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.
Your patient records will be reviewed by your attending physician and staff members of this practice. The information will be used for the purposes of treatment, payment and day-to-day healthcare operations (including referrals, the scheduling of tests and labs, etc.) We may use this information to remind you of upcoming appointments, and to offer information to you concerning treatment and other healthcare services. We take every precaution to protect your health information through administrative, physical and technical safeguards.
You have the right under this Notice of Privacy Practices to:
- Request restrictions
- Receive confidential communications
- Inspect & copy protected health information
- Amend information
- Receive an accounting of disclosures for any purposes other than treatment, payment, and day-to-day operations.
Consent to Use and Disclosure of Health Information For Treatment, Payment, or Health Care Operations
I understand that as part of my health care, this organization originates and maintains health records describing my health history, symptoms, examination and test results, diagnoses, treatment, and any plans for future care or treatment. I understand this information serves as a:
- Basis for planning my care and treatment.
- Means of communication among the many health professionals who contribute to my care.
- Use of name and address for direct marketing purposes.
- Source of information for applying my diagnosis and surgical information to my bill.
- Means by which a third-party payer can verify that services billed were actually provided.
- Tool for routine health care operations such as assessing quality and reviewing the competence of health care professionals.
**All patients must sign “Patient HIPAA Consent Form”, if the patient refuses to sign the consent, the physician will not provide medical treatment.
I understand and have been provided with a Notice of Privacy Practices and understand that a more complete description of information uses and disclosures will be provided upon written request.
If you feel that your medical record has not been properly protected please notify our privacy officer Mid-Valley Hearing Center, LLC. We maintain the right to modify the privacy practices and will make the new notices immediately available for review. I have read and understood the information provided.
For your convenience, Advanced Professional Hearing Aid Services, Inc. and Mid-Valley Hearing Center are located in Charleston and Hurricane.
Find the location nearest you, and call to schedule your consultation with our audiological experts today!