The individuals listed above as members of North Carolina Medical Massage OHCA will have access to medical information about you ONLY WHEN NEEDED (1) to perform treatment, (2) to conduct health care operations at North Carolina Medical Massage, or (3) to secure payment for services provided.
This Notice of Privacy Practices applies only to North Carolina Medical Massage OHCA and its members.
I. OUR COMMITMENT TO SAFEGUARD YOUR MEDICAL INFORMATION.
We are committed to protecting the privacy of medical information about you. This includes information that can be used to identify you that we create or receive about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. We are required by law to maintain the privacy of your medical information and we must provide you with this Notice about our privacy practices that explains how, when, and why we use and disclose medical information about you. With some exceptions, we may not use or disclose any more of your medical information than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this Notice.
This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
II. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
Uses and Disclosures Without Authorization
The following categories describe different ways that we are permitted to use and disclose your medical information without a specific authorization from you.
For Treatment
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Different departments or members of North Carolina Medical Massage OHCA may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x rays. We may disclose medical information about you to other health care providers who request such information for purposes of providing medical treatment to you.
For Payment
We may use and disclose medical information about you in order to bill and collect payment for the treatment and services provided to you. For example, we may need to give your insurance company information about therapy you received at one of our centers so it will pay for the therapy. We may also contact your insurance company to obtain prior approval for a treatment you are going to receive or to determine whether it is covered by your plan.
We may also provide medical information about you to our business associates, such as billing companies, claims processing companies, and others that process our health care claims. We require these business associates to appropriately safeguard the privacy of your information.
We also may provide information about you to other health care providers that have treated you or provided services to you to assist them in obtaining payment.
For Health Care Operations
We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to operate North Carolina Medical Massage and make sure that all of our patients receive quality care. For example, we may use your medical information in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you.
We may disclose medical information about you to another health care provider or health plan with which you also have a relationship for such things as quality assurance and case management.
We may also provide medical information about you to our business associates, such as accountants, attorneys, consultants, and others in order to make sure we're complying with the laws that affect us. We require these business associates to appropriately safeguard the privacy of your information.
Appointment reminders and services
We may use and disclose medical information to provide appointment reminders or test results.
Health-related products and services
We may use and disclose medical information to tell you about health-related products or services necessary for your treatment, to advise you of new products and services we offer, to provide general health and wellness information, or to provide you with promotional gifts of nominal value.
Media Requests
No information about you will be provided to the media by North Carolina Medical Massage OHCA or any of its members. Providing information to the media will be your responsibility.
Individuals involved in your care or payment for your care
We may provide medical information about you to a family member, friend, or other person who is involved in your care or the payment for your health care. We may also tell your family or friends your condition.
As required by law
We will disclose medical information about you when required to do so by federal, state, or local law. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; to report reactions to medications or problems with products; or to notify people of recalls of products they may be using.
To avert a serious threat to health or safety
We may use and disclose medical information about you 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 the threat or lessen such harm.
Lawsuits and disputes
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a court or administrative ordered subpoena or discovery request.
Public health activities
We may disclose medical information about you for public health activities. For example, we report information about births, deaths, and various diseases, to government officials in charge of collecting that information, and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death.
Health oversight activities
We may disclose medical 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.
Organ and tissue donation
If you are a potential organ donor, we may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
Minors
We may release medical information about minors to their parents or legal guardians. However, in instances where California law allows minors to consent to their own treatment without parental consent (i.e., HIV testing), information will not be released to a minor's parents without the minor's authorization unless otherwise specifically allowed under California law.
Workers' compensation
We may release medical information about you for workers' compensation or similar agencies as necessary to determine if you are eligible for benefits for work-related injuries or illness.
Military and veterans
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. We may also disclose medical information about you to the Department of Veterans Affairs upon your separation or discharge from military services. This disclosure may be necessary to determine if you are eligible for certain benefits.
Employers
We may release medical information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either (i) to conduct an assessment relating to a medical examination of the workplace or (ii) to determine whether you have a work-related illness or injury. In such circumstances, we will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you sign a specific authorization for the release of that information to your employer.
National security and intelligence
We may release medical information about you for national security purposes, such as protecting the President of the United States or foreign heads of state, or for conducting intelligence operations.
Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release may be necessary for the institution to provide you with health care; to protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.
Uses and Disclosures Requiring Authorization
The following categories describe different ways that we are permitted to use and disclose your medical information only with a specific authorization from you.
Other Uses and Disclosures of Medical Information
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization; however, we cannot take back any disclosures we have already made based upon your prior permission.
Marketing activities
We may not use medical information about you to contact you to encourage you to buy a product or service, which is unrelated to your current care management except with your specific authorization.
Alcohol and Drug Abuse Patient Records
Use and disclosure of any medical information about you relative to alcohol or drug abuse programs, is protected by federal law and regulations. Generally, we may not say to a person outside the program that you are or have attended the program, or disclose any information identifying you as an alcohol or drug abuser unless: (i) you have consented in writing; (ii) we receive a court order requiring the disclosure; or (iii) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.
HIV/AIDS Information
Use and disclosure of any medical information about you relative to HIV testing, HIV status, or AIDS, is protected by federal and state law. Generally, an authorization must be obtained for the disclosure of such information; however, state law may allow for or require disclosure of information for public health purposes.
