Rights and Responsibilities
These rights belong to the person or persons being served. For sound legal or medical reasons, a family member, guardianor legal representative may exercise these rights on the person's behalf.
- The right to be treated with dignity and respect
- The right to personal privacy and confidentiality of information to the extent permitted by law
- The right to receive written notice of your rights as early as possible when receiving care
- The right that services be provided without regard to race, ethnicity, gender, age, religion, national origin, sexual orientation or disability
- The right to receive care that recognizes cultural or religious beliefs
- The right to receive care that is free from abuse or harassment
- The right to file a complaint without retribution and to ask for and receive prompt review and resolution of the complaint
- The right to be involved in all aspects of your care and to assist in the development and implementation of your own plan of care
- The right to receive a clear and complete explanation of your status (e.g., diagnosis, treatment options, prognosis, etc.) and to be informed of potential or lack of potential for improvement in terms you can understand
- The right to accept or reject services and recommendations to the extent permitted by law and the right to express your choices of goals and methods of service delivery
- The right to know the name and professional qualifications of the person or persons providing services
- The right to accept or reject participation in teaching, research or promotional activities
- The right, to the extent permitted by law, to review information contained in your records, to receive explanation of record entries on request and to request correction of inaccurate records
- The right that services be provided in a timely and competent manner, which includes making referrals to other appropriate professionals when necessary
- The right to adequate notice of and reasons for discontinuation of services, an explanation of these reasons, in person, on request; and referral to other providers, if so requested
- The right to know, in advance, the costs for services, regardless of the method of payment
- The right to receive a clear explanation of your bill
Consumers are considered part of the service team and have a responsibility to actively participate in the evaluation and treatment process and completely inform CHSC of their needs and abilities.
- Consumers must provide the most accurate and current information regarding personal health, restrictions and risks, including but not limited to past illnesses, hospital stays and use of medicine, and immediately notify office manager or service provider of any changes.
- Consumers must provide complete information regarding insurance coverage and eligibility and immediately notify office manager or service provider of any changes.
- Actively participate in your own/your family member's care by developing and implementing the treatment plan with service provider.
- Agree to, sign and follow CHSC attendance policy.
- Ask questions when information provided to you is not clear.
- Accept the consequences for not following the instructions of the attendance policy and treatment plan.
- Arrive five to ten minutes prior to the scheduled appointment, and check in with office manager prior to each visit to verify insurance, address and phone number are accurate and current.
- Make all payments/co-payments at the time of each visit.
- Follow-up on any referrals suggested by your service provider.
- Be considerate of the needs of others.
In providing services, CHSC has the right to:
- Cancel and/or reschedule patients when necessary for medical or personal reasons. Every attempt will be made to reschedule prior to canceling appointments.
- Discharge and/or refuse services to those who do not follow the attendance policy, do not comply with the treatment plan or fail to pay for services.
- Receive complete and accurate information regarding needs and abilities of consumers.
- Receive payment/co-payment for services at the time of service delivery.
CHSC is responsible for ensuring a safe environment conducive to learning and achieving goals. This is accomplished by:
- Providing a continuum of care within our system, and coordinating care with other service providers
- Providing education to patients and families regarding needs, strategies and therapy progress
- Utilizing treatment strategies based on current research, literature and professional best practices and consensus
- Keeping records accurate, complete, safe and confidential
- Providing referrals to other care providers as needed
- Ensuring all staff members are appropriately credentialed to provide services
- Ensuring all individual team members provide services consistent with their profession's scope of practice and licensure laws
- Providing ongoing training for staff regarding consumers' rights and needs, safety requirements, billing procedures and record-keeping
- Providing a safe and secure location where services are provided
- Informing you of attendance policy and procedures for scheduling and canceling appointment
NOTICE OF PRIVACY PRACTICES
Revised September 2013
The terms of this Notice of Privacy Practices applies to Cleveland Hearing & Speech Center (CHSC) operating as a provider of clinical services, and the clinicians and other professionals seeing and treating patients for CHSC. The staff of CHSC work and practice at 11635 Euclid Avenue, Cleveland, Ohio, one or more of our satellite office(s), or out in the general community. All of our staff will share personal health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients’ health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at 11635 Euclid Avenue, Cleveland, Ohio; or a copy may be obtained by mailing a request to HIPAA Compliance Officer, CHSC, 11635 Euclid Avenue, Cleveland, Ohio, 44106; or you may view a copy on our website at http://www.clevelandhearingandspeech.org.
USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization. Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that consent or authorization in writing, but we cannot take back any uses or disclosures already made with your permission.
Uses and Disclosures for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, audiologists and speech-language-pathologists and other professionals involved in your care will use information in your record and information that you provide to plan a course of treatment with you. We may also release your personal health information to another health care facility or professional who is not affiliated with our practice but who is or will be providing treatment to you.
Uses and Disclosures for Payment. We will make uses and disclosures of your personal health information as necessary for payment purposes. For instance, we may forward information about services rendered to your insurance company. We may also use your information to prepare a bill to send to you or the person responsible for your payment.
Uses and Disclosures for Health Care Operations. We will use and disclose your personal health information as necessary, and as permitted by law, for operations which include clinical improvement, peer review, business management, etc.
Uses and Disclosures for Fundraising. We may contact you in an effort to raise money for Cleveland Hearing & Speech Center and its operations. The information released to the fundraising office would only include your name, address, telephone number, gender, insurance status, and dates of service at CHSC. You have a right to opt out of receiving these communications from us. If you do not want CHSC to release this information about you for fundraising efforts, you must notify in writing to any clinical scheduling or billing office representative.
