NOTICE OF PRIVACY PRACTICES OF

CAROLINA NEUROSURGERY & SPINE ASSOCIATES. P.A.


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: April 14, 2003

If you have any questions or requests, please contact: S. Brooke Hinsdale, Privacy Officer
Carolina Neurosurgery & Spine Associates, P.A.
1010 Edgehill Rd., North
Charlotte, NC 28207
704-972-1568 (phone)
704-376-1903 (fax)
brooke.hinsdale@cnsa.com

TABLE OF CONTENTS


A. We have a legal duty to protect health information about you.

B. We may use and disclose protected health information (PHI) about you in the following circumstances:
1. To provide, coordinate and manage health care treatment and related services to you;
2. To make coverage determinations and to obtain payment for services;
3. For health care operations;
4. Under certain circumstances without your authorization;
5. For other purposes, unless you object to such use and disclosure;
6. To contact you with information about treatment, services, products or health care providers; and
7. For fundraising activities.

C. You have several rights regarding PHI about you:
1. To request restrictions on uses and disclosures of PHI about you.
2. To request different ways to communicate with you.
3. To see and copy PHI about you.
4. To request a change to PHI about you.
5. To a listing of disclosures we have made.
6. To a copy of this Notice.

D. You may file a complaint about our privacy practices.

E. Effective date of this Notice is April 14, 2003.







A. WE HAVE A LEGAL DUTY TO PROTECT HEALTH INFORMATION ABOUT YOU


We are required to protect the privacy of health information about you and that can be identified with you, which we call “protected health information,” or “PHI” for short. We must give you notice of our legal duties and privacy practices concerning PHI:

We must protect PHI that we have created or received about your past, present, or future health condition; health care we provide to you, or payment for your health care.

We must notify you about how we protect PHI about you (this notice).

We must explain how, when and why we use and/or disclose PHI about you.

We may only use and/or disclose PHI as we have described in this Notice.

This Notice describes the types of uses and disclosures that we may make and gives you some examples. In addition, we may make other uses and disclosures that occur as a byproduct of the permitted uses and disclosures described in this Notice.

We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice, and our privacy practices, and to make new notice provisions effective for all PHI that we maintain by first:

Posting the revised notice in our offices;

Making copies of the revised notice available upon request (either at our offices or through the Contact Person listed in this Notice); and

Posting the revised notice on our website.


B. WE MAY USE AND DISCLOSE PHI ABOUT YOU WITHOUT YOUR AUTHORIZATION IN THE FOLLOWING CIRCUMSTANCES


1. We may use and disclose PHI about you to provide, coordinate and manage health care treatment and related services to you.

We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others.

EXAMPLE: if you are referred to another doctor, that doctor will need to know why you are being referred. Similarly, your doctor may share PHI about you with a pharmacy when calling in a prescription.

2. We may use and disclose PHI about you to make coverage determinations and to obtain payment for services.

Generally, we may use and give your medical information to others to determine coverage, bill and collect payment for the treatment and services provided to you. Before you receive scheduled services, we may share information about these services with your health insurance plan(s). Sharing information allows us to ask for coverage under your insurance plan or policy and for approval of payment before we provide the services. We may also share portions of your medical information with the following:

Billing departments;

Collection departments or agencies;

Insurance companies, health plans and their agents which provide you coverage;

Hospital departments that review the care you received to check that it and the costs associated with it were appropriate for your illness or injury; and Consumer reporting agencies (e.g., credit bureaus).

EXAMPLE: If you have a slipped or ruptured disc we may need to give your health insurance plan(s) information about your condition, supplies used (such as cervical collar or back brace), and services you received (such as x-rays or surgery). The information is given to our billing department and your health insurance plan so we can be paid or you can be reimbursed.

3. We may use and disclose your PHI for health care operations.

We may use and disclose PHI in performing business activities, which we call “health care operations”. These “health care operations” allow us to improve the quality of care we provide and reduce health care costs. Examples of the way we may use or disclose PHI about you for “health care operations” include the following:

Reviewing and improving the quality, efficiency and cost of healthcare that we provide to our patients. For example, we may use PHI about you to develop ways to assist our health care providers and staff in deciding what medical treatment should be provided to others.

Improving health care and lowering costs for groups of people who have similar health problems and to help manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information, for instance, about treatment alternatives, classes, or new procedures.

Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.

Providing training programs for healthcare students, trainees, or practitioners to help them learn under supervision to practice or improve their skills as health care providers, or providing training of non-healthcare professionals (for example, billing clerks or assistants, etc.)

Cooperating with outside organizations that assess the quality of the care we provide. These organizations might include government agencies or accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations.

