PLEASE REVIEW IT CAREFULLY
OUR HIPAA COMPLIANCE
We are required by applicable federal and state law to:
Maintain the privacy and security of your health information.
Provide you with this Notice about our privacy practices, legal duties, and your rights regarding your health information.
Notify you and affected individuals in the event of a breach of unsecured health information.
Follow the privacy practices outlined in this Notice while it is in effect.
This Notice takes effect on April 1, 2019, and remains in effect unless replaced. We reserve the right to change our privacy practices and this Notice in compliance with applicable law. You have the right to request a copy of our Notice at any time.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose your health information for the following purposes:
- Treatment We may use and disclose your health information to provide and coordinate your healthcare, consult with other healthcare providers, make referrals, and provide appointment reminders and recall information.
- Payment - We may use and disclose your health information to facilitate payment for treatment and services, including billing, claims submission, and disclosure to consumer reporting agencies for payment collection.
- Health Care Operations - We may use and disclose your health information for operational purposes such as quality assessments, training programs, medical review, legal services, and fraud and abuse detection. This also includes improving the quality and effectiveness of the care we provide and managing our business operations.
- Notification - We may use or disclose your health information to notify your family member, personal representative, or other responsible individuals about your location or general condition, as necessary.
- Required by Law - We may use and disclose information about you as required by applicable law, including court orders, custody arrangements, reporting abuse, assisting law enforcement officials, and protecting public health and safety.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights regarding your health information:
- AccessYou can request access to your health information and receive copies, subject to limited exceptions. You may be charged a reasonable fee for copies.
- Disclosure Accounting - You can request a list of non-routine disclosures of your health information for the last 6 years (or a shorter period if applicable). Additional requests within a year may incur a reasonable fee.
- Restriction - You can request additional restrictions on our use or disclosure of your health information, although we are not obligated to agree except in limited circumstances.
- Alternative Communication - You can request communications of health information by alternative means or at alternative locations.
- Amendment - You can request amendments to your health information. We may deny the request under certain circumstances.
- Breach Notification - In case of a breach of unsecured health information, we will notify you without unreasonable delay and no later than 60 days following our discovery of the breach.
- Changes to Privacy Practices - We will notify you of changes to our privacy practices as required by law.
PRIVACY QUESTIONS AND COMPLAINTS
If you have questions or concerns about our privacy practices, or if you believe your privacy rights have been violated, please contact us:
- Senior Security & Privacy Official
- Privacy Office
- 8300 Falls of Neuse Road Suite 110
- Raleigh, NC 27615 USA
- Phone: 888.449.9540
- Email: firstname.lastname@example.org
You have the right to file a complaint with us or the U.S. Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you for filing a complaint.
[If you prefer to receive this Notice electronically, please let us know, and we will provide a written copy upon request.]