Visit with A Doctor of Audiology Today

2421 West Faidley Ave, Grand Island, NE 68803

(308) 384-2101

Hear The Difference A Doctor of Audiology Can Make!



This notice takes effect on April 14, 2003 and remains in effect until we replace it.


The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.


We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Notice of Privacy Practices and may change the terms of this notice at any time, provided that such changes are permitted by law. You may request and receive a copy of our Notice at any time by calling our office and requesting a copy be sent to you in the mail, or asking for one at your next appointment.


We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.

Treatment: We will use and disclose your protected health information for treatment to provide coordinate or manage your health care and any related services. This includes the coordination of management of your health care with a third party. We would disclose your protected health information, as necessary, to a home health agency that provides care to you or other physicians who may be treating you. In addition we may disclose your protected health information from time to time to another physician or health care provider who becomes involved in your care, diagnosis or treatment. For example, this would include a referral to an ear, nose and throat specialist.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include obtaining premiums, reimbursement, eligibility and coverage determinations, risk adjustment, billing and claims management coverage and utilization review activities as well as disclosure to consumer reporting agencies of certain information. For example, in order to receive payment from an insurance company, we must submit paperwork that releases protected health information because it identifies you, your diagnosis, and the treatment provided to you.

Health Care Operations: We may use or disclose your protection health information to conduct certain business and operational activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training of students, licensing and conducting or arranging for other business activities. For example, we may call you by name in the waiting room when your doctor is ready to see you.

Other uses and disclosures of your protected health information will be made only with your authorization, unless other permitted or required by law as described below:
Others involved in your health care: Unless you object, we may disclose to a member of your family, relative, close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care.

Health related benefits and services: We may use your protected health information to provide appointment reminders by telephone or mail.

Public Health and Safety: We may disclose your protected health information to a public health authority that is permitted to collect or receive said information. This includes reporting child abuse or neglect.

Abuse or Neglect: We may disclose your protected health information to an authorized governmental entity or agency if we believe you have been a victim of abuse or neglect. The disclosure will be made pursuant to the requirements of federal and state laws.

Health Oversight: We may disclose your protected health information to appropriate authorities for activities including but not limited to monitoring, investigating, inspecting and disciplining or licensing those who work in the healthcare system or for government benefit programs.

Required by Law: We may disclose your protected health information for law enforcement purposes as required by law. We will make disclosure in compliance with the law and you will be notified of any such uses or disclosures.

Judicial and Administrative Proceedings: We may disclose your protected health information that is authorized by an administrative proceeding, in response to an order of a court, and under certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement Purposes: We may disclose limited information to a law enforcement official concerning the protected health information of a suspect, fugitive, material witness, crime victim or missing person.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law.

Charges Against Provider: In the event you should file suit against us, we may disclose health information necessary to defend said action. Also, we must make disclosure to you and when required by the Secretary of the Department of Health to investigate and determine our compliance with the law.


Request Provider Not to Disclose: You may request in writing, that we not use or disclose your information for treatment, payment or administrative purpose, or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency. We will consider your request, however we are not legally required to accept it.

Inspect and Copy Information: Within the limits of the State statutes and regulations, you have the right to inspect and receive copies of your protected health information, with limited exceptions. You must make a request in writing to the contact person listed herein to obtain access to your protected health information. If you request copies, we will charge you $20.00 for the first 10 pages then .50 for each page thereafter and for postage if you want the copies mailed to you.

Request to Amend Healthcare Information: If you believe the information in your record is incorrect, you have the right to request that we amend your protected health information. Your request must be in writing, and it must explain why the information should be amended. We may, under certain circumstances, deny your request.

Receive an Accounting: You have the right to receive an accounting of disclosure of your protected health information. This includes disclosures made other than for treatment, payment, heathcare operation, for a facility directory, to family member or friends involved in your care, requests made by you, pursuant to an authorization, or for notification purposes. If you request this list more than once in a 12 month period, we may charge you a reasonable cost-based fee.



If you want more information about our privacy practices or have questions or concerns, please contact us using the information below.

If you believe that we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information or in response to a request you made, you may complain to us using the contact information below. You may also submit a written complaint to the U.S. Department of Health and Human Services.

We support your right to protect the privacy of your protected health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Please contact us for more information: or to file a complaint:

The Hearing Clinic
Craig A. Foss, Au.D.
Katie Kowalski, Privacy Officer
2421 West Faidley Avenue
Grand Island NE 68803
For more information about HIPAA or to file a complaint:

The U.S. Department of HHS
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775