HIPAA Notice of Privacy Practices

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act (HIPAA)

 

1.     The purpose of the attached Notice of Privacy Practices (Notice) is to tell you how we can use and disclose your medical information. It also describes certain rights that you have about your medical information kept by us. Please look at it with care.

2.     We are legally required to give you this Notice and to get a signed statement that you received it. By signing this, you are only saying that you have received our Notice.

3.     This Notice also sets forth the name and contact information for the person you can contact if you have any questions. It tells you how to file a complaint if you think your rights have been denied. It also tells you how to file a complaint about our practices described in the Notice.

 

By signing this paper, you confirm receipt of the SAFEchild Advocacy Center Notice of Privacy Practices.

NOTICE OF SAFEchild ADVOCACY CENTER's PRIVACY PRACTICES

THIS NOTICE OF PRIVACY PRACTICES (NOTICE) DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

This Notice is intended to inform you about how we protect the privacy of our patients' medical information. Generally, we are required by law to ensure that medical information that identifies you, including all medical records and other individually identifiable information (known as “Protected Health Information”) is kept private. Further, we must inform you of our legal duties and privacy practices with respect to any Protected Health Information we create or receive about you. We are required by law to follow the terms of this Notice that are currently in effect.

This Notice will explain how we may use and disclose your Protected Health Information, our obligations related to the use and disclosure of your Protected Health Information and your rights related to any Protected Health Information that we have about you. If our patient is a minor child, references to "you" or "your" Protected Health Information in this Notice are references to your minor child’s records. You are asked to sign an Acknowledgement of Receipt of this Notice in your capacity as a parent or legal representative of a minor child. In most circumstances, we are permitted to provide a minor's Protected Health Information to either parent of the child. There may be situations, however, where HIPAA or North Carolina state law does not require or permit us to provide a minor’s Protected Health Information to both parents.  For example, we may not be required to provide a minor’s Protected Health Information to (1) a non-custodial parent if a custodial agreement provides that only one parent has rights to such information, or (2) a parent if we believe that the minor may have been subject to abuse or neglect and that providing such information to that parent could endanger the minor. Further, we may provide a minor’s Protected Health Information to the minor’s legal representative (e.g., a person appointed by a Durable Power of Attorney for Health Care or Legal Guardian). This Notice applies to the medical records that are generated in or by this practice.

With a few exceptions, we are required to obtain your authorization for the use or disclosure of your Protected Health Information for reasons other than for treatment, payment or health care operations. We have listed below some of the reasons why we might use or disclose your Protected Health Information and some examples of the types of uses or disclosures below. Not every use or disclosure is covered, but all of the ways that we are allowed to use and disclose your Protected Health Information will fall into one of the categories.

If you have any questions about the content of this Notice, or if you need to contact someone at the SAFEchild Advocacy Center about any of the information contained in this Notice, the contact person is:

Name of Contact: Cristin DeRonja
Title: Director
Address: 2815 Kidd Road, Raleigh, NC 27610
Phone Number: 919-231-5515

In addition to the SAFEchild Advocacy Center employees, staff and other personnel, any health care professional who is authorized to enter information in your medical record must follow the practices set forth in this Notice. 

Use and Disclosure of Your Protected Health Information for Treatment, Payment or Health Care Operations:

We may use or disclose your Protected Health Information for purposes of treatment, payment for services, or certain health care operations.  The use and disclosure of your Protected Health Information for treatment, payment or health care operations does NOT require your authorization.

For Treatment:  To provide you with medical treatment or services, we may need to use or disclose your Protected Health Information to doctors, nurses, technicians, students or other SAFEchild Advocacy Center personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Other doctors may share your medical information to coordinate your care. For instance, the laboratory may request information to complete lab work. We may also disclose your Protected Health Information to people who may be involved in your medical care after you leave the practice, such as home health agencies, your family and clergy members. We may also disclose your medical information to other covered entities that are not affiliated with the practice for your treatment (e.g. pharmacists, emergency medical providers, and unaffiliated physicians).

