THIS NOTICE OF PRIVACY PRACTICES applies only to care and treatment you receive at Carolina HealthSpan Institute under the federal law known as the Health Insurance Portability and Accountability Act (HIPAA) that protects the privacy of your health information. Terms defined in the HIPAA Rules will have the same meaning in this Notice. This Notice also applies to all the people who provide healthcare services at Carolina HealthSpan Institute, even if they are not employees or agents. These people provide care along with us as part of an "organized healthcare arrangement." All of these healthcare providers are referred to as "we" in the Notice. 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.

Effective: September 2004 Revised:   October 2013

We must protect the privacy or health information about you that can be identified with you, sometimes called "PHI" for short. PHI includes information about your past, present or future health, the healthcare we provide to you, and payment for your healthcare. This Notice explains Carolina HealthSpan Institute's legal duties with respect to PHI and how we can use and disclose PHI about you. In addition, we can make other uses and disclosures that occur as a byproduct of the uses and disclosures described in the Notice. This Notice also explains your privacy rights, and how you can file a complaint if you believe those rights have been violated. In the event that PHI about you is affected by a breach of unsecured PHI, Carolina HealthSpan Institute will provide notice as required by HIPAA.
  1. When We Can Use and Disclose PHI About You Without an Authorization. We may use and disclose PHI about you without your authorization in the following ways:
    • To remind you about appointments. We may use and/or disclose PHI to tell you about an appointment you have with us.
    • To tell you about treatment options. We may use and/or disclose PHI to tell you about treatment options that may interest you.
    • To our business associates. We provide some services through other businesses we call business associates. We may give business associates health information about you so they can do the job we asked them to do. For example, we might use a copy service to make copies of requested medical records. When we do this, we require the business associate to safeguard health information about you.
  2. When We May Use and Disclose PHI About You Without an Authorization or an Opportunity to Object. In some situations, we may use and/or disclose PHI about you without your authorization or an opportunity to object. These situations include when the use or disclosure is:
    • When it is required by law
    • For public health activities. We may disclose PHI about you for public health activities. These activities generally include disclosing PHI in order to:
      • Prevent or control disease, injury or disability
      • Report reactions to medicine or problems with medical products
      • Tell people that a medical product they are using has been recalled
      • Support public health surveillance and combat bioterrorism
    • For health oversight activities. We may disclose PHI about you to a state or federal health oversight agency that is authorized by law to oversee our operations.
    • For a legal proceeding. We may disclose PHI about you if a judge orders us to.
  1. Other Uses and Disclosures. In any situation other than those listed above, we will ask for your written authorization before we use or disclose your PHI. If you sign a written authorization allowing us to disclose PHI, you can cancel it later. Your cancellation must be in writing and delivered to the privacy official at the address provided below, and we will not disclose PHI about you after we receive your cancellation and had a reasonable time to implement the cancellation.
You have the following rights about the health information we maintain about you. If you want to exercise your rights, please contact Carolina HealthSpan Institute's privacy officer at 704-333-4817.
  1. Right to Ask for Restrictions. You have the right to ask us to limit the ways we use and disclose your PHI for treatment, payment or healthcare operations. You also have the right to ask us to limit the health information we share about you to someone involved in your care or the payment of your care. Your request must be in writing. Your restrictions may not be followed in some situations such as emergencies or when disclosure is required by law.
  2. Right to Ask for Different Ways to Communicate with You. You have the right to ask us to contact you in a certain way or at a certain location. For example, you can ask us to contact you at your work phone number.
  3. Right to See and Copy PHI. You have the right to see and get a copy of the health information about you. You must sign a special form called an Authorization. We may charge you a fee if you asked for a copy of your records.
  4. Right to a Paper Copy of this Notice. We will give you a paper copy of this Notice on the first day we treat you at our facility if you request it.