Privacy Policy

Notice of Privacy Practices

This notice described how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. 

ABOUT THIS NOTICE 

Connect Audiology, PLLC is committed to protecting your health information. This Notice of Privacy Practices (“Notice”) is provided pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) as revised in the 2013 HIPAA Omnibus Rule. This Notice describes how Connect Audiology, PLLC may use and disclose your protected health information to carry out treatment, payment or audiologic/health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights and Connect Audiology, PLLC’s duties with respect to your protected health information. 

“Protected health information” is information about you that may identify you and that relates to your past, present, or future physical or mental health/condition and related audiologic/health care services. Connect Audiology, PLLC must follow the privacy practices that are described in this Notice while it is in effect. If you have any questions about this Notice, please contact our Privacy Officer, Dr. Sreedivya Radhakrishnan, (845) 507-3239.

HOW CONNECT AUDIOLOGY, PLLC MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION 

The following categories describe the different ways that Connect Audiology, PLLC may use and disclose your protected health information. 

• To provide, coordinate, or manage your audiologic treatment and any related services. 
• To other third party providers involved in your audiologic/health care. For example, your protected health information may be provided 
• To a physician or other audiologic/health care provider (e.g. a specialist or laboratory) to whom you have been referred to ensure that the physician or other audiologic/health care provider has the necessary information to diagnose or treat you. 

Payment 

Connect Audiology, PLLC may use and disclose your protected health information so that the treatment and health care services you receive may be billed to you, your insurance company, a government program, or third party payors. This may include certain activities that your health insurance plan may undertake before it approves or pays for the audiologic/health care services Connect Audiology, PLLC recommends for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, Connect Audiology, PLLC may provide your health plan with medical information about the audiologic/health care services Connect Audiology, PLLC rendered to you for reimbursement purposes.

Audiological/Health Care Operations 

Connect Audiology, PLLC may use and disclose your protected health information for audiologic/health care operation purposes. These uses and disclosures are necessary to make sure that all patients receive quality care, for operation and management purposes and to evaluate the performance of Connect Audiology, PLLC’s team members in caring for you. Connect Audiology, PLLC also may disclose information to audiologists, physicians, nurses, technicians, medical students, audiology and speech language pathology students and other personnel for educational and learning purposes. 

Treatment Communications 

Connect Audiology, PLLC may provide treatment communications concerning treatment alternatives or other health related products or services. For communications for which Connect Audiology, PLLC or a business associate may receive financial remuneration in exchange for making the communication, Connect Audiology, PLLC must obtain written authorization unless the communication is made face-to-face and/or involving promotional gifts of nominal value. If you do not wish to receive these communications, please submit a written request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Connect Audiology, PLLC, 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965.

 Fundraising Activities 

Connect Audiology, PLLC may use or disclose your demographic information and dates of services provided to you, as necessary, in order to contact you for fundraising activities supported by Connect Audiology, PLLC. You have the right to opt out of receiving fundraising communications. If you do not want to receive these materials, please submit a written request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, Connect Audiology, PLLC, 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965. 

Others Involved in Your Healthcare 

Unless you object, Connect Audiology, PLLC may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, Connect Audiology, PLLC may disclose such information, as necessary, if Connect Audiology, PLLC determines that it is in your best interest based on professional judgment. Also, for example, if you are brought into this office and are unable to communicate normally with your clinician for some reason, Connect Audiology, PLLC may find it is in your best interest to give your hearing instrument and other supplies to the friend or relative who brought you in for treatment. Connect Audiology, PLLC may also use and disclose protected health information to notify such persons of your location, general condition, or death. Connect Audiology, PLLC also may coordinate with disaster relief agencies to make this type of notification. Connect Audiology, PLLC also may use professional judgment and experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up your hearing instruments, supplies, records, or other things that contain protected health information about you. 

Required by Law 

Connect Audiology, PLLC may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health

Connect Audiology, PLLC may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. Connect Audiology, PLLC may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority. 

Business Associates

Connect Audiology, PLLC may disclose your protected health information to business associates that perform functions on Connect Audiology, PLLC’s behalf or provide Connect Audiology, PLLC with services if the information is necessary for such functions or services. To protect your health information, however, Connect Audiology, PLLC require the business associate to appropriately safeguard your information. 

Communicable Diseases

 Connect Audiology, PLLC may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight 

Connect Audiology, PLLC may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the audiologic/health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect 

Connect Audiology, PLLC may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect. In addition, Connect Audiology, PLLC may disclose your protected health information if Connect Audiology, PLLC believes that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration 

Connect Audiology, PLLC may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required by law.

Legal Proceedings 

Connect Audiology, PLLC may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process. 

Law Enforcement 

Connect Audiology, PLLC may disclose your protected health information, so long as applicable legal requirements are met, for law enforcement purposes.

Coroners, Funeral Directors, and Organ Donation 

Connect Audiology, PLLC may disclose your protected health information to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. Connect Audiology, PLLC may also disclose your protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out its duties. Connect Audiology, PLLC may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research

Connect Audiology, PLLC may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

 Serious Threat to Health or Safety Consistent with applicable federal and state laws, 

Connect Audiology, PLLC may disclose your protected health information to prevent or lessen a serious threat to your health and safety, or to the health and safety of another person or the public. 

Military Activity and National Security 

If you are involved with military, national security or intelligence activities or if you are in law enforcement custody, Connect Audiology, PLLC may disclose your protected health information to authorized officials so they may carry out their legal duties under the law. 

Workers’ Compensation 

Connect Audiology, PLLC may disclose your protected health information as authorized for workers’ compensation or other similar programs that provide benefits for a work-related illness.