For Payment:  We may use and disclose your Protected Health Information for the SAFEchild Advocacy Center to bill and receive payment for the treatment that you received here. For example, we may use or disclose your medical information to the North Carolina Medicaid program to receive reimbursement for the services we provided you.

For Health Care Operations:  We may use and disclose your Protected Health Information for the SAFEchild Advocacy Center practice operations. These include uses and disclosures that are necessary to run the practice and make sure that our patients receive quality care. For example, we may use or disclose your medical information to evaluate our staff's performance in caring for you. Your medical information may be combined with the medical information of other SAFEchild Advocacy Center patients to allow us to evaluate whether the practice should offer additional services or discontinue other services and whether certain treatments are effective. We may also compare this information with other practices to evaluate whether we can make improvements in the care and services that we offer.

Other Uses and Disclosures of Your Protected Health Information That Do NOT Require Your Authorization:

We may use or disclose your Protected Health Information without your authorization when there is an emergency or when we are required by law to treat you, when we are required by law to use or disclose certain information, or when there are substantial communication barriers to obtaining consent from you.

Further, we may use or disclose your Protected Health Information without your consent or authorization in any of the circumstances set forth below:

Public Health Risks:  We may disclose your Protected Health Information to public health authorities that are authorized by law to collect information, including for the following purposes:

·       Maintaining vital records, such as births and deaths;

·       Reporting child abuse, neglect or domestic violence;

·       Preventing or controlling disease, injury or disability;

·       Notifying a person regarding potential exposure to a communicable disease;

·       Notifying a person regarding a potential risk for spreading or contracting a disease or condition;

·       Reporting reactions to drugs or problems with products or devices regulated by the Federal  Food and Drug Administration (FDA);

·       Notifying individuals if a product or device they may be using has been recalled; and

·       Notifying your employer under limited circumstances to workplace injury/illness or medical surveillance information

Health Oversight Activities:  We may use or disclose your Protected Health Information for the purpose of health oversight activities, such as audits, investigations, licensure or disciplinary actions or legal proceedings or actions.

Required by Law:  We may use or disclose your Protected Health Information for judicial and administrative proceedings in accordance with state and/or federal law, for instance, in response to a court order, court-ordered subpoena or legal request.

Law Enforcement:  We may use or disclose your Protected Health Information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness or missing person or regarding a victim of a crime who can not give consent or authorization because of incapacity.

Coroners, Funeral Directors, & Organ Donation:  We may disclose medical information about deceased persons to medical examiners, coroners and funeral directors, and we may use or disclose your Protected Health Information for organ and tissue donation purposes.

Research:  We may use or disclose your Protected Health Information related to a research project when a waiver of authorization has been approved by the Privacy Board.

Criminal Activity:  We may use or disclose your Protected Health Information when we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the public's safety.

Specialized Government Functions:  We may use or disclose your Protected Health Information when necessary for specialized government functions, such as military service, for the protection of the president or for national security and intelligence activities.

Military:  We may use or disclose your Protected Health Information when required by military command authorities, if you are a member of the armed forces (or if foreign military personnel, to appropriate foreign military authorities.

Inmates:  In the case of a juvenile housed in a correctional facility such as a juvenile detention center or other such facility, we can release medical information about such juvenile to the facility in which he or she resides for the following purposes: (1) for the institution to provide the juvenile with health care; (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility.

Workers’ Compensation:  We may use or disclose your Protected Health Information when necessary to comply with workers' compensation laws or for workers’ compensation purposes.

Required by HIPAA Privacy Rule:  We are required to disclose your Protected Health Information to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule.

Business Associates:  We may disclose your Protected Health Information to a contractor or service provider (known as a “business associate”) that needs the information in order to perform services for the practice and agrees to protect the confidentiality of your information.

Planned Uses or Disclosures of Your Protected Health Information to Which You MAY Object:

We will use or disclose your Protected Health Information for any of the purposes described in this section unless you affirmatively object to or otherwise restrict a particular release.  You must direct your written objections or restrictions to the contact person, whose information is included on the first page of this Notice.