Family and Friends Involved In Your Care. With your approval, we may disclose your personal health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable or incapacitated and we determine that limited disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval. We may also disclose limited personal health information to an entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates. Certain aspects of our services are performed through contracts with outside persons or organizations, such as subcontracted clinical professionals, supporting services such as language interpreting, auditing, accreditation, legal services, etc. At times it may be necessary for us to provide your personal health information, limited to what the business associates need to know, to one or more of these outside persons. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Appointments and Services. We may contact you to provide appointment reminders or test results. You have the right to request and we will accommodate reasonable requests to receive communications by alternative means. For instance, if you wish appointment reminders to not be left on voice mail, we will accommodate reasonable requests. You may request such confidential communication in writing and may send your request to: HIPAA Compliance Officer, CHSC, 11635 Euclid Avenue, Cleveland, OH 44106.
Health Products and Services. We may from time to time use your personal health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and to provide general health and wellness information.
Research. In limited circumstances, we may use and disclose your personal health information for research purposes. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements.
Other Uses and Disclosures. We will not use or disclose your health information for any purpose other than those you identified in the previous sections without your specific, written authorization. If you give us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose information about you for the reasons covered by your revocation, but we cannot take back any uses or disclosures already made with your permission. We also will not use or disclose your health information for the following purposes without your specific, written authorization.
- For our marketing purposes. This does not include face-to-face communication about products or services that may benefit you.
- For the purpose of selling your health information. We may receive payment for sharing your information for, as an example, public health purposes, research, and releases to you or others you authorize a release to as long as payment is reasonable and related to the cost of providing your health information.
Special Situations. We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization.
- We may release your personal health information for any purpose required by law;
- We may release your personal health information for public health activities;
- We may release your personal health information as required by law if we suspect child abuse or neglect; we may also release your personal health information if we believe you to be a victim of abuse, neglect or domestic violence;
- We may release your personal health information to the FDA if necessary;
- We may release your personal health information to your employer when we have provided service at the request of your employer; in most cases you will receive notice about this;
- We may release your personal health information if required by law to a government oversight agency;
- We may release your personal health information if required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release;
- We may release your personal health information to law enforcement officials as required by law to report wounds and injuries and crimes;
- We may release your personal health information for certain research purposes when such research is approved by an IRB with established rules to ensure privacy;
- We may release your personal health information in limited instances if we suspect serious threat to health or safety;
- We may release your personal health information if you are a member of the military as required by the armed forces services; also if necessary for national security or intelligence activities; and
- We may release your personal health information to workers’ compensation agencies if necessary for your workers’ compensation benefit determination.
Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnoses of AIDS or an AIDS related condition, before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program, and before disclosing information about mental health services you may have received. For full information on when such consents may be necessary, you can contact HIPAA Compliance Officer, CHSC.
RIGHTS THAT YOU HAVE
Access to your Personal Health Information. You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We may charge you for copying, mailing and compiling information. You may obtain an access request form from: HIPAA Compliance Officer, CHSC.
Amendments to Your Personal Health Information. You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from: HIPAA Compliance Officer, CHSC.
Accounting for Disclosures of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information after 4/14/03. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from: HIPAA Compliance Officer, CHSC. The first accounting in any 12-month period is free; you will be charged $5.00 for each subsequent accounting you request in the same 12-month period.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment for it. We are not required to agree with your request if the information is needed for emergency treatment or we are required by law to use or disclose the information. We are required to agree with your request if you pay for treatment, services, or supplies “out of pocket” and you request the information not be communicated to your health plan for payment or health care purposes, except where we must use or disclose the information as required by law.
Complaints. If you believe your privacy rights have been violated, you can file a complaint in writing with the HIPAA Compliance Officer, CHSC. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
Breach of Health Information. We will inform you if there is a breach of your unsecured health information.
Acknowledgment of Receipt of Notice. You may be asked to sign an acknowledgment form that you received this Notice of Privacy Practices.
FOR FURTHER INFORMATION.
If you have questions or need further assistance regarding this Notice, you may contact the HIPAA Compliance Officer, CHSC, 216 231-8787.
As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.
This Notice of Privacy Practices was originally effective April 2003. This notice was revised effective March 2006, then again effective September 2013.
No Rendering of Advice
The information contained within this website is provided for informational purposes only and is not intended to substitute for obtaining speech-language and audiological advice from professional clinicians. Presentation of the information via the Internet is not intended to create, and receipt does not constitute, a patient-clinician relationship. Internet subscribers, users and online readers are advised not to act upon this information without seeking the service of a professional clinician.
Accuracy of Information
While we use reasonable efforts to furnish accurate and up-to-date information, we do not warrant that any information contained in or made available through this website is accurate, complete, reliable, current or error-free. We assume no liability or responsibility for any errors or omissions in the content of this website or such other materials or communications.
Disclaimer of Warranties and Limitations of Liability
This website is provided on an "as is" and "as available" basis. Use of this website is at your own risk. We and our suppliers disclaim all warranties. Neither we nor our suppliers shall be liable for any damages of any kind with the use of this website.
Links to Third-Party Websites
For your convenience, this website may contain hyperlinks to websites and servers maintained by third parties. We do not control, evaluate, endorse or guarantee content found in those sites. We do not assume any responsibility or liability for the actions, products, services and content of these sites or the parties that operate them. Your use of such sites is entirely at your own risk.