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.
Who Will Follow This Notice
This notice describes the practices of the Communication Disorders Clinic and that of:
- Any speech-language pathologist or audiologist authorized to enter information in your clinic chart.
- All departments and units of the Clinic.
- All students, both graduate and undergraduate, majoring in Communication Disorders at Appalachian State University.
- Any member of a volunteer group we allow to help in the Clinic.
- All employees, staff, and other clinic personnel.
- Employees, contractors, or volunteers of the Preschool, Language Classroom (including personnel from the schools and other agencies involved in the classroom); It Takes Two to Talk - The Hanen Program for Parents; various childcare and home-based sites; the Language-Learning Program for School-Age Children, Adolescents and Adults; preschool speech-language screening program; Watauga Medical Center Speech-Language Pathology Program; Foothills Correctional Institution; Watauga County Schools Hearing Screening Program; and Ashe County Schools Hearing Screening Program. (These entities may share information with each other for treatment, payment, or clinic operations purposes described in this notice.)
Our Pledge Regarding Medical Information
We understand that medical information about you and your communication disorder is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Communication Disorders Clinic. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- make sure that medical information that identifies you is kept private;
- give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- follow the terms of the notice that is currently in effect.
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
For treatment.
We may use medical information about you to provide you with treatment or services. We may disclose medical information about you to speech-language pathologists, audiologists, graduate and undergraduate students, and other clinic personnel who are involved in your care. For example, a speech-language pathologist treating you for a language problem may need to know if you have a hearing loss because a hearing loss may affect language development. In addition, the speech-language pathologist may need to communicate with a graduate student who will assist in your treatment. We also may disclose information about you to people outside the clinic who may be involved in your care, such as family members and others. In most instances, we will get your signed authorization to release this information.
For payment.
We may use and disclose medical information about you so that treatment and services you receive at the clinic may be billed and payment may be collected from you, an insurance company, or another third party. For example, we may need to disclose information about the hearing test you receive at the clinic so your health plan will pay us or reimburse you for the test. We also may tell your health plan about a treatment you are going to receive to determine whether your plan will cover the treatment.
For healthcare operations.
We may use and disclose medical information about you for clinic operations. These uses and disclosures are necessary to run the clinic and make sure that all of our clients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We also may combine medical information about many clients to decide what additional clinical services should be offered, what services are not needed, and whether new treatments are effective. We may disclose information to the professionals, staff, and students for review and learning purposes. We may combine the information with information from other clinical programs to compare how we are doing and to see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning the identities of clients.
Appointment reminders.
We may use and disclose medical information to contact you as a reminder that you have an appointment at the clinic. For example, a graduate student may phone you the day before your appointment as a reminder. A message may be left on your answering machine.
Treatment alternatives.
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-related benefits and services.
We may use or disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Fundraising activities.
We may use medical information about you to contact you in an effort to raise money for the clinic and its operations. We may disclose information to a foundation related to the clinic so that the foundation may contact you in raising money for the clinic. We only would release contact information, such as your name, address, and phone number and the dates you received services at the clinic. If you do not want the clinic to contact you for fundraising efforts, you must notify the clinic director in writing.
Clinic calendar.
We may include certain limited information about you on a clinic calendar which may be shared with clinic personnel and students involved in the clinic. This information may be sent to the staff in the form of email or discretely posted in the clinic.
Individuals involved in your care or payment for your care.
We may release information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care.
Observation of services.
The clinic is a training ground for graduate and undergraduate students majoring in communication disorders. We may allow students to observe services. In addition, personnel from other agencies involved with your care may be allowed to observe services.
Classroom disclosures.
As a teaching facility, we may disclose certain information in classes taught at the university. We will remove information that identifies you from this set of medical information so students may use it to study health care and health care delivery without learning the identities of clients.
Research.
Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparisons of two treatment techniques. All research projects are subject to the university approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with the clients need for privacy of their medical information. Before we disclose or use the medical information for research, the project will have been approved through this research approval process, but we may disclose information about you to people preparing to conduct a research project. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the clinic.
As required by law.
We will disclose medical information about you when required to do so by federal, state, or local law.
To avert serious threat to health or safety.
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety, or to the safety of the public or another person.
Worker's compensation.
We may release medical information about you for worker's compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public health risks.
We may disclose medical information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report child abuse or neglect
- To report problems with products
- To notify people of recalls of products they may be using
- To notify the appropriate government authority if we believe a client has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health oversight activities.
We may disclose medical information to an oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government programs, and compliance with civil rights laws.
Lawsuits and disputes.
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. Generally, we will try to notify you about the subpoena, discovery request, or order prior to such disclosure.
Law enforcement.
We may release medical information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons, or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime;
- About alleged criminal conduct at the clinic.
National security and intelligence activities.
We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary 1) for the institution to provide you with health care; 2) to protect your health and safety or the health and safety of others; or 3) for the safety and security of the correctional institution.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you.
Right to inspect and copy.
You have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect and copy medical information about you, you must submit your request in writing to the clinic office. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or supplies associated with your request.
We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the clinic 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.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the clinic. To request an amendment, your request must be made in writing and submitted to the clinic director. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing and 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, unless the person or entity that created the information is no longer available to make the amendment;
- Is not a part of the information kept by or for the clinic;
- s not a 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 a right to request an accounting of disclosures. This is a list of the disclosures that we have made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing to the clinic director. Your request must state a time period, which may not be longer than six years and may not include dates before February 26, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request in a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. 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. Under federal regulations, we may omit certain disclosures from an accounting (for example, disclosures made to you or otherwise to carry out treatment, payment, or healthcare operations.
Right to request restrictions.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you could ask that we not use or disclose information about a diagnosis or your treatment.
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 or disclosure as required by law or regulations. If we disclose medical information to a healthcare provider for your emergency treatment, we will request that the provider not further use or disclose the information.
To request restrictions, you must make your request in writing to the clinic director. In your request, you must tell us 1) what information you want to limit; 2) whether you want to limit our use, disclosure, or both; and 3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to request confidential communications.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can request that we contact you at work or by mail.
To request confidential communications, you must make your request in writing to the clinic director. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how and/or where you wish to be contacted.
Right to a paper copy of this notice.
You have a right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website:
cdclinic.appstate.edu
To obtain a paper copy of this notice, call the clinic office at 828-262-2185.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the clinic. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you begin a new treatment at the clinic, we will offer you a copy of the current notice in effect.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the clinic or with the Secretary of the Department of Health and Human Services. To file a complaint with the clinic, contact the University Privacy Official. All complaints must be submitted in writing. You will not be subjected to any retaliation for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke this permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care we provide to you.