Psychotherapy Notes
We must obtain an authorization for use or disclosure of psychotherapy notes, except under limited circumstances, such as (i) for treatment purposes by the originator of the psychotherapy notes; (ii) for use in training programs in which mental health students, trainees, or practitioners learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; (iii) for use or disclosure in defending ourselves in a legal action or other proceeding; or (iv) with respect to oversight activities involving the person who created the psychotherapy notes.
III. WHAT RIGHTS YOU HAVE REGARDING YOUR MEDICAL INFORMATION.
You have the following rights with respect to your medical information:
A. The Right to Inspect and Copy
You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. Normally we will provide access to your medical information within five (5) working days of a written request to inspect the information. We will notify you in writing if more time is necessary due to the length of your medical record or recent date of discharge. We will provide copies of your medical information within fifteen (15) days of a written request.
To inspect and receive a copy of medical information that may be used to make decisions about you, submit your request in writing to the Health Information Services Department. A form is available. If you request a copy of the information, we will charge a fee for the costs of copying, mailing, or other supplies and services associated with your request.
In certain limited situations, we may deny your request, such as when research is in progress. If we do, we will advise you in writing in a timely manner of our reasons for the denial and information on how you may have the denial reviewed. We will comply with the outcome of any such review.
B. The Right to Request Restrictions
You have a right to submit a written request to restrict or limit the medical information we use or disclose for treatment, payment or health care operations. You may not limit the uses and disclosures that we are legally required or allowed to make. You also have the right to request a limit on medical information we disclose about you (i) to someone who is involved in your care or the payment for your care, like a family member or friend, (ii) for the hospital's patient directory; or (iii) for fundraising purposes.
We may deny certain requests
Your request for restriction will be reviewed and granted or denied based on the established criteria of administrative practicality, concurrence with hospital practices, technical ability to comply with the request, and the best medical interests of you, the patient. If we do agree to your request, we will comply with it unless the information is needed to provide you emergency treatment.
To request restrictions on the use or disclosure of your medical information, you may submit your request in writing at the time you register for hospital services. Your request must include (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). You may also request such a restriction at any time by contacting North Carolina Medical Massage. A form is available and can be faxed or mailed to you.
A previously agreed to restriction may be terminated by you, North Carolina Medical Massage either orally or in writing. If we terminate the restriction, we can only use or disclose medical information we create or obtain after such restriction is terminated.
C. The Right to Amend
If you believe that medical information we have about you is incorrect or incomplete, you have the right to request that we amend the existing information or add the missing information. You have the right to request an amendment for as long as the information is kept by or for North Carolina Medical Massage. To request an amendment, you must provide the request in writing along with your reason for the request to North Carolina Medical Massage. We will respond within 60 days of receiving your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if the medical information is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don't file a written statement of disagreement, you have the right to request that your request and our denial be attached to all future disclosures of your medical information.
If we approve your request, we will add the amendment to your medical information, tell you that we have done it, and tell others that need to know about the change to your medical information.
D. The Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of instances in which we have disclosed medical information about you, with certain exceptions specifically defined by law. The list will not include certain uses or disclosures, such as those you have specifically authorized and those that are otherwise permitted, such as ones made for treatment, payment, or health care operations, directly to you, to your family, or in our patient directory.
To request this list or accounting of disclosures, you must submit your request in writing to North Carolina Medical Massage. 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 during the same year, we will 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 any costs are incurred.
We will respond within 60 days of receiving your request. We will notify you in writing if we need an additional 30 days to respond. The list we will give you will include the date of each applicable disclosure, to whom medical information was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure.
E. The Right to Request an Exception to Standard Confidential Communications
You have the right to ask that we send information to you to an alternate address (for example, if you want appointment reminders to not be left on an answering machine or if you want information sent to your work address rather than your home address). We will agree to all reasonable requests so long as we can easily provide it in the format you requested. Any such requests should be submitted in writing to North Carolina Medical Massage.
F. The Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice at any time. To obtain a paper copy of this Notice, please contact North Carolina Medical Massage. You may also obtain a copy of this Notice on our website at www.ncmedmassage.com or by clicking here.
IV. COMPLAINTS
If you believe that we may have violated your rights with respect to your medical information, you may file a written complaint with North Carolina Medical Massage. You may also send a written complaint to the Office for Civil Rights, U.S. Department of Health and Human Services within 180 days of an alleged violation of your rights. If you wish to do so, kindly contact North Carolina Medical Massage for the address. You will not be penalized for filing a complaint about our privacy practices. You will not be required to waive this right as a condition of treatment.
V. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you have any questions about this Notice or wish to make a complaint about our privacy practices, please send all written requests or complaints to the North Carolina Medical Massage, 143 North Main Street Suite 6, Kernersville, NC 27284. You may also contact by phone calling (336)-992-2417.
VI. CHANGES
We reserve the right to change the terms of this Notice and our privacy policies at any time. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. Before we make an important change to our policies, we will promptly change this Notice and post a new Notice in the North Carolina Medical Massage Centers and on www.ncmedmassage.com. The Notice will contain on the first page, in the top right-hand corner, the effective date.
VII. ACKNOWLEDGEMENT
You will be asked to sign an acknowledgement of your receipt of this Notice of Privacy Practices. We are required by law to make a good faith effort to provide you with our Notice of Privacy Practices and obtain such acknowledgement from you. However, your receipt of care and treatment from North Carolina Medical Massage is not conditioned upon your providing the written acknowledgement.
NC Med Massage, Inc. © 2004
