Notice of Privacy Practices of A-Advanced Hearing Care, Inc. &

R.D. ’Dan’ Taylor, Audioprosthologist

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.

Uses & Disclosures

Treatment: Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluation of your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage, such as an automobile insurer or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of services, the services provided, and the medical condition being tested.

Health care options: Your health information may be used as necessary to support the day to day activities and management of A-Advanced Hearing Care, Inc. and R. D. Taylor, Audioprosthologist. For example, information on the services you receive may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.

Public Health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Other uses and disclosures require your authorization: Disclosure of your health information or it use for any purpose other than those listed above, requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional uses of information: Your health information will be used by our staff to send you appointment reminders.

Information about treatments, new products and procedures: Your health information will be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health related products and service that we believe may interest you.

Individual Rights: You have certain rights under the federal privacy standards. These include:

The right to request restrictions on the use and disclosure of your protected health information.
The right to receive confidential communications concerning your medical condition and treatment.
The right to inspect and copy your protected health information.
The right to amend or submit corrections to your protected health information.
The right to receive and accounting of how and to whom your protected health information has been disclosed.
The right to receive a printed copy of this notice.

A-Advanced Hearing Care is required by law to maintain the privacy of your protected health information and to provide you with a copy of this notice of privacy practices. We are also obligated to abide by the privacy policy and practices outlined in this notice.

Right to revise privacy practices: As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies will be applied to all protected health information that we maintain.

Requests to inspect PHI: You may generally inspect or receive copies of the PHI that we maintain. As permitted by federal regulation, we require that requests to inspect or copy PHI be submitted in writing. You may obtain the form to request access to your records at our office. Your request will be reviewed and will generally be approved within seventy-two hours unless there are legal or medical reasons to deny the request.

Comments & Complaints: If you would like to submit a coment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to: A-Advanced Hearing Care, Attention: Privacy Officer, 720 East New Haven Ave. Suite #12, Melbourne, Florida, 32901.

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint. You may also receive further information concerning our privacy practices by written request to the above mentioned address.

This notice is effective as of 14 April, 2003, revised 14 June 2004.