would be reasonably likely to impede their activities. - Right to a Paper or Electronic Copy of this Notice
You have the right to notice of our legal duties and privacy practices
with respect to your health information, including a right to a paper
copy of this Notice of Privacy Practices, even if you have previously
requested its receipt by e-mail.
If you would like to have a more detailed explanation of these rights
or if you would like to exercise one or more of these rights, contact
our Privacy Officer.
CHANGES TO THIS NOTICE
We reserve the right to amend this Notice of Privacy practices at any
time in the future. Until such amendment is made, we are required
by law to comply with terms of this Notice currently in effect. After
an amendment is made, the revised Notice of Privacy Protections
will apply to all protected health information that we maintain,
regardless of when it was created or received. We will keep a copy
of the current notice posted in our reception area, and a copy will be
available at each appointment. We will also post the current notice
on our website.
COMPLAINTS
Complaints about this Notice of Privacy Practices or how this
medical practice handles your health information should be directed
to our Privacy Officer.
If you are not satisfied with the manner in which this office handles
a complaint, you may submit a formal complaint to:
OCRMail@hhs.gov
The complaint form may be found at
www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf. You
will not be penalized in any way for filing a complaint.