Appointment Reminders:  We may use or disclose your Protected Health Information to contact you and remind that you have an appointment for treatment or medical care.

Information about Treatment, Services, or Products:  We may use or disclose your Protected Health Information to provide you with information about or recommendations of possible treatment options or alternatives that may interest you. We may use and disclose your Protected Health Information to inform you about health benefits or services that may interest you.

Release of Information to Family/Friends: Unless you object or in an emergency, we may release your Protected Health Information to a friend and/or family member who is involved in your care. We can tell your family and/or friends of your condition and that you are at our practice for treatment or services. We can also give this information to someone who will help or is helping to pay for your care.

Disaster Relief Efforts:  Unless you object or in an emergency situation, we may use or disclose your Protected Health Information to assist a public or private entity to assist in disaster relief efforts, i.e., the American Red Cross, for the purpose of notification of family and/or friends of your whereabouts and condition.

Other Uses or Disclosures of Your Medical Information:

Uses or disclosures of your Protected Health Information not covered in this Notice will not be made unless authorized or required by law or with your written authorization. If you provide us written authorization to use or disclose your medical information, you can change your mind and revoke your authorization at any time, as long as it is in writing. If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to take back any uses or disclosures that we have made pursuant to your previous authorization. We may not withhold treatment if you refuse to authorize the use or disclosure of your Protected Health Information for these other purposes. 

We Are Required under North Carolina State Law to Comply with Certain Requirements:

Under North Carolina state law, we are required to comply with the requirements described below.

Communicable Diseases:  If you have one of several communicable diseases (for example, tuberculosis, syphilis or HIV/AIDS), North Carolina law requires that information about your disease be treated as confidential, and such information will be disclosed without written permission only in limited circumstances. We need not obtain your permission to report information about your communicable disease to North Carolina state and local officials or to otherwise use or disclose your medical information in order to prevent against the spread of the disease. Also, we may disclose information about your communicable disease to health care personnel who care for you.

Special Provisions for Minors:  Under North Carolina law, minors, with or without consent from their parents or guardians, have the right to consent to services for the prevention, diagnosis and treatment of certain illnesses, including (1) venereal disease and other diseases that may be reported to the State of North Carolina, (2) pregnancy, (3) abuse of controlled substances and (4) alcohol and emotional disturbance. If you are a minor and you consent to one of these services, you have all the authority and rights included in this Notice relating to that service. In addition, North Carolina law permits certain minors to be treated as adults for all purposes (for example, an emancipated minor). These minors have all rights and authority included in this Notice for all services.

Your Rights with Respect to Your Medical Information:

The medical records we maintain are the physical property of SAFEchild Advocacy Center. The information in them, however, belongs to you. Listed below are your rights with regard to your Protected Health Information. Each of these rights is subject to certain requirements, limitations and exceptions. If you wish to exercise any of these rights, please contact our contact person, whose information is included on the first page of this Notice.  Our contact person will provide you with assistance on the steps to take to exercise your rights.

Right to Request Restrictions:  You have the right to request that we restrict any use or disclosure of your Protected Health Information. If you request restrictions on the use and disclosure of your Protected Health Information and (1) the disclosure is to a health plan for payment or health care operations and (2) you have paid out-of-pocket in full for the services to which the Protected Health Information is related, we are required to comply with your request. Otherwise, we are NOT required to agree to your requested restriction (except that, if you are mentally competent, you may restrict disclosures to family members and friends). If we do agree to adhere to your restrictions, we will comply with your request unless the information is needed to provide you emergency treatment or to comply with federal or state law. Any request to restrict uses or disclosures must be made in writing to our contact person, whose information is included on the first page of this Notice. Your request must indicate (1) what information you want limited; (2) whether you want to limit our use, disclosure or both: and (3) to whom you want the limits to apply.

