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Privacy Statement

Privacy Statement

Associates in Ear, Nose & Throat - Head & Neck Surgery

Notice of Privacy Practices

Effective Date: January 1, 2014


This Notice of Privacy Practices (this "Notice") will tell you about the ways in which Associates in Ear, Nose & Throat - Head & Neck Surgery ("we" or "us") protects, uses and discloses your protected health information ("PHI"). This Notice also describes your rights and certain obligations we have regarding the use and disclosure of PHI.

"PHI" means any information, transmitted or maintained in any form or medium, which we create or receive that relates to your physical health, the delivery of health care services to you, or payment for health care services, and that identifies you or could be used to identify you. We maintain your PHI in records we create related to the services and items you receive from us. This Notice applies to all of those records created, received or maintained by us.

We are required by law to: make sure that PHI is kept private; give you this Notice of our legal duties and privacy practices with respect to your PHI; and comply with the currently effective terms of this Notice.


Associates in Ear, Nose & Throat - Head & Neck Surgery
1724 Hamill Rd Ste 102, Hixson, TN 37343


The following paragraphs describe examples of the different ways in which we may use and disclose your PHI.

1. Treatment. We may use your PHI to provide, coordinate and manage your health care treatment and related services. For example, we may disclose your PHI to our personnel, as well as to physicians, nurses, hospitals, clinics, medical technicians, medical students, laboratories and other health care providers who are involved in your care.

2. Payment. We may use and disclose your PHI so that the items and services you receive from us may be billed to and payment may be collected from you, an insurance company or a third party payor. For example, we may need to give your insurance company information about the services or items that you received from us so that your insurance company will pay us or reimburse you for the services or items.

3. Health Care Operations. We may use or disclose your PHI to carry out health care operations. These are activities that are needed to operate our facilities and for administrative and quality assurance purposes. They include, for example: conducting quality assessment and improvement activities; reviewing the qualifications and performance of health care providers; training and performing accreditation, certification, licensing or credentialing activities; and managing our business and performing general administrative activities.


Listed below are a number of other ways that PHI can be used or disclosed. This list is not exhaustive. Therefore, not every use or disclosure in a category is listed.

1. Release of PHI to Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a family member, friend, guardian, or person representative who is involved in your medical care or who helps to pay for your care. In addition, we may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. You have the right to object to such disclosures unless you are unable to express your preference (e.g. if you are unconscious) or there is an emergency, in which case we will share your PHI if we believe it is in your best interest.

2. Disclosures Required by Law. We may use and disclose your PHI when we are required to do so by federal, state or local law.

3. Public Health Risks. We may disclose your PHI for public health activities, including to prevent or control disease, or, when required by law, to notify public authorities concerning cases of abuse or neglect. We may disclose necessary information about you to law enforcement, to family members, or to others if we believe that you may present a serious health danger to others.

4. Lawsuits and Similar Proceedings. We may disclose your PHI in response to a court or administrative order. We also may disclose your PHI in response to a valid discovery request, subpoena, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

5. Law Enforcement. We may release PHI about you for law enforcement purposes as required or permitted by law.

6. Medical Examiners; Coroners; Funeral Directors. We may release PHI about you to a medical examiner or coroner. This may be necessary, for example, to identify a person who died or determine the cause of death. We may also release PHI about you to help a funeral director to carry out duties.

7. Research. We may use and disclose your PHI for research purposes in certain limited situations. For example, we might disclose PHI for use in a research project involving the effectiveness of certain medical procedures. In some cases, we might disclose PHI for research purposes without your knowledge or approval. However, such disclosures will be made only if approved through a special process. This process evaluates a proposed research project and its use of PHI, and balances the research needs with your need for privacy of your PHI.

8. Serious Threats to Health or Safety. We may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health or safety or the health or safety of another individual or the public.

9. Government Functions. We may disclose your PHI if you are a member of the armed forces, as required by military command authorities.  Additionally, we may share your PHI for special government functions, such as military, national security and presidential protective services.

10. Workers' Compensation. We may release your PHI for workers' compensation and similar programs that provide benefits for work-related injuries or illness.

11. Business Associates. We obtain some services provided through contracts with business associates in which PHI is disclosed. For example, we may use a third party for billing and collections, document destruction, software support and quality assurance. At times, we may disclose your PHI to our business associates so that the business associates can provide services to, or on behalf of, us. We will require that any business associate who receives your PHI appropriately safeguards your PHI through a written business associate agreement. If our business associate discloses the PHI to its own subcontractor, it must enter into a similar agreement with the subcontractor regarding your PHI as we have with it.

12. About a Decedent. In the event of your death, disclosures about you (the decedent) can be made to family members or others involved in your care or payment for your care prior to your death unless inconsistent with your prior expressed preferences that are known to us. Disclosures may also be made to your personal representative.

