Nondiscrimination Policy

DISCRIMINATION IS AGAINST THE LAW

Otolaryngology Plastic Surgery Associates, PC and Intercounty Audiology complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Otolaryngology Plastic Surgery Associates, PC and Intercounty Audiology does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Otolaryngology Plastic Surgery Associates, PC and Intercounty Audiology

provides free aids and

services to people with disabilities to communicate effectively with us, such as:

• qualified sign language interpreters

• written information in other formats (large print, audio, accessible electronic

formats, other formats)

provides free language services to people whose primary language is not

English, such as:

• qualified interpreters

• information written in other languages

You can file a civil rights complaint with the U.S. Department of Health and

Human Services, Office for Civil Rights

• Electronically through the Office for Civil Rights Complaint Portal,

available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

• By mail at

U.S. Department of Health and Human Services

200 Independence Ave. SW

Room 509F HHH Building

Washington, DC 20201

• By phone at 1-800-368-1019; 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

HIPAA Policy

HIPAA Notice of Privacy Practices

FOR OTOLARYNGOLOGY PLASTIC SURGERY ASSOCIATES, P.C.
INTERCOUNTY AUDIOLOGY

Effective Date: and revised September 23, 2013
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.


If you have any questions about this notice, please contact:

Rebecca Tomlinson Doylestown Pointe 103 Progress Drive Suite 200 Doylestown, PA 18901
215-348-1152 or

Carol Styer North Penn Medical Arts Center 2100 North Broad Street Lansdale, PA 19446
215-368-5290

Our Pledge Regarding Medical Information:
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the care you receive at this office to provide you with quality care and to comply with legal requirements. This notice will tell you about the ways in which we use and disclose your medical information. We also describe your rights and the obligations we have regarding the use and disclosure of medical information. We are required by law to make sure that medical information that identifies you is kept private; give you this notice of our privacy practices with respect to your medical information; and follow the terms of the current notice.

We reserve the right to change our privacy practices provided law permits the changes. Before we make a significant change, this Notice will be amended to reflect the changes and we will make the new Notice available upon request. We reserve the right to make any change in our privacy practices and the new terms of our Notice effective for all health information maintained, created and/or received by us before the date changes were made.

You may request a copy of our Privacy Notice at any time by contacting our listed privacy officers contained in this agreement.

How We May Use and Disclose Medical Information About You:

For Treatment: While we are providing you with healthcare services, we may share your protected information (ePHI) with other health care providers, business associates and their subcontractors or individuals who are involve in your treatment, billing administrative support or data analysis. These business associates and subcontractors through signed contracts are required by Federal law to protect your health information. We have established "minimum necessary or "need to know" standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.

For Payment: We may use and disclose information about you for insurance and payment services.

Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in or helps pay for your medical care. We may disclose medical information about you to assist in a disaster relief effort.

Emergencies: To Avert a Serious Threat to Health or Safety. We may use and disclose information about you to prevent a serious threat to your health and safety, the public or to another person. We may disclose medical information about you to assist in a disaster relief effort.

For Health Care Operations: We may use and disclose information about you for practice operations to make sure that you receive quality care and for learning purposes.

Disclosure: We may disclose and/or share protected health information (PHI) including electronic disclosure with other healthcare professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and /or other person you choose to involve in your healthcare, only if you agree that we may do so. As if March 26, 2013 immunization records for students may be released without an authorization (as long as PHI disclosed is limited to proof of immunization). If an individual is deceased you may disclose PHI to a family member or individual involved in care or payment prior to death. Psychotherapy notes will not be used or disclosed without your written authorization. Genetic information: Non dischronation Act (GINA) prohibits health plans from using or disclosing genetic information for underwriting purposes. Uses and disclosures not described in this notice will be made only with your signed authorization.

Appointment Reminders: We may use and disclose information to contact you about the time, date and location of your appointment and appropriate information to bring to office.

Phone Messages: We may call and leave messages with whoever answers the phone at your house or on your answering machine unless directed otherwise.

Treatment Alternatives: We may use and disclose information to tell you about treatment options.

Health-Related Benefits and Services: We may tell you about health-related benefits or services.

