Notice of Privacy Practices

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.

At the Tinnitus Treatment Center of Philadelphia, part of Treble Health®, your trust matters to us. We are committed to protecting the privacy of your health information. This notice explains how we may use and share your information, your rights, and our responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).

If you have any questions about this notice, please contact our Privacy Officer at (610) 747-0757.

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your protected health information.
• Give you this notice of our legal duties and privacy practices.
• Follow the terms of the notice currently in effect.
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you give us permission, you may change your mind at any time by letting us know in writing.

How We May Use and Share Your Health Information

Treatment

We may use and share your health information to provide, coordinate, or manage your care. For example, your audiologist may share information about your tinnitus evaluation with your physician or another provider involved in your care.

Payment

We may use and share your health information to bill and receive payment from you, your health plan, or another party. For example, we may give information to your insurance company to confirm coverage or process a claim.

Health Care Operations

We may use and share your health information to run our practice, improve the quality of care, train staff, and contact you when necessary. As part of the Treble Health® network, we may share information with affiliated clinicians and staff for care coordination, quality review, and business operations.

Appointment Reminders and Communications

We may contact you by phone, email, or text message to remind you of appointments, follow up on your care, or share information about treatment options and services that may interest you. You may ask us to contact you in a different way or at a different location. You can opt out of text messages at any time by replying STOP.

Business Associates

We may share your information with companies that perform services on our behalf, such as billing, scheduling, secure telehealth platforms, and electronic health record systems. These business associates are required by law and by contract to protect your information.

Individuals Involved in Your Care

Unless you object, we may share relevant information with a family member, friend, or other person you identify who is involved in your care or helps pay for your care.

Other Ways We May Use or Share Your Information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good. We must meet certain conditions under the law before we can share your information for these purposes:

• When required by federal, state, or local law
• For public health and safety activities, such as reporting adverse reactions to medical devices
• To prevent a serious threat to the health or safety of you or others
• For health oversight activities, such as audits and inspections
• In response to a court order, subpoena, or other lawful process
• For law enforcement purposes, as permitted by law
• For workers' compensation claims
• For specialized government functions, such as military or national security activities
• To coroners, medical examiners, or funeral directors
• For research, when approved under strict privacy protections

Uses That Require Your Written Permission

We will never sell your health information or use it for marketing purposes without your written authorization. Other uses and disclosures not described in this notice will be made only with your written permission.

Pennsylvania law may provide additional privacy protections for certain types of health information. When state law is more protective of your privacy than federal law, we follow the stricter standard.

Your Rights

When it comes to your health information, you have certain rights.

Get a Copy of Your Health Records

You can ask to see or receive an electronic or paper copy of your medical record. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask Us to Correct Your Records

If you believe information in your record is incorrect or incomplete, you can ask us to correct it. We may say no to your request, but we will tell you why in writing within 60 days.

Request Confidential Communications

You can ask us to contact you in a specific way (for example, by mobile phone instead of home phone) or to send mail to a different address. We will say yes to all reasonable requests.

Ask Us to Limit What We Use or Share

You can ask us not to use or share certain information for treatment, payment, or our operations. We are not required to agree, and we may say no if it would affect your care. If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer, and we will say yes unless the law requires us to share it.

Get a List of Those We Have Shared Information With

You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. This list will not include disclosures for treatment, payment, health care operations, or disclosures you asked us to make. We will provide one list per year for free.

Get a Copy of This Notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.

Choose Someone to Act for You

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

How to Exercise Your Rights

To make any of the requests above, please contact our office by phone or in writing. Our team will help you with the request.

File a Complaint

If you believe your privacy rights have been violated, you can file a complaint with us by contacting our Privacy Officer using the information below.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

Changes to This Notice

We may change the terms of this notice, and the changes will apply to all information we have about you. The current notice will be available upon request, in our office, and on our website.

Contact Our Privacy Officer

Tinnitus Treatment Center of Philadelphia
143 Bala Avenue, 2nd Floor, Bala Cynwyd, PA 19004
Phone: (610) 747-0757