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 18th Ave NW
Hickory, NC 28601
This notice was published and becomes effective on July 8 th 2003