Marketing Heatlth-Related Services: We will not use your health information for marketing purposes unless we have written authorization to do so. Effective March 26, 2013, we are required to obtain an authorization for marketing purposes if communication about product or service is provided and we receive financial enumeration (getting paid in exchange for making communication). No authorization is required if communicating is made face-to-face or for promotional gifts.

Fundraising: We may use certain information (name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information of outcome information) to contact you for the purpose of raising money and you will have the right to opt out of receiving such communication include: diagnosis, nature of services and treatment. If you have elected to opt out we are prohibited from making fundraising communication under the HIPAA Privacy Rule.

Sale of PHI: We are prohibited to disclose PHI without authorization if it constitutes enumeration (getting paid in exchange for the PHI) “Sale of PHI" does not include disclosures for public health, certain research purposes, treatment and payment, and for any other purpose permitted by the privacy Rule, where the only enumeration received is " a reasonable cost-based fee" to cover the cost to prepare and transmit the phi for such purpose or a fee otherwise expressly permitted by law. Corporate transactions (ie. sale, transfer, merger, consolidation) are also excluded from the definition of "sale".

Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. We will not use or disclose information about you until a special approval process, which evaluates the use of medical information, has approved the research project. We may disclose information about you to people preparing to conduct a research project so long as the information they review does not leave the practice.

As Required By Law: We will disclose information about you when required to do so by law.

Special Situations:
Organ and Tissue Donation: If you are an organ donor, we may release information to organ banks.

Military and Veterans: We may release information about military personnel as required.

Workers' Compensation: We may release information about you for workers' compensation.

Public Health Risks: We may disclose information about you for public health activities.

Health Oversight Activities: We may disclose information to a health oversight agency.

Lawsuits and Disputes: We may disclose information about you in response to a court or administrative order, a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request.

Law Enforcement: We may release information to a law enforcement official as required by law.

Coroners, Medical Examiners and Funeral Directors: We may release information to a coroner, medical examiner or funeral director as necessary.

National Security and Intelligence Activities and Protective Services for the President: We may release information about you to authorized federal officials for national security activities.

Inmates: We may release information about inmates to a correctional institution or law enforcement.

You have the following rights regarding medical information we maintain about you:

Right to Request Restriction of PHI: If you pay in full out of pocket for your treatment, you can instruct us not to share information about your treatment with your health plan; if the request is not required by law. Effective March 26, 2013, the Omnibus Rule restricts provider's refusal of an individual’s request not to disclose PHI.

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures" of you protected information if the disclosure was made for purposes other an providing services, payment and or business operations. In light of increasing use of Electronic Medical Record technology (EMR, the HITECH Act allows you the right to request a copy of your health information in electronic form if we store your information electronically. Disclosures can be made available for a period of 6 years prior to your request and for electronic health information 3 years prior to the date on which the accounting is requested. If for some reason we aren't capable of electronic format, a readable hardcopy will be provided. To request this list or accounting disclosures, you must submit your request in writing to one of our Privacy officers listed above. Lists if requested, will be $1.42 for each page. Please contact one of our privacy officers for an explanation of our fee structure.

Access: You have the right to inspect and copy your medical information. This includes medical and billing records, but does not include psychotherapy notes. You must submit your request in writing to Rebecca Tomlinson or Carol Styer. We may charge a fee for the costs of copying. We may deny your request to inspect and copy. You may request that the denial be reviewed. Another neutral health care professional, not the person who denied your request, will review your request and the denial. We will comply with the outcome of the review.

Right to Amend: You have the right to request to amend your healthcare information, if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, your request may be denied.

Breach Notification Requirements: It is presumed that any acquisition, access, use or disclosure of PHI not permitted under HIPAA regulations is a breach. We are required to complete a risk assessment, and if necessary, inform HHS and take any other steps required by law. You will be notified of the situation and any steps you should take to protect yourself against harm due to a breach.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, www.ENT-DRS.com

Questions and Complaints: You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer. If you feel we have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us in writing. Request a complaint Form from out Privacy Officer. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with U.S. Department of Health and Human Services.

HOW TO CONTACT US:

Otolaryngology Plastic Surgery Associates, PC
Rebecca Tomlinson
215-348-1152 ext 104
fax: 215-348-1947
email: becky.tomlinson@verizon.net
103 Progress Drive Suite 200 Doylestown, PA 18901

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