Hampden Hearing Center 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 audiological/health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights and our 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 audiological/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, Susan B. Chunyk, at (413) 525-7979 or email@example.com.
The following categories describe 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.
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.
The following uses and disclosures will be made only with your written authorization:
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 may revoke this authorization, at any time, in writing, except to the extent that Hampden Hearing Center 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 use, it is our intent to meet the requirements of the more stringent law.
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.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. If you have a question about this Notice or wish to file a complaint with us, please contact our Privacy Officer, Susan B. Chunyk, at (413) 525-7979 or firstname.lastname@example.org, or at the address listed below. All complaints must be submitted in writing. Hampden Hearing Center will not retaliate against you for filing a complaint.
We reserve the right to change this Notice at any time. The new Notice will be effective for all health information we already have about you as well as any information we receive in the future. You can also obtain a revised Notice at www.hampdenhearing.com or by contacting our Privacy Officer, Susan B. Chunyk, Hampden Hearing Center, 200 North Main Street, North Building, Suite 103, East Longmeadow, MA 01028. Hampden Hearing Center Attn: Corporate Privacy Officer
This Notice is effective as of September 23, 2013.