13. Additional State and Federal Requirements. Some state and federal laws provide additional privacy protection of your health information. These include:

  • Sensitive Information. Some types of health information are particularly sensitive, and the law, with limited exceptions, may require that we obtain your written permission or in some instances, a court order, to use or disclose that information. Sensitive health information includes information dealing with genetics, HIV/AIDS, mental health, sexual assault and alcohol and substance abuse.
  • Information Used in Certain Disciplinary Proceedings. State law may require your written permission if certain health information is to be used in various review and disciplinary proceedings by state health oversight boards.
  • Information Used in Certain Litigation Proceedings. State law may require your written permission for us to disclose information in certain legal proceedings.

14. Marketing and Sale.  We will not sell your information or share or use it for marketing purposes without your written authorization and, even then, only if permitted by applicable law.

15. Uses and Disclosures of PHI that Require Your Written Permission (Authorization). Uses and disclosures of your PHI for purposes other than those referred to in this Notice will be made only with your written authorization. You also have the right to revoke such authorization in writing for any future uses and disclosures. However, it will not stop any uses or disclosures that we have already made before you revoked your authorization.


1. Confidential Communications.  You have the right to request that we communicate with you about your health care matters in a particular way or at a certain location. For example, you may ask that we use an alternative address for billing purposes. In order to request a type of confidential communication, you must make a written request to our Privacy Officer specifying the requested method of contact, or the location where you wish to be contacted. We will accommodate all reasonable requests. We will not ask you the reason for your request.

2. Requesting Restrictions. You have the right to request that we restrict uses and/or disclosures of your PHI to carry out treatment, payment or health care operations.  We are not required to agree to your request and may say “no” if it would affect your care.  However, you have the right to request that we restrict disclosure to a health plan and we are obligated to agree to your request if the disclosure would be for the purpose of carrying out payment or health care operations, is not otherwise required by law and the PHI pertains solely to a health care item or service for which you or a person other than a health plan on your behalf has paid us in full. To request restrictions, you must make your request in writing to our Privacy Officer. Your request must specify (1) the PHI 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 (e.g., disclosures to your spouse).

3. Inspection and Copies. With certain limited exceptions, you have the right to inspect and obtain an electronic or paper copy of your PHI maintained by us. Generally, this information includes health care and billing records. To inspect and/or obtain copies of your PHI maintained by us, you must submit your request in writing to our Privacy Officer, and we will provide a copy or summary of your PHI.  We charge a reasonable, cost-based fee, consistent with state and federal law.

4. Amendment. You may ask us to amend your PHI we have about you (for example, if you believe that your medical record is incorrect or incomplete). To request an amendment to your PHI, your request must be made in writing and submitted to our Privacy Officer. In addition, you must provide a reason that supports your request. We will generally make a decision regarding your request for amendment no later than sixty (60) days after receipt of your request.  If we say “no” to your request, we will explain the reasons in writing.

5. Accounting of Disclosures. You have the right to request a list (accounting) of the times we have disclosed your PHI for six (6) years prior to the date of your request, including information on the parties with whom we have shared your PHI and why.  We do not have to list certain disclosures, such as those made pursuant to a prior authorization by you or for certain law enforcement purposes. In order to obtain an accounting of such disclosures, you must submit your request in writing to our Privacy Officer. All requests for an accounting of disclosures must state a time period, which may not be longer than six (6) years. Your request should also specify the format of the list you prefer (i.e., on paper or electronically). The first list you request within a twelve (12) month period is free of charge, but we may charge you for additional lists requested within the same twelve (12) month period. We will notify you of the costs involved with additional requests, and you may choose to withdraw or modify your request at that time before you incur any costs.

6. Right to a Paper Copy of This Notice. You have the right to receive a paper 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. To obtain a paper copy of this Notice, please write to or call our Privacy Officer. When receiving a procedure, you will be given a paper copy before the procedure begins for review and signature.


We are required by law to notify you in the event we become aware of a breach of your unsecured PHI.


We reserve the right to change our privacy practices that are described in this Notice. We reserve the right to make the revised or changed privacy practices applicable to PHI we already have about you as well as any information we receive in the future. Prior to a material change to the uses or disclosures, your rights, our legal duties or other privacy practices stated in this Notice, we will promptly revise the Notice. The Notice will contain the effective date on the first page.


If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, write to our Privacy Officer. All complaints must be in writing. Complaints to the Secretary may be filed either in paper or electronically.

You will not be penalized or retaliated against for filing a complaint.

Contact Us

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  • Associates in E.N.T. Head & Neck Surgery
    1724 Hamill Rd Ste 102
    Hixson, TN 37343

    (423) 267-6738

    In Business Since 1953