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Todd W. Cline, P. A.
Attorney & Counselor at Law 101 N McDowell Street, Suite 220,Charlotte, NC 28204 (704) 334-7779 |
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Notice of Privacy Practices THIS NOTICE DESCRIBES HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We are required by law to:
WHO WILL FOLLOW THIS NOTICE? This notice describes our practices and that of:
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION: The following categories describe different ways that we may use and disclose health and medical information. For each category of uses or disclosures we will explain what we mean and try to give examples. We will not list every use or disclosure in a category. However, all of the ways we are permitted to use and disclose information will fall within at least one of the categories. For Treatment: We may use your health information to assist you with medical treatment or services. We may disclose your health information to doctors, nurses, technicians, medical students, or other health care personnel who are involved in treating you. We also may disclose your health information to people outside of a health care provider to provide services that are a part of your medical care. Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care at a health care facility. Business Associates. There are some services provided in our organization through contacts with business associates. For example, we may use a copy service to make copies of your medical records. When we hire companies to perform these services, we may disclose your health information to these companies so that they can perform the job we have asked them to do and bill you or your insurance company for the services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your health information. Individuals Involved in Your Care or Payment for Your Care: We may release your health information to a family member, other relative, close personal friend, or any other person who is involved in your care or payment related to your care. To Avert a Serious Threat to Health or Safety: We may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or reduce the threat.
SPECIAL SITUATIONS: Disaster Relief: We may release your health information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. Workers’ Compensation: We may release your health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses. Public Health Risks: We may disclose your health information for public health activities. These activities generally include the following:
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We also may disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. Law Enforcement: We may release health information if asked to do so by a law enforcement official:
Coroners, Medical Examiners and Funeral Directors: We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release health information to funeral directors as necessary for them to carry out their duties. National Security and Intelligence Activities: We may release your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We also may disclose your health information to authorized federal officials, so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your health information to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) for the safety and security of the correctional institution.
OTHER USES OF HEALTH INFORMATION: Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose your health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your health information for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission. North Carolina Law: In the event that North Carolina Law requires us to give more protection to your health information than stated in this notice or required by Federal Law, we will give that additional protection to your health information.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION: You have the following rights regarding the health information we maintain about you: Right to Inspect and Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your case. Usually, this includes medical and billing records. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing tour office. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We will respond to you within 30 days of receiving your written request. We may deny your request to inspect and/or obtain a copy of your health information in limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Right to Request an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made concerning your health information. To request this list or accounting of disclosures, you must submit your request in writing to:
Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before nay costs are incurred. We will respond within 60 days of receiving your request. The list will include the date of the disclosure; to whom health information was disclosed (including their address, if known); a description of the information disclosed; and the reason for the disclosure. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or is provided in response to a subpoena or court order. You may not limit uses and disclosures that we are legally required or allowed to make. To request confidential communications, you must make your request in writing to:
We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may obtain a copy of this notice at any time from our website, www.carolinattorney.com, or from our office. CHANGES TO THIS NOTICE:We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. The notice will contain the effective date on the first page. You can view the current notice at our website, www.carolinattorney.com. COMPLAINTS:If you believe your privacy rights have been violated, you may file a complaint with Todd W. Cline, P. A. or with the Secretary of the Department of Health and Human Service. If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact: Todd W. Cline 101 N. McDowell Street, Suite 220, Charlotte, NC 28204. You will not be penalized for filing a complaint.
OUR PLEDGE REGARDING HEALTH INFORMATION: We understand that information about you and your health is personal. We are committed to protecting your health and medical information. This notice will apply to all of the records of your treatment generated by a health care provider. This notice will tell you about the ways we may use and disclose your health and medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
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