Notice of Privacy Practices

I.      THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS DOCUMENT CAREFULLY.

II.     WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMAITON (PHI)

        We are legally required to protect the privacy of your health information.  We call this information “Protected Health Information” or “PHI.”  PHI is information that we have created or received about you.  We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI.  With some exceptions, we may not use or disclose any more of your PHI than is absolutely necessary.  We are legally required to follow the privacy practices that are described in this notice.  However, we reserve the right to change the terms of this notice and our privacy policies at any time.  Any changes will apply to the PHI we already have.  Before we make an important change to our policies, we will promptly change this notice and post a new notice in our lobby and on our website at www.pinehurstmedical.com.

III.    HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

        We use and disclose health information for many different reasons.  For some of these uses or disclosures we need your prior consent or specific authorization.  Below we describe the different categories of our uses and disclosures and give you some examples in each category.

A.     Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Require Your Prior Written Consent

                We may use and disclose your PHI with your consent for the following reasons:

1.      For treatment.  We may disclose your PHI to physicians, nurses, and other health care personnel who provide you with health care services or are involved in your care.  For example, if you’re being treated for a knee injury, we may disclose your PHI to the physical rehabilitation department in order to coordinate your care.

2.      To obtain payment for treatment.  We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you.  For example, we may provide portions of your PHI to our billing department and your health plan to receive payment for the health care services we provided to you.  We may also provide your PHI to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.

3.      For health care operations.  We may use your PHI 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 also provide your PHI to our accountants, attorneys, consultants and others in order to make sure we are complying with the laws that affect us.

Exceptions to consent requirements for treatment, payment, and health care operations.  Although your consent is required for numbers 1-3 of this section above, we may disclose your PHI to others without your consent if you need emergency treatment, as long as we try to obtain your consent after treatment.

B.      Certain Uses and Disclosures Do Not Require Your Consent

We may use and disclose your PHI without your consent or authorization for the following reasons:

1.      When a disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement.  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; or when ordered in a judicial or administrative proceeding.

2.      For public health activities.  For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information.  We provide coroners, medical examiners, and funeral directors necessary information relating to an individual’s death.

3.      For health oversight activities.  For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.

4.      For purposes of organ donation.  We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.

5.      For research purposes.  In certain circumstances, we may provide PHI in order to conduct medical research.

6.      To avoid harm.  In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

7.      For workers’ compensation purposes.  We may provide PHI in order to comply with workers’ compensation laws.

8.      Appointment reminders and health-related benefits or services.  We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits we offer.  This contact may be by phone, in writing, or otherwise and may involve leaving a message on an answering machine, which could (potentially) be picked up by others.

IV.    WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

        You have the following rights with respect to your PHI:

A.     The Right to Request Limits on Uses and Disclosures of Your PHI.  You have the right   to ask us to limit how we use and disclose your PHI.  We will consider your request but we are not legally required to agree to your requested restrictions.  If we accept your request, we will put any limits in writing and abide by them except in emergency situations.  You may not limit the uses and disclosures that we are legally required or allowed to make.

B.      The Right to Choose How We Send PHI to You.  You have the right to ask that we send information to you at an alternate address.  We will agree to your request if we can easily provide information in the format you request.

C.     The Right to Review and Obtain Copies of Your PHI On-Site.  In most cases, you have the right to review and copy medical information that may be used to make decisions about your care.  You must make the request in writing to us on our Release of Information Form.  In certain situations, we may deny your request to review and copy your PHI.  If we do, we will notify you of our reasons for the denial in writing.  There will be a charge associated if you request copies of your PHI.

D.     The Right to Request a List of the Disclosures We Have Made.  You have the right to request a list of instances in which we have disclosed your PHI.  Your request must be made in writing and submitted to our Health Information Department, stating a specific time period not longer than six (6) years and may not include dates prior to April 14, 2003.  The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations.  The list also will not include uses and disclosures made for national security purposes or to corrections or law enforcement personnel.

E.      The Right to Correct or Update Your PHI.  If you believe that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You must provide the request and your reason for the request in writing and submit it to our Health Information Department.  We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, (iv) not part of our records or (v) your request is not in writing or does not include a reason to support the request.  If we approve your request, we will make the change to your PHI.  If we deny your request, we will state the reasons for the denial and explain your right to file a written statement of disagreement.  If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI.

V.     HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

        If you disagree with a decision we made about access to your PHI, you may file a complaint with the Administrative Office.

VI.    PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

        If you have any questions, problems or complaints about privacy practices, please call our switchboard at (910) 295-5511.

VII.   EFFECTIVE DATE

        The effective date of this notice is April 14, 2003.  We reserve the right to change this notice.  We reserve the right to make revisions to information we already have about you as well as any information we receive in the future.