The Hearing and Tinnitus Center (HTC) respects your right to privacy and will protect the confidentiality of your health information-whether this information is stored in a paper or electronic file.

HTC adheres to the requirements outlined by the Health Insurance Portability and Accountability Act of 1996 (http://www.hhs.gov/ocr/privacy/index.html) (HIPPA), as well as applicable Colorado General Laws, which ensure the privacy and security of an individual’s health information and promotes privacy and trust between patients and their health care providers.

We have privacy procedures in place to safeguard your rights to privacy and confidentiality.

You may obtain a copy of your health information by submitting a request in writing and by calling The Hearing & Tinnitus Center  1001 w.120th Ave. Suite 214 Westminster, Colorado 80234 phone# 720-749-3152.

All new patients, upon their initial visits, are required to sign the Acknowledgement of Receipt Notice form to indicate that they have received our Notice of Privacy Practices that describes how we may use or disclose your health information, your rights to access your health information and request changes to your health information.

HIPAA STATEMENT

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.

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you you by submitting a written request to: HTC • 1001 W. 120th Ave, Suite 214 • Westminster, CO 80234 and by calling us at 720-749-3152.

We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge fees as allowed by state law.

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

You can ask us not to use or share certain health information for treatment, payment or our operations.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

You can complain if you feel we have violated your rights by contacting us at: HTC • 1001 W. 120th Ave, Suite 214 • Westminster, CO 80234 and by calling us at 720-749-3152.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or by visiting: www.hhs.gov/ocr/privacy/hipaa/complaints.

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved your care.

Share information in a disaster relief situation.

Include your information in a hospital directory.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

Marketing purposes.

Sale of your information.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

The effective date of this notice is January 4th, 2016.