Purpose: This Notice of Privacy Practices, presents information that federal law requires us to give our patients regarding our privacy practices. We are required to provide this notice to each patient beginning no later than the date of our first service delivery to the patient including services delivered electronically. We must attempt to obtain acknowledgement of receipt of the Notice from the patient. We must post this Notice in our office in a clear and prominent location that is reasonable for patients seeking service from us to be able to read.

Adult Internal Medicine

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.

If you have any questions about this Notice please contact our Privacy Officer

Our Legal duty: We are required by applicable federal and state law to maintain the privacy of your health information. We are required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your information. We must follow the privacy practices that are described in this Notice while it is in effect.

We reserve the right to change the terms of this Notice and our privacy practices at any time, as permitted by applicable law. Whenever this Notice is revised, we must make Notice available upon request on or after the effective date. Thereafter we must distribute the notice to each new patient at the time of service delivery and to any person requesting a Notice. We must also post the revised Notice in our office.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION: We use and disclose health information about you for treatment, payment and healthcare operations as described.

Treatment: We may use and disclose protected health information to a physician or other healthcare providers providing treatment and other services to you. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you.

Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided to you- for example, disclosures to claim and obtain payment from your insurer, HMO etc.

Health Care 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, fundraising activities, and conducting or arranging for other business activities.

We will share your protected health information with third party "business associates" that perform various activities (for example, billing or transcription services) for our practice.

Required BV Law: We may use or disclose your protected health information to the extent that the use or disclose as required by law.

Abuse or Neglect: We may disclose your protected health information to appropriate authorities if we reasonably believe you are a possible victim of abuse, neglect or domestic violence. In this case, the disclosure will be consistent with the requirements of applicable federal and state laws.

Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.

Marketing-Health related services: We will not use your health information for marketing communications without your written authorization.

National Security: We may disclose to military authorities the health information of armed forces personnel in certain circumstances. We may disclose to authorized federal officials health information required for lawful and other national security activities. We may disclose to law enforcement officials as required or permitted in compliance with a court order, grand jury or subpoena.

 YOUR RIGHTS

You have the right to inspect and copy your protected health information: You may request access to your medical file and billing records that your physician and the practice uses for making decisions about you. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records.

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 laboratory results that are subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions or a request for access to your medical record.

You have the right to request a restriction of your protected health information: You have the right to request that we place additional restrictions on our use or disclosure of any part of your protected health information. 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 your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.

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 request that we communicate with you about your health information by reasonable alternative means or to alternative locations (you must make your request in writing). Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.

You may have the right to have your physician amend your protected health information: You may request an amendment of protected health information about you in a designated record set for so long as we maintain this information. In certain cases, we may deny your request for an amendment. 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. Please contact our Privacy Officer if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment or health care operations as described in this Notice of Privacy Practices.

If you request this accounting more than once in a month period, we may charge you a reasonable, cost-based fee for responding to these additional request

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 electronically, you have the right to obtain a paper copy of this Notice.

Appointment reminders: We may use or disclose your health information to provide you with an appointment or appointment changes (such as voicemail messages, postcards or letters).

Complaints:

If you are concerned that that we may have violated your privacy rights, or you disagree with a decision we made about access to our health information you may complain to us using the contact information listed at the end of this Notice. You may also submit in writing to the Secretary of Health and Human Services. We will provide you the address to file your complaint to the U.S. Department of Health and Human Services upon request. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you {Or filing a complaint.

You may contact our Privacy Officer: Dr. Lawrence Carter

Telephone: (828) 267-2246

Fax: (828) 267-1623

Address: 21 18^th Ave NW
Hickory, NC 28601

This notice was published and becomes effective on July 8 ^th 2003

PCMH

Patient Centered Medical Home

Welcome to your Medical Home

When it comes to your health care, you are seeking wellness, recovering from illness or managing a chronic condition. It is a cycle of staying well, getting well, and being well. If you deal with these health situations in a long-term relationship with a trusted doctor, then you’ve found your Patient-Centered Medical Home.

Think about it. Your personal provider and an extended team of health professionals build a relationship in which they know you, your family situation, your medical history and health issues in turn, you come to trust and rely on them for expert, evidence-based health care answers that are suited entirely to you or to your family.

A Medical Home is all about you

Caring about you is the most important job of your Patient Centered Medical Home. In this personal model of health care, your primary provider leads the team of health care professionals that collectively take responsibility for your care. They make sure you get care you need in wellness and illness to heal your body, mind, and spirit.

Who is your Medical Home team?

Your team may include a doctor, medical assistant, and receptionist, as well as many other healthcare professionals. These Professionals work together to help you get healthy, stay healthy, and get care and services that are right for you. When needed, your personal doctor arranges for an appropriate care with qualified specialist.

Here is what you can do.

• Actively participate in your care
• Understand that you are a full partner in your own healthcare
• Learn about your condition and what you can do to stay as healthy as possible.
• As best you can, follow the care plan that you and your medical team have agreed is important for your health.
• Communicate with your home team
• Bring list of questions to each appt. Also, bring a list of any medicines, vitamins, or remedies you use.
• If you don’t understand something your doctor or other member of your medical home team says, ask them to explain it to you in a different way.
• If you get care from other health professionals, always tell your medical home team so they can coordinate for the best care possible.
• Talk openly with your care team about your experience in getting care from the medical home so they can keep making your care better.

