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.
Federal regulations developed under the Health
Insurance Portability and Accountability Act (HIPAA) requires that the Speech,
Hearing & Learning Center (SHLC) provide you with this Notice Regarding
Privacy of Personal Health Information.
The Notice describes (1) how the SHLC may use and disclose your
protected health information, (2) your rights to access and control your
protected health information in certain circumstances, and (3) the SHLC’s
duties and contact information.
I.
Protected Health Information
“Protected health information” is health information
created or received by your health care provider that contains information that
may be used to identify you, such as demographic data. It includes written or oral health
information that relates to your past, present, or future mental health; the
provision of health care to you; and your past, present, or future payment for
health care.
II. The use and Disclosure of Protected
Health Information in Treatment, Payment, and Health Care Operations
Your protected health information may be used and
disclosed by the SHLC in the course of providing treatment, obtaining payment
for treatment, and conducting health care operations. Any disclosures may be made in writing, electronically, by
facsimile, or orally. The SHLC may also
use or disclose your protected health information in other circumstances if you
authorize the use of disclosure, or if state law or the HIPAA privacy regulations
authorize the use or disclosure.
Treatment. The SHLC may use and disclose your protected
health information in the course of providing or managing your health care as
well as any related services. For the
purpose of treatment, the SHLC may coordinate your health care with a third party. For example, the SHLC may disclose your
protected health information, which may include audiometric test results,
speech language evaluation results and/or therapy goals and progress, IQ,
achievement or other psychological test results and evaluations, to your
primary care physician or another physician who is treating you. In addition, the SHLC may disclose protected
health information to other physicians or health care providers for treatment
activities of those other providers.
Payment. When needed, the SHLC will use or disclose
your protected health information to obtain payment for its services. Such uses or disclosures may include
disclosures to your health insurer to get approval for a recommended treatment
or to determine whether you are eligible for benefits or whether a particular
service is covered under your health plan.
When obtaining payment for your health care, the SHLC may also disclose
your protected health information to your insurance company to demonstrate the
medical necessity of the care or for utilization review when required to do so
by your insurance company. Finally, the
SHLC may also disclose your protected health information to another provider
where that provider is involved in your care and requires the information to
obtain payment.
Healthcare
Operations. The SHLC may
use or disclose your protected health information when needed for the SHLC’s
health care operations for the purposes of management or administration of the
SHLC and of offering quality health care services. Health care operations may include: (1) quality evaluations and improvement activities; (2) employee
review activities and training programs; (3) accreditation, certification,
licensing, or credentialing activities; (4) reviews and audits such as
compliance reviews, medical reviews, legal services, and maintaining compliance
programs; and (5) business management and general administrative
activities. For instance, the SHLC may
use, as needed, protected health information of patients to review their
treatment course when making quality assessments regarding allergy care or
treatment. In addition, the SHLC may
disclose your protected health information to another provider or health plan
for their health care operations.
Other
Uses and Disclosures. As part
of treatment, payment, and healthcare operations, the SHLC may also use or
disclose your protected health information to: (1) remind you of an
appointment; (2) inform you of potential treatment alternatives or options; or
(3) inform you of health-related benefits or services that may be of interest
to you; (4) raise funds for our non-profit agency’s operations (you will have
the opportunity to let us know you do not want to receive future communication
of this type).
III. Additional uses
and Disclosures Permitted Without Authorization or An Opportunity to Object
In addition to treatment,
payment, and health care operations, the SHLC may use or disclose your
protected health information without your permission or authorization in
certain circumstances, including:
When Legally Required. The SHLC will comply with any Federal, state, or local law that
requires it to disclose your protected health information.
When There Are Risks to
Public Health. The SHLC may disclose your protected
health information for public health purposes, including to, as permitted or
required by law:
(1)
Prevent,
control, or report disease, injury, or disability;
(2)
Report
vital events such as birth or death;
(3)
Conduct
public health surveillance, investigations, and interventions;
(4)
Collect
or report adverse events and product defects, track FDA regulated products,
enable product recalls, repairs, or replacements, and conduct post marketing
surveillance;
(5)
Notify
a person who has been exposed to a communicable disease or who may be at risk
of contracting or spreading a disease; and
(6)
Report
to an employer information about an individual who is a member of the
workforce.
To Report Abuse, Neglect, or
Domestic Violence. As required or authorized by
law with the patient’s agreement, the SHLC may inform government authorities if
it is believed that a patient is the victim of abuse, neglect, or domestic
violence.
