THE UNIVERSITY OF MEMPHIS
School of Communication Sciences and Disorders
The Memphis Speech and Hearing Center
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.
This notice describes how we may use and disclose your protected health information
(PHI) for purposes of treatment, payment, health care operations, and for other purposes
that are permitted or required by law.
The Memphis Speech and Hearing Center is required to:
• Maintain the privacy of your Protected Health Information
• Provide you with a copy of this Notice describing our duties and privacy practices
as to the information we collect and maintain about you
• Abide by the terms of our current Notice
• Notify you if we cannot accommodate a requested restriction or request
• Accommodate reasonable requests to communicate with you about your Health Information
• Obtain written permission from you for any uses and disclosures not mentioned in
We reserve the right to change, amend or eliminate provisions in our privacy practices
and to make the new provisions effective for all Health Information we keep. Should
our privacy practices change, we will amend our notice. You are entitled to receive
a copy of the amended notice by calling and requesting a copy of the amended notice
or by visiting our office and picking up a copy.
We will not use or disclose your Private Health Information without obtaining a signed
authorization from you except as described in this Notice or as otherwise permitted
or required by law; for example, in emergency treatment situations.
To Request Information or to File a Complaint
If you have questions, would like additional information, or want to report a problem
regarding the handling of your information, you may contact: The Privacy Officer, 807 Jefferson Avenue Memphis, TN 38105, 901-378-5800.
Additionally, if you believe that your privacy rights have been violated, you may
file a written complaint with The Privacy Officer, 807 Jefferson Avenue, Memphis TN 38105, 901-678-5800. You may also file a complaint by mailing it to the Secretary of Health and Human
Services, 200 Independence Avenue SW, Washington DC 20201.
• We cannot and will not require you to waive the right to file a complaint with the
Secretary of Health and Human Services (HHS) as a condition of receiving treatment
from this clinic.
• We cannot and will not retaliate against you for filling a complaint with the Secretary
of Health and Human Services (HHS).
HOW IS YOUR MEDICAL INFORMATION USED
Each time you visit the Memphis Speech and Hearing Center a record of your visit is
made. This information is commonly called your Medical Record; this and other information
regarding your care is referred to in this Notice as Protected Health Information
Your insurance company may request information that we are required to submit in order
to provide and bill for your care, such as procedure and diagnostic information.
PHI is a valuable tool used by University researchers in finding the best treatment
for communication problems. Your record may be used for such research, or for contacting
you to participate in research studies, after protocols have been approved by the
University committee for the protection of human research participants. Information
that may identify you will not be released for research purposes to anyone outside
the Memphis Speech and Hearing Center without your written authorization.
SPECIFIC EXAMPLES OF HOW YOUR MEDICAL INFORMATION MAY BE USED FOR TREATMENT, PAYMENT
OR HEALTHCARE OPERATIONS
• Medical information may be used to justify needed patient care services.
• We may use your PHI to establish a treatment plan
• We will submit claims to your insurance company containing PHI
• We may contact your health insurance carrier to certify that you are eligible for
benefits and to determine the range of benefits
• We may contact you to remind you of your appointment or need to make an appointment
by calling you or mailing a postcard
• We may use your PHI to evaluate the quality of care you receive from us, train our
students or to make business plans for our clinic
• Being an educational institution involved in teaching and research, we may use your
PHI for research purposes and/or request your participation in research projects as
a research participant.
• In consideration of our educational function, sessions or services may be observed
or videotaped by faculty, staff, and graduate students for research or educational
purposes. It is understood that these observers will consider any information revealed
during such session or services as confidential and will not be published or distributed
in any form in which you could be identified. Your case may be discussed as part of
the educational process in classroom settings. In these cases only limited information
will be used which could lead to your identification.
• We may use certain demographic information such as name, address, telephone number,
age and gender to contact you to raise funds for our Foundation. If you do not wish
to be contacted for fundraising efforts please contact: The School Development officer
YOUR HEALTH INFORMATION – PATIENT RIGHTS
• You may request a copy or summary of your PHI or you may inspect it
• You may request an amendment to you PHI if you feel there is an error
• You have the right to ask questions and receive answers
• You have the right of refusal to sign an authorization and it not be held against
• You may change your mind and revoke your authorization, except where actions have
already been taken by us relating to that authorization
• You have the right to an accounting of all entities with whom we have shared or
disclosed you PHI unrelated to treatment, payment or healthcare operations.
• You may request a restriction on certain uses of your PHI (we will consider reasonable,
appropriate requests but are not obligated to agree to them)
• You have the right to obtain a paper copy of this Notice of Privacy Practices
• You may file a complaint if you believe that your privacy rights have been violated
Any requests or other communications about the rights listed above should be directed
to: The Privacy Officer, Memphis Speech and Hearing Center, 807 Jefferson Avenue,
Memphis, TN 38105