Purpose: This Notice of Privacy Practices, presents information that federal law requires us to give our patients regarding our privacy practices. We are required to provide this notice to each patient beginning no later than the date of our first service delivery to the patient including services delivered electronically. We must attempt to obtain acknowledgement of receipt of the Notice from the patient. We must post this Notice in our office in a clear and prominent location that is reasonable for patients seeking service from us to be able to read.

Adult Internal Medicine

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.

If you have any questions about this Notice please contact our Privacy Officer

Our Legal duty: We are required by applicable federal and state law to maintain the privacy of your health information. We are required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your information. We must follow the privacy practices that are described in this Notice while it is in effect.

We reserve the right to change the terms of this Notice and our privacy practices at any time, as permitted by applicable law. Whenever this Notice is revised, we must make Notice available upon request on or after the effective date. Thereafter we must distribute the notice to each new patient at the time of service delivery and to any person requesting a Notice. We must also post the revised Notice in our office.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION: We use and disclose health information about you for treatment, payment and healthcare operations as described.

Treatment: We may use and disclose protected health information to a physician or other healthcare providers providing treatment and other services to you. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you.

Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided to you- for example, disclosures to claim and obtain payment from your insurer, HMO etc.

Health Care 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, fundraising activities, and conducting or arranging for other business activities.

We will share your protected health information with third party "business associates" that perform various activities (for example, billing or transcription services) for our practice.

Required BV Law: We may use or disclose your protected health information to the extent that the use or disclose as required by law.

Abuse or Neglect: We may disclose your protected health information to appropriate authorities if we reasonably believe you are a possible victim of abuse, neglect or domestic violence. In this case, the disclosure will be consistent with the requirements of applicable federal and state laws.

Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.

Marketing-Health related services: We will not use your health information for marketing communications without your written authorization.

National Security: We may disclose to military authorities the health information of armed forces personnel in certain circumstances. We may disclose to authorized federal officials health information required for lawful and other national security activities. We may disclose to law enforcement officials as required or permitted in compliance with a court order, grand jury or subpoena.

 YOUR RIGHTS

You have the right to inspect and copy your protected health information: You may request access to your medical file and billing records that your physician and the practice uses for making decisions about you. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records.

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 laboratory results that are subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions or a request for access to your medical record.

You have the right to request a restriction of your protected health information: You have the right to request that we place additional restrictions on our use or disclosure of any part of your protected health information. 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 your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.

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 request that we communicate with you about your health information by reasonable alternative means or to alternative locations (you must make your request in writing). Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.

You may have the right to have your physician amend your protected health information: You may request an amendment of protected health information about you in a designated record set for so long as we maintain this information. In certain cases, we may deny your request for an amendment. 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. Please contact our Privacy Officer if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment or health care operations as described in this Notice of Privacy Practices.

If you request this accounting more than once in a month period, we may charge you a reasonable, cost-based fee for responding to these additional request

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 electronically, you have the right to obtain a paper copy of this Notice.

Appointment reminders: We may use or disclose your health information to provide you with an appointment or appointment changes (such as voicemail messages, postcards or letters).

Complaints:

If you are concerned that that we may have violated your privacy rights, or you disagree with a decision we made about access to our health information you may complain to us using the contact information listed at the end of this Notice. You may also submit in writing to the Secretary of Health and Human Services. We will provide you the address to file your complaint to the U.S. Department of Health and Human Services upon request. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you {Or filing a complaint.

You may contact our Privacy Officer: Dr. Lawrence Carter

Telephone: (828) 267-2246

Fax: (828) 267-1623

Address: 21 18^th Ave NW
Hickory, NC 28601

This notice was published and becomes effective on July 8 ^th 2003

• What are Patient Assistance Programs?
  Patient Assistance Programs (PAP) are sponsored by the companies that make prescription medications. PAP’s allow individuals who qualify to receive prescription medications at a reduced or no cost. Each company has its own rules about who qualifies for their programs.

• How do I enroll in PAP?
  Each PAP has its own application process. There is programs that require your doctor, nurse, or social worker to apply for you. Some program applications can be completed online while others have to be faxed or mailed applications.lease understand that applying does not guarantee you will be qualified for the program

Please understand that applying does not guarantee you will be qualified for the program

• Does Adult Internal Medicine assist you in the application process?
  The staff of adult internal medicine will be glad to assist you in completion of the PAP forms. Please talk to your doctor about enrolling in PAP program at your routine visits.
  
  
• Is there a charge for completion of PAP forms?
  There is a $20.00 application fee for the completion of each PAP application.

Payment is due at the time of application completion whether patient is approved or not.

• How will I know if I been approved?
  You will receive a letter or a letter from the pharmaceutical company telling you whether or not you have been approved. This could take up to 6 weeks before you will receive notification and in some cases even longer. Please review each application for the notification policy.

• How will I get my medication?
  Some companies will mail the medications directly to you while others require that they be mailed to your doctor’s office. If medications are mailed to our office we will notify you when they arrive to be picked up.

If you have any other questions about PAP forms and enrollment please feel free to contact our office for further assistance.

Thank You!