Conn Hearing Aid Center LLC
Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

Uses, Disclosures and Authorizations

Treatment
Your health information may be used by staff members or disclosed to other healthcare professions for the purpose of providing, coordinating and managing treatment.

Payment
Your health information may be used to seek payment from your health plan, from other sources of coverage or from credit card companies that you may use to pay for services.

Health Care Operations
Your health information may be used as necessary to support the day-to-day activities and management of Conn Hearing Aid Center LLC.

Law Enforcement
Your health information may be disclosed to law enforcement agencies without your permission in order 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.

Authorizations
We will not use or disclose your medical information for any other purpose without your written authorization.  Once given, you may revoke your authorization in writing at any time.

Additional Uses of Information

Appointment Reminders/Changes
Your health information may be used by our staff regarding appointment scheduling.

Information About Treatments
Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest.  We may also send you information describing other health-related goods and services that we believe may interest you.

Your Rights Regarding Your Medical Information

You have the following rights with respect to your medical information:
1.  You may ask us to restrict certain uses and disclosures of your medical information.  We are not required to agree to your request, but if we do, we will honor it.
2.  You have the right to receive communications from us in a confidential manner.
3.  Generally, you may inspect and copy your medical information.  This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.
4.  You may ask us to amend your medical information.  We may deny your request for certain specific reasons.  If we deny your request, we will provide you with a written explanation for the denial and information regarding further rights you may have at that point.
5.  You have the right to receive an accounting of the disclosures of your medical information made by Conn Hearing Aid Center LLC during the last six years (or following April 14, 2003).  Exceptions would include disclosures for treatment, payment or healthcare operations, disclosures which you authorize and certain other specific disclosure types.
6.  You may request a paper copy of the Notice of Privacy Practices for Protected Health Information.  You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights.  If you choose to file a complaint, you will not be retaliated against in any way.

Additional Practices

Conn Hearing Aid Center LLC Duties
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.  We also are required to abide by the privacy policies and practices that are 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 and practices may be required by changes in federal and state laws and regulations.  Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit.  The revised policies and practices will be applied to all protected health information that we maintain.

Request to Inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing.

If you have any questions about this notice, please contact the Privacy Officer at:

Conn Hearing Aid Center LLC
Attn:  HIPAA Privacy Officer
1516 Spring Street
Jeffersonville IN 47130

THIS NOTICE EFFECTIVE ON OR AFTER APRIL 14, 2003

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