Miracle-Ear Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND SHARED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Miracle-Ear, Inc., or an independently owned and operated Miracle-Ear® franchise location (collectively “Miracle-Ear”, “We”), may collect information about you, including, but not limited to, your name, address, email address, phone number, other uniquely identifying information, your medical history, current health, and treatment(s) received. This notice applies to the medical information Miracle-Ear may create, collect, or receive about you, and explains how that information may be used and shared with others. It also explains our obligations and your privacy rights regarding this kind of information.
Our Uses and Sharing of Your Information
Miracle-Ear may use or share your information for the following reasons:
- Treatment: We can use or share your health information to provide, coordinate, and manage your care and treatment. For example, a Miracle-Ear staff member may share your medical information with another health care provider for a consultation or a referral.
- Payment: We can use and share your medical information to bill and get payment for the treatment and services you received. For example, we may need to give your health plan information about treatment you received at Miracle-Ear so your health plan will pay us or reimburse you.
- Operations: We can use and share your health information to run our business, improve your care, and contact you when necessary.
- Research: We can use or share your information for health research.
- Vendors/Service Providers: Miracle-Ear can share your health information to other entities that provide a service to Miracle-Ear, or performs a service on our behalf, that requires the use of your medical information, such as a billing service.
- Fundraising: Miracle-Ear can use (or release to a third party) certain information such as your name, address, department of service, and treatment dates for fundraising purposes. If you do not want to be contacted for fundraising efforts, you may opt-out by sending notification to Miracle-Ear at the address provided in the Contact Information section of this Notice or by following the opt-out instructions in the fundraising materials.
- Marketing Purposes: Miracle-Ear can use your information to send you materials about Miracle-Ear products or services, unless and until you tell us to stop. Miracle-Ear will not sell, lease, or share your information with third parties for their marketing purposes.
- Public Health and Safety: Miracle-Ear can share your health information for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- Other Circumstances: Examples of other circumstances where Miracle-Ear can use your health information include:
- Complying with federal or state law
- Responding to organ and tissue donation requests
- Working with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions such as a court or administrative order, search warrant, or subpoena.
For more information on how we can use or share your health information, visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Your Rights and Choices
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy: You have the right to inspect and receive a copy (either in hard copy or in an electronic format) of your medical information that Miracle-Ear has about you. Please contact your Miracle-Ear provider’s office for instructions on how to request to inspect or obtain a copy of your medical information. You may be charged a cost-based fee for copying, mailing, or other supplies associated with your request, to the extent permitted by state and federal law. Miracle-Ear may deny your request to inspect or obtain a copy of your medical information in certain very limited circumstances. For example, we may deny your request if we believe it will be harmful to your health, or could cause a threat to others. If you are denied access to medical information, you may request that the denial be reviewed. Another health care provider chosen by Miracle-Ear will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Request Amendment: You have the right to ask us to amend the medical information we have on file about you. To request a change to your information, you must complete and return a Request for Amendment Form (a copy of which is available upon request), including justification for your request. Miracle-Ear may deny your request for an amendment if it is not in writing or does not include justification to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by Miracle-Ear, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for Miracle-Ear;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to an Accounting of Disclosures: You have the right to ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date you ask, who we shared it with, and why. We will include all of the disclosures except for those about treatment, payment, and health care operations, and certain disclosures (such as disclosures that you asked us to make, or where we are legally required not to.
- Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or share about you. For example, you could ask that we not use or share information about treatment that you received from us with other health care providers or to your insurance company. We are not required to agree to your request regarding restrictions on disclosure with the following exception: you may request, and we must comply, that we not share health information directly related with a health care product or service that you paid for yourself in full out of pocket. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must complete and return an Authorization for the Use and Disclosure of Private Health Information Form (a copy of which is available upon request).
- Right to Request Confidential Communications: You have the right to request that we communicate with you about your medical matters in a certain way or at a certain location. For example, you can ask that we only contact you only at work or only by mail. To request confidential communications, you must complete and return a Confidential Communication Request Form (a copy of which is available upon request). We will not ask you the reason for your request. We will accommodate reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Notification: Miracle-Ear will notify you, without unreasonable delay, if your unsecured medical information is breached, and in no case later than sixty (60) days following the discovery of a breach or as required by law.
- Right to Choose Someone to Act on your Behalf. If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and makes choices about your health information on your behalf. We will make sure the person has this authority and can act for your before acting on any request.
- Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this notice. You may ask us to give you a copy of this notice any time.
- Right to Tell Us Who to Share Your Information With: You have the right and choice to instruct Miracle-Ear to share your health information with your friend, family member, or legal guardian. For example, you may want us to share appointment reminders with a family member because they bring you to your appointments. Please note that if you are not able to tell us your preference, you are unconscious for example, we may share your information with a friend or family member if we believe it is in your best interest to do so, such as in an emergency.
- Right to Revoke Permission to Share Your Information: If you provide us with written permission to use or share your medical information, you have the right to change your mind at any time. To let us know you’ve changed our mind, notify us in writing using the address provided in this notice. If you revoke your permission, we will no longer use or share your medical information for the reasons you indicate. We are unable to take back sharing your information done prior to you telling us to stop. We also can continue to use or share your information to provide you care.
We are required by law to:
- Maintain the privacy and security of your protected health information.
- Promptly notify you if a breach occurs that may have compromised the privacy or security of your information.
- Follow the duties and privacy practices described in this notice and give you a copy.
- Not use or share your information other than as described in this notice unless you tell us we can in writing.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to This Notice
The effective date of this notice is July 1, 2017. We reserve the right to change this notice, such changes applying to the information we have about you. The new notice will be available upon request and on our web site.
If you believe your rights in this notice have been violated or you would like to contact Miracle-Ear about the content of this notice, please contact us by:
Sending a letter to:
Attn: Customer Care Department
5000 Cheshire Parkway N
Plymouth, MN 55446
We will not retaliate against you for filing a complaint.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:
Sending a letter to:
200 Independence Avenue, SW, Washington, DC 20201