Effective April 14, 2003

          Ear, Nose & Throat Associates of Charleston, Inc. (EN&T)  EN&T Hearing Aid Center

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Any information that is about you or can be identified with you about your health, the health care you receive, or payment  for that care is considered confidential and protected by EN&T. This is called "protected health information" or "PHI" for short. We must give you notice of our legal duties and privacy practices concerning PHI.

We are required to abide by the terms of the notice that is currently in effect at the time your PHI is used or disclosed. We reserve the right to change the terms of this notice and to make the new provisions effective for all PHI that we maintain. A copy of the revised notice will be posted in our office, on our website, entchas.com, and a copy of the revised notice will be available on the request.

How We May Use and Disclosure Your PHI: The following categories describe different ways that we may use and disclose your PHI. We have provided you with example(s) from each category, but cannot list every permitted use or disclosure.

For Treatment: we may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. For example, we may use and disclose PHI about you to schedule surgery or tests, phone prescriptions to the pharmacy, or refer you to another health care provider.

For Payment: We may use or disclose PHI about you to obtain payment for services. For example, we may use and give your PHI to others to bill and collect payment for the treatment and services provided to you. Before you receive scheduled service(s), we may share information about these services with your insurance, or a third party, to determine coverage and approval before we provide the services. These may include billing departments, health care clearinghouse, collection agencies, insurance companies which provide your coverage, and the credit bureau.

For Health Care Operations: We may use or disclose PHI about you for our activities and operations. These uses and disclosures are necessary to run our practice and to make sure that all of our patients receive quality care. For example, we may use PHI to review quality of care, competency of health care providers, business management, and general administrative activities related to our organization, such as appointment reminders.

Business Associates: We may disclose your PHI to a person or organization that performs a service on behalf of EN&T, such as a billing service or copy service. When this is necessary, we require them to appropriately safeguard any information disclosed to them during the performance of their service.

Health-Related Benefits and Services (Marketing): We may use and disclose your PHI to tell you about possible health care services, health-related benefits that may be of interest to you. For example, a newsletter is mailed periodically to patients with hearing loss. If you do not wish to receive this, please let us know in writing.

As Required By Law: We may use or disclose your PHI when required to do so by federal, state or local law or in response to a court order or valid subpoena. For example, we disclose PHI to Workers Compensation if you have made a claim for benefits.

Military and Veterans: Your PHI may be disclosed for military and veterans affairs, national security and intelligence activities, protective services for the President and others, and medical suitability or determination for the Department of State.

Public Health: we will follow West Virginia law that requires us to notify the health department when a patient is diagnosed with a serious disease that can be spread to others, such as HIV or tuberculosis (TB).

Food and Drug Administration: We may disclose your PHI to the Food and Drug Administration when there is a reaction to certain medications or products.

Victim of Abuse, Neglect or Domestic Violence: If we believe you have been a victim of abuse, neglect or domestic violence, we may disclose your PHI to a government authority.

Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, but are not limited to, audits, investigations, inspections, and licensure. For example, PHI may be reported to the Tumor Registry who tracks outcomes on certain cancer(s).

Personal Representatives: We may disclose your PHI to a person who has authority, under the law, to act on your behalf in making decision related to your health care. For example, PHI would be made available to an individual holding Medical Power of Attorney or Power of Attorney.

Decedents: Consistent with applicable law, we may release your PHI to a coroner, medical examiner, or funeral director.

While in the Office: We may confirm to an individual that you are present in the office. For example, someone may attempt to reach you either in person or via telephone while you are in the office for a scheduled appointment.

Individuals Involved in Your Care or Payment of Your Care: We may release your relevant PHI to a friend, family member, or other person designated by you who is involved in your medical care or payment for that care. We may also notify these individuals of your location, general condition, or death.

Disaster Relief: We may share your PHI with a public or private agency assisting in disaster relief, for example, American Red Cross. Even if you object, we may still share the PHI about you if necessary for emergency circumstances.

Under any circumstances other than those listed above, we will ask for your written authorization before we use or disclose PHI about you. If you sign a written authorization allowing us to disclose PHI in a specific situation, you may later cancel this authorization in writing. However, this cancellation will not apply to disclosures processed before we received your cancellation.

Records related to HIV, drug/alcohol abuse, testing, diagnosis, or treatment is further protected. This information will be disclosed with a valid authorization, if all the requirements of the law are met.

For purposes of ensuring proper documentation the following requests must be in writing on a form that we provide and directed to our Privacy Officer.

Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment of your care. For example, you may ask that we not disclose information about a surgery you have had to a family member(s).

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment as outlined previously in this document.

We may terminate an agreed upon restriction without your consent. In that situation, the restriction will only apply to PHI created or received before you were informed of the termination of the restriction.

The Right to Request Different Ways to Communicate with You: You have the right to request how and where we contact you about PHI. For example, you can ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate all reasonable requests.

Right to Inspect and Copy: You have the right to see and receive a copy of most of your PHI maintained at EN&T. If you request a copy of the information, we may charge a fee for the cost of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and obtain a copy in certain limited circumstances. IF you are denied access, you may have the right to request that the denial be reviewed. Another licensed health care professional chosen by EN&T 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 Amend: You have the right to request an amendment if you feel that clinical, billing, and other records used to make decisions about you are incorrect or incomplete.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• was not created by us
• is not part of the record used to make decisions about you
• is not part of the information you would be permitted to inspect and copy
• is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an accounting of certain of our disclosures of PHI about you. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures except the following:

• for treatment, payment, or health care operations
• made to or requested by you, or that you authorized
• occurring as a result of permitted uses and disclosures
• made to individuals involved in your care or for directory or notification purposes
• as part of a limited data set, which does not contain information that would identify you.

We will comply with your request within sixty (60) days or we will provide you with an explanation for the delay. The first list you request within a 12-month period will be free, you may be charged for additional lists. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to provide a copy at any time. To obtain a copy of this notice, you may request it from the receptionist.

Use & Disclosure of Health Information for Minors: Parents have the right to access and control the PHI of their minor children except for the following instances as provided by West Virginia law:

• both parents will have equal access to the PHI of the child, except as limited by court order or other West Virginia law. The parent objecting to the release of records has the duty to provide us with a court prohibiting release
• records of the diagnosis, treatment or counseling of a minor for drug or alcohol abuse or addiction will not be released to parents or guardians without consent of the minor
• records of the diagnosis, testing or treatment of a minor for a sexually transmitted disease will not be released to the parents or guardians without the consent of the minor
• records involving the use of birth control by a minor, or prenatal care rendered to a minor, will not be released

Complaints: If you believe your privacy rights have been violated by us or you want to complain to us about our privacy practices, you may contact Elizabeth Doran, Managing Director. You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. If you file a complaint we will not take any action against you or change our treatment of you in any way.

Questions? If you have any questions regarding this notice or our health information privacy policies, please contact our Privacy Officer at the following address or by telephone (304) 340-2211.

Elizabeth Doran, Privacy Officer

Ear, Nose & Throat Associates of Charleston, Inc.

PO Box 1628

Charleston, WV 25326-1628