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Serving Residents of Cary and Surrounding Areas. 115 Parkway Office Court, Suite 100
Cary, NC 27518

919-851-3800

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HIPAA & 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  
Cary Audiology Associates, PLLC 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, Michelle  Hardin, at (919) 851-3800 or [email protected]  


HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION  

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.  
1. 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 audiological/health care. For example,  your protected health information may be provided to a physician or other audiological/health 
care provider (e.g. a 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.  
2. 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 audiological/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  audiological/health care services Cary Audiology Associates, PLLC rendered to you for  reimbursement purposes.  
3. Audiological/Health Care Operations  
We may use and disclose your protected health information for audiological/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.  
4. Treatment Communications  
We may provide treatment communications concerning treatment alternatives or other health  related products or services. 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. If you do not wish to receive these communications please  submit a written request to our Privacy Officer, Michelle Hardin, Cary Audiology Associates,  PLLC, 115 Parkway Office Court, Suite 100, Cary, NC 27518. 
5. Fundraising Activities  
We may use or disclose your demographic information and dates of services provided to you, as  necessary, in order to contact you for fundraising activities supported by Cary Audiology  Associates, PLLC. You have the right to opt out of receiving fundraising communications. If you  do not want to receive these materials, please submit a written request to our Privacy Officer,  Michelle Hardin, Cary Audiology Associates, PLLC, 115 Parkway Office Court, Suite 100,  Cary, NC 27518.  
6. 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 coordinate with disaster relief  agencies to make this type of notification. 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 hearing instruments, supplies, records, or  other things that contain protected health information about you.  
7. Required by Law  
We may use or disclose your protected health information to the extent that the use or disclosure  is required by law. The use or disclosure will be made in compliance with the law and will be  limited to the relevant requirements of the law. You will be notified, as required by law, of any  such uses or disclosures.  
8. Public Health  
We may disclose your protected health information for public health activities and purposes to a  public health authority that is permitted by law to collect or receive the information. The  disclosure will be made for the purpose of controlling disease, injury or disability. We may also 
disclose your protected health information, if directed by the public health authority, to a foreign  government agency that is collaborating with the public health authority.  
9. Business Associates  
We may disclose your protected health information to our business associates that perform  functions on our behalf or provide us with services if the information is necessary for such  functions or services. To protect your health information, however, we require the business  associate to appropriately safeguard your information.  
10. Communicable Diseases  
We may disclose your protected health information, if authorized by law, to a person who may  have been exposed to a communicable disease or may otherwise be at risk of contracting or  spreading the disease or condition.  
11. Health Oversight  
We may disclose your protected health information to a health oversight agency for activities  authorized by law, such as audits, investigations, and inspections. Oversight agencies  seeking this information include government agencies that oversee the audiological/health care  system, government benefit programs, other government regulatory programs and civil rights  laws.  
12. Abuse or Neglect  
We may disclose your protected health information to a public health authority that is authorized  by law to receive reports of abuse or neglect. In addition, we may disclose your protected health  information if we believe that you have been a victim of abuse, neglect or domestic violence to  the governmental entity or agency authorized to receive such information. In this case, the  disclosure will be made consistent with the requirements of applicable federal and state laws.  
13. Food and Drug Administration  
We may disclose your protected health information to a person or company required by the Food  and Drug Administration to report adverse events, product defects or problems, biologic product  deviations, track products to enable product recalls, to make repairs or replacements, or to  conduct post marketing surveillance, as required by law.  
14. Legal Proceedings  
We may disclose your protected health information in the course of any judicial or administrative  proceeding, in response to an order of a court or administrative tribunal (to the extent such 
disclosure is expressly authorized), and in certain conditions in response to a subpoena,  discovery request or other lawful process.  
15. Law Enforcement  
We may disclose your protected health information, so long as applicable legal requirements are  met, for law enforcement purposes.  
16. Coroners, Funeral Directors, and Organ Donation  
We may disclose 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 disclose such information in reasonable anticipation of death. Protected health  information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.  
17. Research  
We may disclose your protected health information to researchers when their research has been  approved by an institutional review board that has reviewed the research proposal and  established protocols to ensure the privacy of your protected health information.  18. 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.  
19. 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.  
20. Workers’ Compensation  
We may disclose your protected health information as authorized for workers’ compensation or  other similar programs that provide benefits for a work-related illness.  
21. For Data Breach Notification Purposes  
We may use or disclose your protected health information to provide legally required notices of  unauthorized access to or disclosure of your health information. 
22. Required Uses and Disclosures  
Under the law, we must make disclosures to you and when required by 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  
The following uses and disclosures will be made only with your written authorization:  

1. Uses and disclosures of protected health information for marketing purposes for which we or a  business associate may receive remuneration; and  
2. 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 may revoke this authorization, at any time, in writing, except to the extent that Cary  Audiology Associates, PLLC 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.  

