HIPAA PRIVACY NOTICE

Effective Date: 01/01/2025
Santa Rosa Hearing Specialists, Inc.
111 Santa Rosa Ave # 115, Santa Rosa, CA 95404

(707) 234-7345

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NOTICE OF PRIVACY PRACTICES

This Notice of Privacy Practices describes how Santa Rosa Hearing Specialists, Inc. may use and
disclose your protected health information (PHI) to carry out treatment, payment, and healthcare
operations, and for other purposes that are permitted or required by law.

Please review this notice carefully. If you have any questions about this notice, please contact our
office at (707) 234-7345.

USES AND DISCLOSURES OF HEALTH INFORMATION

We may use and disclose your protected health information (PHI) in the following ways:

1. Treatment: We may use or disclose your health information to provide, coordinate, or manage your
healthcare and any related services. For example, we may share your information with other
healthcare providers involved in your care.
2. Payment: We may use or disclose your health information to bill and collect payment for the
treatment and services you receive. For example, we may disclose your PHI to your health insurance
plan to obtain reimbursement for your care.
3. Healthcare Operations: We may use or disclose your health information for our normal healthcare
operations. These operations include quality assessment, training programs, and administrative
activities necessary to run our practice.
4. Appointment Reminders: We may use or disclose your PHI to remind you of an appointment by
phone, email, or text message.
5. Treatment Alternatives and Health-Related Benefits and Services: We may use or disclose your
PHI to inform you about treatment options, alternative treatments, or health-related benefits and
services that may be of interest to you.

USES AND DISCLOSURES THAT REQUIRE YOUR CONSENT

In some situations, we must obtain your written consent before disclosing your health information.
These situations include:

● Psychotherapy Notes: These are notes recorded by a mental health professional during
counseling sessions that are kept separate from your medical records.
● Marketing Communications: We will only disclose your PHI for marketing purposes if you
have provided written authorization.
● Sale of Health Information: If your PHI is ever to be sold, we will obtain your written
consent first.

OTHER USES AND DISCLOSURES OF YOUR PHI

We may also use or disclose your health information without your consent in certain situations, such
as:

1. As Required by Law: We may disclose your PHI as required by federal, state, or local law. For
example, we may report certain communicable diseases to public health authorities.
2. To Prevent a Serious Threat to Health or Safety: We may disclose your health information if it is
necessary to prevent or lessen a serious and imminent threat to the health or safety of yourself or
others.

3. Abuse, Neglect, or Domestic Violence: We may disclose your PHI to appropriate authorities if we
believe you are a victim of abuse, neglect, or domestic violence.
4. Health Oversight Activities: We may disclose your PHI to health oversight agencies for activities
such as audits, investigations, and inspections related to healthcare practices.
5. Legal Proceedings: We may disclose your PHI in response to a court or administrative order,
subpoena, or other legal process.
6. Law Enforcement: We may disclose your PHI to law enforcement officials in certain
circumstances, such as if required by law or in response to a court order.
7. Military and Veterans: If you are a member of the armed forces, we may disclose your PHI to
military authorities under certain conditions.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your health information:

1. Right to Inspect and Copy: You have the right to inspect and obtain a copy of your medical
records. To request a copy, contact us in writing.
2. Right to Amend: If you believe your medical information is incorrect or incomplete, you have the
right to request an amendment. Your request must be in writing and provide a reason for the
amendment.
3. Right to an Accounting of Disclosures: You have the right to request an accounting of certain
disclosures of your PHI made by us, except for those made for treatment, payment, or healthcare
operations.
4. Right to Request Restrictions: You have the right to request restrictions on how your PHI is used
or disclosed. While we are not required to agree to all requests, we will consider them and notify you
of our decision.
5. Right to Request Confidential Communications: You have the right to request that we
communicate your PHI by alternative means or at an alternative location, such as through a phone
call to your home or office.
6. Right to a Copy of This Notice: You have the right to receive a copy of this Privacy Notice at any
time. You can ask for a copy at any time, even if you have agreed to receive this notice electronically.

CHANGES TO THIS PRIVACY NOTICE

We reserve the right to change this Privacy Notice at any time. Any changes will be effective
immediately upon posting to our practice’s website or in our office. We will provide you with a copy
of the updated notice if you request it.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the
U.S. Department of Health and Human Services. We will not retaliate against you for filing a
complaint.

● To file a complaint with our practice, contact:
Santa Rosa Hearing Specialists, Inc.
(707) 234-7345
● To file a complaint with the U.S. Department of Health and Human Services:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201

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