To Conduct Health Oversight
Activities. The SHLC may disclose your protected health
information to a health oversight agency for use in (1) audits; (2) civil,
administrative, or criminal investigations, proceedings or actions; (3)
inspections; (4) licensure of disciplinary actions; or (5) other necessary
oversight activities as permitted by law.
However, if you are the subject of an investigation, the SHLC will not
disclose protected health information that is not directly related to your
receipt of health care or public benefits.
For Judicial and
Administrative Proceedings. The SHLC may disclose your
protected health information for any judicial or administrative proceeding if
the disclosure is expressly authorized by an order of a court or administrative
tribunal as expressly authorized by such order or a signed authorization is
provided.
For Law Enforcement
Purposes. The SHLC may disclose your
protected health information to a law enforcement official for law enforcement
purposes when:
(1)
Required
by law to report of certain types of physical injuries;
(2)
Required
by court order, court-ordered warrant, subpoena, summons, or similar process;
(3)
Needed
to identify or locate a suspect, fugitive, material witness, or missing person;
(4)
Needed
to report a crime in an emergency situation;
(5)
You
are the victim of a crime in specific limited instances; and
(6)
Your
death is suspected by the SHLC to be the result of criminal conduct.
For Research Purposes. The SHLC may use or disclose your protected health
information for research if such use or disclosure has been approved by an
institutional review board or privacy board that has examined the research
proposal and the research protocols which maintain the privacy of your
protected health information.
To Prevent or Diminish a
Serious and Imminent Threat to Health or Safety. If in good faith the SHLC believes that use or disclosure of your
protected health information is necessary to prevent or diminish a serious and
imminent threat to your health or safety or to the health and safety of the
public, the SHLC may use or disclose your protected health information as permitted
under law and consistent with ethical standards of conduct.
For Specified Government
Functions. As authorized by the HIPAA privacy
regulations, the SHLC may use or disclose your protected health information to
facilitate specified government functions relating to military and veterans
activities, national security and intelligence activities, protective services
for the President and others, medical suitability determinations, correctional
institutions, and law enforcement custodial situations.
For Worker’s Compensation. The SHLC may disclose your protected health information to comply
with worker’s compensation laws or similar programs.
IV. Uses and Disclosures
Permitted With an Opportunity to Object.
Subject
to your objections, the SHLC may disclose your protected health information (1)
to a family member or close personal friend if the disclosure is directly
relevant to the person’s involvement in your care or payment related to your
care; or (2) when attempting to locate or notify family members or others
involved in your care to inform them of your location, condition or death. The SHLC will inform you orally or in
writing of such uses and disclosures of your protected health information as
well as provide you with an opportunity to object in advance. Your agreement or objection to the uses and
disclosures can be oral or in writing.
If you do not object to these disclosures, the SHLC is able to infer
from the circumstances that you do not object, or the SHLC determines, in its
professional judgment, that it is in your best interests for the SHLC to
disclose information that is directly relevant to the person’s involvement with
your care, then the SHLC may disclose your protected health information. If you are incapacitated or in an emergency
situation, the SHLC may exercise its professional judgment to determine if the
disclosure is in your best interests and, if such a determination is made, may
only disclose information directly relevant to your health care.
V. Uses
and Disclosures Authorized by You
Other
than the circumstances described above. The SHLC will not disclose your health
information unless you provide written authorization. You may revoke your authorization in writing at any time except
to the extent that the SHLC has taken action in reliance upon the
authorization.
VI. Your
Rights
You have certain rights
regarding your protected health information under the HIPAA privacy
regulations. These rights include:
The
right to inspect and copy your protected health information. For as long as the SHLC holds your
protected health information, you may inspect and obtain a copy of such
information included in a designated record set. A “designated record set” contains medical and billing records as
well as any other records that your physician and the SHLC uses to make
decisions regarding the services provided to you. The SHLC may deny your request to inspect or copy your protected
health information if the SHLC determines in its professional judgment that the
access requested is likely to endanger your life or safety or that of another
person, or that it is likely to cause substantial harm to another person
referred to in the information. You
have the right to request a review of this decision.
In
addition, you may not inspect or copy certain records by law; including: (1)
information compiled in reasonable anticipation of, or for use in, a civil,
criminal, or administrative action or proceeding; and (2) protected health
information that is subject to a law that prohibits access to protected health
information. You may have the right to
have a decision to deny access reviewed in some situations.