Right to Request to Receive Confidential Communications:  You have the right to request that we take steps to ensure that you receive your Protected Health Information in a confidential manner. We will accommodate any such request that is reasonable. Simple requests at our office, such as calling a patient at an alternate location with a reminder, are not treated as formal requests for confidential communications and are handled directly by our office. If you wish to exercise your right to request confidential communications by alternative means, you should contact our contact person, whose information is included on the first page of this Notice.

Right to Inspect and Copy:  You have the right to inspect and receive a copy of your Protected Health Information with written authorization and photo identification, subject to some exceptions. If we retain your Protected Health Information in electronic format, you may request (1) an electronic copy of your Protected Health Information or a summary or explanation of that information and (2) that we transmit your information electronically to a person or entity you designate. Your request must be made in writing to our contact person, whose information is included on the first page of this Notice. In some cases, a reasonable fee may be charged for this service and we will communicate this cost to you in advance. After evaluation in rare cases your request may be denied. If you are denied access to your Protected Health Information, in some cases you have a right to request review of the denial.

Right to Request Amendment:  You have the right to request an amendment to your Protected Health Information maintained by SAFEchild Advocacy Center for as long as the information is kept by or for us. To exercise this right, your request must be in writing to our contact person, whose information is included on the first page of this Notice, and must state the reason for the requested amendment. We may deny your request for amendment if the Protected Health Information:  (1) was not created by us, unless the originator of the information is no longer available to act on your request; (2) is not part of the Protected Health Information maintained by or for us; (3) is not part of the Protected Health Information to which you have a right to access; or (4) is already accurate and complete, as determined by us. If we deny your request for amendment, we will give you a written denial including the reasons for denial and the right to submit a written statement disagreeing with the denial. Simple requests at our office, such as changing your address or insurance information, are not treated as formal requests for amendment and are handled directly by our office.

Right to an Accounting of Disclosures:  You have the right to request an “accounting” of certain disclosures of your Protected Health Information (i.e., the names of people who we have shared your medical information with). This accounting is a listing of disclosures made by SAFEchild Advocacy Center or others on our behalf but does not include disclosures for treatment, payment and health care operations (until January 1, 2014, after which date electronic disclosures for treatment, payment and health care operations will be tracked), disclosures made pursuant to your authorization and certain other exceptions. To exercise this right, you must submit your request in writing to our contact person, whose information is included on the first page of this Notice, stating a time period beginning after April 13, 2003 that is within 6 years from the date of your request (or 3 years for electronic disclosures for treatment, payment and health care operations after January 1, 2014), and listing the location of all SAFEchild Advocacy Center offices for which you are requesting an accounting. The first accounting provided within a 12-month period will be free; for further requests, we may charge you a fee for this service and we will communicate this cost to you in advance.

Complaints:

If you believe that we have violated any of your privacy rights or have not adhered to the information contained in this Notice, you can file a complaint by putting it in writing and sending it to:  Cristin DeRonja, Director, 2815 Kidd Road, Raleigh, NC 27610, 919-231-5515. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services (DHHS) by putting it in writing and sending it to:  Region IV, Office of Civil Rights, U.S. Department of Health and Human Services, Regional Manager, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street SW, Atlanta, GA 30303-8909, OCRComplaint@hhs.gov. Your complaint to DHHS must be in writing (either in paper or electronically) and filed within 180 days of when you knew, or should have known, that the act or failure to act that you are registering a complaint about occurred. However, DHHS may give you more time to complain if it thinks there is a good reason for your delay. We cannot and will not require you to waive the right to file a complaint with DHHS as a condition of receiving treatment from SAFEchild Advocacy Center or its physicians. You will not be retaliated against for filing a complaint with either the SAFEchild Advocacy Center or the U.S. Department of Health and Human Services.

Changes to This Notice of Privacy Practices:

We reserve the right to change or modify the information contained in this Notice, as long as such change or modification does not violate any law regarding your rights as a patient to your medical information. Any changes that we make can be effective for any medical information that we have about you and any information that we might obtain. The most recent version of Privacy Practices will be posted in our building. Also, you can call or write our contact person, whose information is included on the first page of this Notice, to obtain the most recent version of our notice.