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. 
1. 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.  
2. Right to Inspect and Copy  You may inspect and obtain a copy of your protected health information that is contained in your  medical and billing records and any other records that Cary Audiology Associates, PLLC uses  for making decisions about you. To inspect and copy your medical information, you must submit  a written request to our Privacy Officer, Michelle Hardin, Cary Audiology Associates, PLLC,  115 Parkway Office Court, Suite 100, Cary, NC 27518. If you request a copy of your  information, we may charge you a reasonable fee for the costs of copying, mailing or other costs  incurred by us in complying with you request. Under federal law, you may not inspect or copy  the following records: psychotherapy notes; information compiled in reasonable anticipation of,  or use in, a civil, criminal, or administrative action or proceeding; and protected health  information that is subject to law that prohibits access to protected health information.  Depending on the circumstances, we may deny your request to inspect and/or copy your  protected health information. A decision to deny access may be reviewable. Please contact our  Privacy Officer, Michelle Hardin, at (919) 851-3800 or [email protected] if you  have questions about access to your medical record.  
3. Right to Request Restrictions  
You may ask us not to use or disclose any part of your protected health information for the  purposes of treatment, payment or healthcare operations. You may also request that any part of  your protected health information not be disclosed to family members or friends who may be  involved in your care or for notification purposes as described in this Notice. To request a  restriction on who may have access to your protected health information, you must submit a  written request to our Privacy Officer, Michelle Hardin, Cary Audiology Associates, PLLC, 115  Parkway Office Court, Suite 100, Cary, NC 27518. Your request must state the specific  restriction requested and to whom you want the restriction to apply. Cary Audiology Associates,  PLLC is not required to agree to a restriction that you may request, unless you are asking us to  restrict the use and disclosure of your protected health information to a health plan for payment  or audiological/health care operation purposes and such information you wish to restrict pertains  solely to a audiological/health care item or service for which you have paid us “out-of-pocket” in 
full. If we believe it is in your best interest to permit the use and disclosure of your protected  health information, your protected health information will not be restricted. If we do agree to the  requested restriction, we may not use or disclose your protected health information in violation  of that restriction unless it is needed to provide emergency treatment.  
4. Right to Request Confidential Communication  
You have the right to request to receive confidential communications from us by alternative  means or at an alternative location. We will accommodate reasonable requests. You must request  this by submitting a written request to your our Privacy Officer, Michelle Hardin, Cary  Audiology Associates, PLLC, 115 Parkway Office Court, Suite 100, Cary, NC 27518.  
5. Right to Request Amendment  
You may request an amendment of your protected health information contained in your medical  and billing records and any other records that Cary Audiology Associates, PLLC uses for making  decisions about you, for as long as we maintain the protected health information. You must  request for an amendment by submitting a written request to your our Privacy Officer, Michelle  Hardin, Cary Audiology Associates, PLLC, 115 Parkway Office Court, Suite 100, Cary, NC  27518, and provide the reason(s) that support your request. In certain cases, we may deny your  request for an amendment. If we deny your request for an amendment, you have the right to file a  statement of disagreement with us and we may prepare a rebuttal to your statement and will  provide you with a copy of any such rebuttal.  
6. Right to an Accounting of Disclosures  
You have the right to receive an accounting of certain disclosures we have made, if any, of your  protected health information. This right applies to disclosures for purposes other than treatment,  payment or healthcare operations as described in this Notice. It excludes disclosures we may  have made to you, for a resident directory, to family members or friends involved in your care, or  for notification purposes. The right to receive this information is subject to certain exceptions,  restrictions and limitations. Additionally, limitations are different for electronic health records.  You must request for an accounting of disclosures by submitting a written request to our Privacy  Officer, Michelle Hardin, Cary Audiology Associates, PLLC, 115 Parkway Office Court, Suite  100, Cary, NC 27518, and provide the reason(s) that support your request. 
7. Right to Obtain a Paper Copy of this Notice  
You have the right to receive a paper copy of this Notice even if you have agreed to receive this  notice electronically. You may ask us to give you a copy of this notice at any time. To obtain a  paper copy of this Notice, you can contact our Privacy Officer, Michelle Hardin, at (919) 851- 
3800 or [email protected] You may also obtain a copy of this Notice at  www.caryaudiology.com.  
 

COMPLAINTS OR QUESTIONS  
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, Michelle  Hardin, at (919) 851-3800 or [email protected], or the Corporate Privacy Officer at  the address listed below. All complaints must be submitted in writing. Cary Audiology  Associates, PLLC will not retaliate against you for filing a complaint.  
 

CHANGES TO THIS NOTICE  
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.caryaudiology.com or by contacting our  Privacy Officer, Michelle Hardin, Cary Audiology Associates, PLLC, 115 Parkway Office  Court, Suite 100, Cary, NC 27518.  
Cary Audiology Associates, PLLC  
Attn: Corporate Privacy Officer  


This Notice is effective as of April, 2013.