HIPAA 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
of Privacy describes how we may use and disclose your
protected health information (PHI) to carry out
treatment, payment or health care operations (TPO) and
for other purposes that are permitted or required by
law. It also describes your rights to access and
control your protected health information. “Protected
health information” is information about you, including
demographic information, that may identify you and that
relates to your past, present or future physical or
mental health or condition and related health care
services.
1.
Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information
Your
protected health information may be used and disclosed
by your physician, our office staff and others outside
of our office that are involved in your care and
treatment for the purpose of providing health care
services to you, to pay your health care bills, to
support the operation of the physician’s practice, and
any other use required by law.
Treatment:
We will use and disclose your protected health
information to provide, coordinate, or manage your
health care and any related services. This includes the
coordination or management of your health care with a
third party. For example, we would disclose your
protected health information, as necessary, to a home
health agency that provides care to you. For example,
your protected health information may be provided to a
physician to whom you have been referred to ensure that
the physician has the necessary information to diagnose
or treat you.
Payment:
Your protected health information will be used, as
needed, to obtain payment for your health care
services. For example, obtaining approval for a
hospital stay may require that your relevant protected
health information be disclosed to the health plan to
obtain approval for the hospital admission.
Healthcare
Operations:
We may use or disclose, as-needed, your protected health
information in order to support the business activities
of your physician’s practice. These activities
include, but are not limited to, quality assessment
activities, employee review activities, training of
medical students, licensing, and conducting or arranging
for other business activities. For example, we may
disclose your protected health information to medical
school students that see patients at our office. In
addition, we may use a sign-in sheet at the registration
desk where you will be asked to sign your name and
indicate your physician. We may also call you by name
in the waiting room when your physician is ready to see
you. We may use or disclose your protected health
information, as necessary, to contact you to remind you
of your appointment.
We may use or
disclose your protected health information in the
following situations without your authorization. These
situations include: as Required By Law, Public Health
issues as required by law, Communicable Diseases: Health
Oversight: Abuse or Neglect: Food and Drug
Administration requirements: Legal Proceedings: Law
Enforcement: Coroners, Funeral Directors, and Organ
Donation: Research: Criminal Activity: Military Activity
and National Security: Workers’ Compensation: Inmates:
Required Uses and Disclosures: Under the law, we must
make disclosures to you and when required by the
Secretary of the Department of Health and Human Services
to investigate or determine our compliance with the
requirements of Section 164.500.
Other
Permitted and Required Uses and Disclosures
Will be Made Only With Your Consent, Authorization or
Opportunity to Object unless required by law.
You may
revoke this authorization,
at any time, in writing, except to the extent that your
physician or the physician’s practice has taken an
action in reliance on the use or disclosure indicated in
the authorization.
Your Rights
The following is a statement of your rights with respect
to your protected health information.
You
have the right to inspect and copy your protected health
information.
Under federal
law, however, you may not inspect or copy the following
records; psychotherapy notes; information compiled in
reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and
protected health information that is subject to law that
prohibits access to protected health information.
Fees
You
may request access by sending us a letter to the address
at the end of this Notice or by obtaining a copy . If
you request copies, we will charge you .50 for each
page, $7.00 for each x-ray copy, $15.00 per hour for
staff time to locate and copy your health information,
and postage if you want your copies mailed to you.
You
have the right to request a restriction of your
protected health information.
This means you may ask us not to use or disclose any
part of your protected health information for the
purposes of treatment, payment or healthcare
operations. You may also request any part of your
protected health information not be disclosed to family
members or friends who may be involved in your care or
for notification purposes as described in this Notice of
Privacy Practices. Your request must state the specific
restriction requested and to whom you want the
restriction to apply.
Your
physician is not required to agree to a restriction that
you may request. If the physician believes it is in
your best interest to permit use and disclosure of your
protected health information, your protected health
information will not be restricted. You then have the
right to use another Healthcare Professional.
You
have the right to request to receive confidential
communications from us by alternative means or at an
alternative location. You have the right to obtain a
paper copy of this notice from us, upon request, even if
you have agreed to accept this notice alternatively i.e.
electronically.
You may have
the right to have your physician amend your protected
health information.
If we deny your request for amendment, you have the
right to file a statement of disagreement with us and we
may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal.
You have the
right to receive an accounting of certain disclosures we
have made, if any, of your protected health information.
We
reserve the right to change the terms of this notice and
will inform you by mail of any changes. You then have
the right to object or withdraw as provided in this
notice.
Complaints
You may complain to us or to the Secretary of Health and
Human Services if you believe your privacy rights have
been violated by us. You may file a complaint with us
by notifying our privacy contact of your complaint.
We will not retaliate against you for filing a
complaint.
Contact
Officer: Cathy Evans
300 W.
Northwood St. Greensboro, NC 27401
Telephone: 336-379-0941
Fax: 336-379-7997
This notice
was published and becomes effective on/or before April
14, 2003.
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