For Data Breach Notification Purposes 

Connect Audiology, PLLC may use or disclose your protected health information to provide legally required notices of unauthorized access to or disclosure of your health information. 

Required Uses and Disclosures Under the law, 

Connect Audiology, PLLC must make disclosures to you and when required by the Secretary of the U.S. Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq. 

SPECIAL PROTECTIONS FOR HIV, ALCOHOL AND SUBSTANCE ABUSE, MENTAL HEALTH AND GENETIC INFORMATION 

Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. Some parts of this Notice may not apply to these types of information. 

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION 

The following uses and disclosures will be made only with your written authorization: 

• Uses and disclosures of protected health information for marketing purposes for which Connect Audiology, PLLC or a business associate may receive remuneration; and 
• Disclosures that constitute a sale of protected health information. 

Other uses and disclosures of your protected health information not described in this Notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization, at any time, in writing, except to the extent that Connect Audiology, PLLC has taken an action in reliance on the use or disclosure indicated in the authorization. Additionally, if a use or disclosure of protected health information described above in this Notice is prohibited or materially limited by other laws that apply to use, it is our intent to meet the requirements of the more stringent law.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

 The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. 

Right to be Notified if there is a Breach of Your Protected Health information 

You have the right to be notified upon a breach of any of your unsecured protected health information. 

Right to Inspect and Copy

You may inspect and obtain a copy of your protected health information that is contained in your medical and billing records and any other records that Connect Audiology, PLLC uses for making decisions about you. 

To inspect and copy your medical information, you must submit a written request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, Connect Audiology, PLLC 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965. If you request a copy of your information, Connect Audiology, PLLC may charge you a reasonable fee for the costs of copying, mailing or other costs incurred in complying with you request. Under federal law, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, Connect Audiology, PLLC may deny your request to inspect and/or copy your protected health information. A decision to deny access may be reviewable. Please contact our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, at 275 N Middletown Rd, Ste. 1G-B, Pearl River, NY 10965, if you have questions about access to your medical record. 

Right to Request Restrictions 

You may ask Connect Audiology, PLLC not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. To request a restriction on who may have access to your protected health information, you must submit a written request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, Connect Audiology, PLLC, 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965. Your request must state the specific restriction requested and to whom you want the restriction to apply. Connect Audiology, PLLC is not required to agree to a restriction that you may request, unless you are asking us to restrict the use and disclosure of your protected health information to a health plan for payment or audiologic/health care operation purposes and such information you wish to restrict pertains solely to an audiologic/health care item or service for which you have paid Connect Audiology, PLLC “out-of-pocket” in- full. If Connect Audiology, PLLC believes it is in your best interest to permit the use and disclosure of your protected health information, your protected health information will not be restricted. If Connect Audiology, PLLC does agree to the requested restriction, Connect Audiology, PLLC may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.

Right to Request Confidential Communication 

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. Connect Audiology, PLLC will accommodate reasonable requests. You must request this by submitting a written request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, Connect Audiology, PLLC, 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965. 

Right to Request Amendment 

You may request an amendment of your protected health information contained in your medical and billing records and any other records that Connect Audiology, PLLC uses for making decisions about you, for as long as Connect Audiology, PLLC maintains the protected health information. You must request for an amendment by submitting a written CONTINUED Notice of Privacy Practices 08/2016 Page 6 of 6 request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, Connect Audiology, PLLC 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965, and provide the reason(s) that support your request. In certain cases, Connect Audiology, PLLC may deny your request for an amendment. If Connect Audiology, PLLC denies your request for an amendment, you have the right to file a statement of disagreement with Connect Audiology, PLLC and Connect Audiology, PLLC may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Right to an Accounting of Disclosures

 You have the right to receive an accounting of certain disclosures Connect Audiology, PLLC has made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice. It excludes disclosures Connect Audiology, PLLC may have made to you, for a resident directory, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. Additionally, limitations are different for electronic health records. You must request for an accounting of disclosures by submitting a written request to our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, Connect Audiology, PLLC, 275 N Middletown Road, Ste.1G-B, Pearl River, NY 10965, and provide the reason(s) that support your request. 

Right to Obtain a Paper Copy of this Notice 

You have the right to receive a paper copy of this Notice even if you have agreed to receive this notice electronically. You may ask Connect Audiology, PLLC to give you a copy of this notice at any time. To obtain a paper copy of this Notice, you can contact our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, at (845) 507-3239. You may also obtain a copy of this Notice at https://connectaudiology.com/. 

COMPLAINTS OR QUESTIONS 

If you believe your privacy rights have been violated, you may file a complaint with Connect Audiology, PLLC or with the Secretary of the U.S. Department of Health and Human Services. If you have a question about this Notice or wish to file a complaint with Connect Audiology, PLLC, please contact our Privacy Officer and/or Owner, Dr. Sreedivya Radhakrishnan, Owner, at (845) 507-3239 or the Corporate Privacy Officer at the address listed below. All complaints must be submitted in writing. Connect Audiology, PLLC will not retaliate against you for filing a complaint. 

CHANGES TO THIS NOTICE 

Connect Audiology, PLLC reserves the right to change this Notice at any time. The new Notice will be effective for all health information Connect Audiology, PLLC already has about you as well as any information received in the future. 

You can also obtain a revised Notice by contacting our Privacy Officer, Dr. Sreedivya Radhakrishnan, Connect Audiology, PLLC 275, N Middletown Rd, Ste. 1G-B, Pearl River, NY 10965. 

Connect Audiology, PLLC.

Attn: Privacy Officer

This Notice is effective as of February 2022.