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Notice of Privacy Policy and Procedures

We at JC Audiology, Inc. recognize our obligation to keep information about you secure, confidential and to conduct business honestly with your best interest at the forefront. This Notice of Privacy describes our policy and procedures regarding how you're personal, hearing healthcare/treatment and financial information may be collected, used, disclosed, and discarded, as well as, how you can gain access to your records and your rights as our patient. Please review this notice carefully!
 
Personal Information refers to your name, date of birth, sex, ethnicity, address, social security number, hearing healthcare treatment, hearing records (audiometric/diagnostic examinations), insurance, and financial (payment history) information which is not generally available to the public.
 
JC Audiology, Inc has the right to collect, use, disclose and discard patient personal information.
 
Collection of your personal information is for the sole purpose of evaluating your hearing healthcare treatment and supporting our normal business operations. Besides collecting personal information from you, we may obtain information from your personal physician, qualified health professionals and affiliated third parties (caregivers, nursing homes) who contribute to your care. The information we collect will be stored in your medical record and on our in-house computer and discarded by shredding or by a waste disposal company.
 
Use and disclosure of personal information is for the purpose of diagnosing, providing hearing healthcare treatment, obtaining payment and conducting healthcare business operations.
 
JC Audiology, Inc has the right to use and disclose your Information within the office, outside the office, with affiliated and non-affiliated individuals or companies and, at times, without your authorization or in your 'best interest' subject to the conditions specified below:

• within our office it is restricted to audiologists, lab technicians, and office personnel including insurance and billing personnel. The use and disclosure of your information will be limited to the 'minimum necessary' to do their job effectively and to the operation of running the office. We will only use and disclose information to provide the personalized service you expect including contacting you for appointment reminders and providing you with information concerning hearing-related or product benefits and services
• outside our office it is restricted to individuals whom you authorized on your 'Patient Authorization Record', such as, your spouse, family member, caregiver, physician, and your insurance carrier for purpose of verification of benefits and payments
• affiliated individuals/companies will be held accountable to our Business Associate Agreement Policy and Procedures. Affiliated Individuals/companies are health professionals who may not directly contribute to your care, hearing aid manufacturers involved in creating, repairing, remaking your aid and your insurance carrier/Medicare/Medicaid and other agencies responsible for assisting you with the purchase of your hearing device, and waste disposal company
• non-affiliated individuals/companies will require a separate authorization from you before gaining access and disclosure to your records. Non-affiliated individuals/companies are an attorney, employer, marketing, fund-raising and/or medical research companies including other insurance companies, physicians, family or other representatives acting on your behalf but not indicated on your 'Patient Authorization Record'
• without your authorization when required by:
  • State health agencies
  • Food & Drug Administration
  • case of suspect child abuse or domestic violence
  • court orders
  • law agencies
  • suspected criminal investigations

Although we anticipate any such disclosures to be rare, we will later inform you when information has been disclosed

• In your 'best interest' for your convenience and/or when you may be hospitalized or unable to conduct your hearing care business. We may release personal, hearing healthcare and financial information to a person (family/caregiver) involved in your direct care to pick-up repaired aids, request warranty coverage, and/or request payment information for purpose of making a payment. We will release only that information which is directly relevant to the situation

 
JC Audiology, Inc has the right (without violation of your privacy) to

• request patients to 'Sign-In' upon arrival, to complete our 'Registration/Authorization and Permission for Treatment' form, and to use a patient's first name in the waiting room
• review hearing records to ensure records are complete with audiologist comments when copies of records are requested
• refer a patient to JC Audiology before any service and/or treatment is provided if a patient refuses to sign the Registration/Authorization and/or Permission for Treatment' form
• recommend alternative treatments (implants, listening devices) therapies or healthcare providers as part of your hearing treatment
• leave a phone message when no instructions have been stated on your 'Registration' form to schedule or remind you of an appointment, or to pick-up your repaired aid. Any message will contain the minimum information to convey the message and to safeguard your personal information
• request that when a patient is unable to sign the 'Registration/Authorization and/or Permission for Treatment' form that a personal representative may sign the form, as long as, that person submits a Power of Attorney
• Diagnostic information is considered part of your treatment and can be released without your authorization. We will release your diagnostic information to manufacturers for the purpose of creating, repairing or remaking a hearing aid and to your insurance carrier for the purpose of verification of hearing benefits and payment for hearing aids and services provided to you.

 
Patient's Rights

1. You can access your records during normal business hours and may review your file in the waiting room, conference room, or the exam room
   • Removal of original records from the office is not allowed
2. You can request a copy of your records in person, by phone or by submitting a written request
   • There is a copy fee if over five pages
• We will respond that day, if possible or within 30 days if the record is not readily available
3. You can correct personal information in your record
   • by submitting a written request to correct your record using our "Request to Correct Records" form
   • We will respond to your request within 60 days from date of submission
4. You can request in writing a list of any disclosures made from your records over the last 6 years, starting April 14, 2003.
• We will respond to your request within 60 days from date of written request
5. You can revoke your consent and authorization in writing using the "Revoke Authorization" form
6. You can request in writing confidential communications (although all communications in our office are confidential) and/or restrictions to use and disclose your information by using the "Confidential Communications and/or Restrictions" form
7. A copy of our Notice of Privacy Policy and Procedures will be given with all new patient packets and initially to our existing patients
8. You can complain about our privacy policy or its execution either verbally or in writing to our Privacy Officer. If you do not receive a resolution to your complaint, you can send a written statement to this office or the Secretary of Health and Human Services. You can obtain the address from our Privacy Officer

JC Audiology Inc. employees are schooled in the legal and ethical responsibilities to safeguard the privacy of all patients and protect the confidentiality of patient treatment, hearing healthcare, and financial information whether an employee has direct or indirect access to personal information. Employees who violate our Privacy Policy will be subject to disciplinary action, which may include termination.
 
JC Audiology Inc. will

1. Maintain physical, electronic and procedural safeguards to comply with federal regulations to guard this information. This means that your charts will be stored in a secure area and available only to designated staff and that our computer systems are not easily accessible to non-office personnel
2. Not sell your information
3. Use manual and electronic security procedures to maintain the confidentiality and integrity of personal information in our possession and guard against its unauthorized access
4. Identify information that must be protected and will provide an adequate level of protection for that information and granting access to that information only to individuals who must use it in the performance of their job-related duties
5. Continue to follow this policy regarding personal information even when a customer relationship no longer exists

 
JC Audiology Inc. reserves the right to make changes to this notice. We will notify patients' of any modification by posting a notice of change with the effective date of the change. Copies available upon request.
 
Web site Privacy When visiting our website no personal information is requested. The information provided is for educational purposes and is not considered to be medical advice. We do recommend contacting a qualified physician or a licensed audiologist for any hearing problem. If you have any questions or comments relating to our Privacy Statement please contact us at (813) 949-1331.
 
Amended Date: February 9, 2007