Notice of Privacy Practices & Non-Discrimination

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.

NOTICE OF NON-DISCRIMINATIONAffordable Care Act Section 1557 prohibits discrimination on the basis of race, color, national origin, sex (including gender identity), age, or disability.  This notice outlines Midwest Ear Institute’s policy of non-discrimination.

Please review both of these notices carefully.

The forms are in Adobe Acrobat (PDF) format.  If you do not have Adobe Acrobat Reader, click on the icon below to get a free version.

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If you have any problem getting the forms to print properly, please call our office at 317-842-4901 or 800-818-EARS (3277) and we will gladly mail or fax them to you.