• Treatment: We will use and disclose your Protected Health Information to provide, coordinate or manage your hearing health care. This includes the coordination of your hearing health care with 3rd parties such as hearing aid manufacturers. For example, your audiogram, name date of birth, medical condition, etc. may be sent to a hearing aid manufacturer so that they can build your hearing aid.
• Payment: We will use your Protected Health Information to contact you regarding payment of your hearing aid or for other services we offer. For example, we will use your name and address to send you billing information or to follow up with you on payments.
• Healthcare Operations: We will use and disclose your Protected Health Information in the normal course of running our Healthcare Operations. Your name, contact information, hearing aid S/N, etc, become integral parts of our business records, allowing us to coordinate our business. For example, we will utilize your telephone number or address to contact you to inform you that your hearing instrument has arrived.
• Fund Raising: Non-applicable.
• Other Health Related Activities: We will use and disclose your Protected Health Information to contact you regarding follow up services, future appointments, treatment options, and new products that are available. For example, we may call you to check on how well you are adapting to use of your hearing aid and to schedule an appointment.

2. Uses and Disclosures that REQUIRE your Authorization. We are prevented by law from using or disclosing your Protected Health Information for most purposes other that listed in (1.) above or (3) below, unless we have Authorization. Your authorization will be requested using the Findlay Hearing Aid Center’s Authorization for Use of Protected Health
Information form. Your authorization may be revoked at any time you choose by contacting us in writing.

3. Other Uses and Disclosures that May be Made with your Consent, Authorization or opportunity to Object. There are a variety of rare conditions under which we are either required or allowed to use or disclose your Protected Health Information. If you are not present or able to object or agree, we may, using professional judgment, determine whether the disclosure is in your best interest. If so, only the Protected Health Information that is relevant to your health care will be disclosed. The following list outlines conditions and entities under which we would/must use or disclose.

• As part of a US Food and Drug requirement or investigation
• When under court order in response to a subpoena, discovery request or other lawful process.
• For law enforcement purposes as long as applicable legal requirements are met.
• For Research, provided the research has been reviewed by a Research Board and protocols for your privacy has been established.
• For Military Activity and National Security, including for the purpose of determining your eligibility for VA benefits.
• As required by Workers Compensation Laws
• When required by the Secretary of the Dept. of Health and Human Services
• When you request such use or disclosure.

II. Your Rights under the Health Insurance and Portability and Accountability Act of 1996

1. You have the right to inspect and receive a copy of your Protected Health Information. We will make available to you to inspect, and provide a copy upon request, any Protected Health Information we have and which we are legally required or allowed to provide to you. You can exercise this right by requesting such information to us in writing.
We mist provide your information within the 30 days required by law. Under federal law, there are some instances in which we can not or may choose not to provide you this access. Those instances typically revolve around us in a civil, criminal or
administrative action. If we deny you access to your Protected Health Information, you may have the right to a review of that denial. Please contact our Privacy contact if you have questions about your access.

2. You have the right to request a restriction of your Protected Health Information. You can request at any time that we not use or disclose your Protected Health Information for a particular purpose, including those involved in treatment, payment or our healthcare operations. For example, you may request that we do not send your information to your physician, that we do not provide any information to your relatives, etc. You should know that we are not required to honor your request if it revolves around treatment, payment or our healthcare operations or if we believe it to be in your best interest. We are required to honor restrictions you request relative to Uses and Disclosures that REQUIRE your
Authorization.

You can exercise this right by making a request in writing to us.

3. You have the right to request to receive confidential communications from us be lternate means or at an alternate location. We will accommodate or reach agreement on all reasonable requests. You do not have to provide us a reason for your request, but we do ask that you put the request in writing.

4. You have the right to have us amend your Protected Health Information. If you believe there is an inaccuracy or other reason to change our records, you may request that we make those changes. In most circumstances, we require to make the change within 60 days.

5. You have the right to receive an accounting of certain disclosures we have made. This right does not apply to disclosures for treatment, payment or our healthcare operations. We are required to provide this accounting for disclosure going back 6 years.

6. You have the right to a copy of this notice from us.

III.      Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe our privacy rights have been violated. You may file a complaint with us by notifying our privacy Contact. We will not retaliate against you for filing a complaint.