You
must submit a written request to the SHLC’s Privacy Officer to inspect and copy
your health information. The SHLC may
charge you a fee for the costs of copying, mailing, or other costs incurred by
the SHLC in complying with your request.
Please contact our Privacy Officer if you have questions about access to
your medical record at the number given on the last pages of this Notice.
The
right to request a restriction on uses and disclosures of your protected health
information. You may request
that the SHLC not use or disclose specific sections of your protected health
information for the purposes of treatment, payment, or health care
operations. Additionally, you may
request that the SHLC not disclose your health information to family members or
friends who may be involved in your care or for notification purposes as
described in this Notice. In your
request, you must specify the scope of restriction requested as well as the
individuals for which you want the restriction to apply. Your request should be directed to the
SHLC’s Privacy Officer.
The SHLC may choose to deny
your request for a restriction, in which case the SHLC will notify you of its
decision. Once the SHLC agrees to the
requested restriction, the SHLC may not violate that restriction unless use or
disclosure of the relevant information is needed to provide emergency treatment. The SHLC may terminate the agreement to a
restriction in some instances.
The
right to request to receive confidential communications from the SHLC by
alternative means or at an alternative location. You have the right to request that the SHLC
communicates with you through alternative means or at an alternative
location. The SHLC will make every
effort to comply with reasonable requests.
However, the SHLC may condition its compliance by asking you for
information regarding the procurement of payment or
specific information regarding an alternative address or other method of
contact. You are not required to
provide an explanation for your request.
Requests should be made in writing to the SHLC’s Privacy Officer.
The right to request an
amendment of your protected health information. During the time that the SHLC holds your protected health information,
you may request an amendment of your information in a designated record
set. The SHLC may deny your request in
some instances. However, should the
SHLC deny your request for amendment, you have the right to file a statement of
disagreement with the SHLC. In turn,
the SHLC may develop a rebuttal to your statement. If it does so, the SHLC will provide you with a copy of the
rebuttal. Requests for amendment must
be submitted in writing to the SHLC’s Privacy Officer. Your written request must supply a reason to
support the requested amendments.
The
right to request an accounting of certain disclosures. You have the right to request an accounting
of the SHLC’s disclosures of your protected health information made for
purposes other than treatment, payment or health care operations as described
in this Notice. The SHLC is not
required to account for disclosures (1) which you requested, (2) which you
authorized by signing an authorization form, (3) for a facility directory, (4)
to friends or family members involved in your care, and (5) certain other
disclosures the SHLC is permitted to make without your authorization. The request for an accounting must be made
in writing to our Privacy Officer and should state the time period for which
you wish the accounting to include, up to a six-year-old period. The SHLC is not required to provide an
accounting for disclosures that take place prior to April 14, 2003. The SHLC will not charge you for the first
accounting you request of any 12-month period.
Subsequent accountings may require a fee based on the SHLC’s reasonable
costs for compliance of the request.
The
right to obtain a paper copy of this notice. The SHLC will provide a
separate paper copy of this Notice upon request even if you have already been
given a copy of it or have agreed to review it electronically. You may also get
a copy from our website, www.shlcgreenville.org.
VII. The
SHLC’s Duties
The SHLC is required to
ensure the privacy of your health information and to provide you with this
Notice of your rights and the SHLC’s duties and procedures regarding your
privacy. The SHLC must abide by the
terms of this Notice, as may be amended periodically. The SHLC reserves the right to change the terms of this Notice
and to make the new Notice provisions effective for all protected health
information that the SHLC collects and maintains. If the SHLC alters its Notice, the SHLC will provide a copy of
the revised Notice through regular mail or in-person contact.
VIII. Complaints
If
you believe that your privacy rights have been violated, you have the right to
relate complaints to the SHLC and to the Secretary of the Department of Health
and Human Services. You may provide
complaints to the SHLC’s Privacy Officer.
The SHLC encourages you to relate any concerns you may have regarding
the privacy of your information and you will not be retaliated against in any
way for filing a complaint.
IX. Contact
Person
The
SHLC’s contact person regarding the SHLC’s duties and your rights under the
HIPAA privacy regulations is the Privacy Officer. The Privacy Officer can provide information regarding issues
related to this Notice by request.
Complaints to the SHLC should be directed to the Privacy Officer at the
following address:
Stephen T. Guryan
The Speech, Hearing, &
Learning Center
29 North Academy
Greenville SC 29601
The Privacy Officer can be contacted by telephone at
(864) 331-1400.
X. Effective
Date: This notice is effective
on April 14, 2003.