Cooperating with outside organizations that evaluate, certify or license health care providers, staff or facilities in a particular field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as having expertise in a specific field of nursing, such as oncology nursing.

Assisting various people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in complying with applicable laws.

4. We may use and disclose PHI under certain circumstances without your authorization.

We may use and/or disclose PHI about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:

When law requires the use and/or disclosure. For example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding (i.e., in response to a valid subpoena or court order) provided certain conditions are met.

When the use and/or disclosure is necessary for public health activities. For example, we may disclose PHI about you if you have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if authorized by law.

When reasonable belief exists that you may be a victim of abuse, neglect or domestic violence, we may be required to disclose/report information about abuse, neglect of domestic violence to public authorities authorized to receive such reports.

When the use and/or disclosure is for health oversight activities authorized by law. For example, we may disclose PHI about you to a state or federal health oversight agency (i.e., Centers for Medicare and Medicaid Services), which is authorized by law to oversee our operations.

When the disclosure is for law enforcement purposes. For example, we may disclose PHI about you in order to comply with laws that require the reporting of certain types of wounds or other physical injuries.

When the disclosure is for the identifying or locating a suspect, fugitive, material witness or missing person, or for disclosing PHI of a victim (or suspected victim) of a crime if the victim agrees or under emergency circumstances.

When the use and/or disclosure relates to decedents. For example, we may disclose PHI about you to a coroner or medical examiner for the purposes of identifying you should you die or determining the cause of your death.

When the use and/or disclosure to an organ procurement organization relates to cadaver organ, eye or tissue donation or transplantation purposes.

When the use and/or disclosure relates to medical research. Under certain circumstances, we may disclose PHI about you for medical research. For example, we may disclose information to researchers when their use and/or disclosure of your PHI in their research has been approved by an institutional review board or a privacy board that has reviewed the research protocol and established guidelines to ensure the privacy of your health information.

When the use and/or disclosure is, in good faith, to avert or lessen a serious and imminent threat to health or safety. For example, we may disclose PHI about you to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.


When the use and/or disclosure relates to specialized government functions. For example, we may disclose PHI about you if it relates to military activities, national security and intelligence activities and the provision, protective services for the President or foreign heads of state.

When the use and/or disclosure relates to correctional institutions and in other law enforcement custodial situations. For example, in certain circumstances, we may disclose PHI about you to a correctional institution or a law enforcement official having lawful custody of you.
ß When the disclosure is related to a workers’ compensation claim. For example, we may disclose PHI about you to the extent necessary to comply with State Workers’ Compensation laws.

5. We may use and disclose PHI about you for other purposes, unless you object to such use and disclosure.

Unless you object, we may use or disclose PHI about you in the following circumstances:

We may share your name, your room number, and your general condition in our patient listing with people who ask for you by name.

We may share with a family member, relative, friend or other person identified by you, PHI directly related to that person’s involvement in your care or payment for your care. We may share with a family member, personal representative or other person responsible for your care PHI necessary to notify, or assist in the notification of, such individual of your location, general condition, or death.

We may share with a public or private agency (for example, American Red Cross) PHI about you for disaster relief purposes. Even if you object, we may still share the PHI about you, if necessary for the emergency circumstances.

If you would like to object to our use or disclosure of PHI about you in the above circumstances, please call our contact person listed on the cover page of this Notice.

6. We may contact you with information about treatment, services, products or health care providers.

We may use and/or disclose PHI to manage or coordinate your healthcare. This may include telling you about treatments, services, products and/or other healthcare providers.

EXAMPLE: If you are diagnosed with a brain tumor, we may tell you about counseling services or support groups that may be of interest to you.

7. We may contact you for fundraising activities.

We may use and/or disclose certain limited PHI about you to a business associate or to an institutionally related foundation, to contact you to raise money for its own benefit. We may only release demographic contact information and the dates you received treatment or services at the medical practice.

** ANY OTHER USE OR DISCLOSURE OF PHI
ABOUT YOU REQUIRES YOUR WRITTEN AUTHORIZATION **

Under any circumstances other than those listed above, we will ask for your written authorization before we use or disclose PHI about you. If you sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing. If you cancel your authorization in writing, we will not disclose PHI about you after we receive your cancellation, except for disclosures, which were being processed before we received your cancellation.


C. YOU HAVE SEVERAL RIGHTS REGARDING PHI ABOUT YOU


1. You have the right to request restrictions on uses and disclosures of PHI about you.

You have the right to request that we restrict the use and disclosure of PHI about you to carry out treatment, payment or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. Your request must be in writing. We are not required to agree to your requested restrictions. However, even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services, and uses and disclosures described in subsection 4 of the previous section of this Notice. You may obtain a form to request a restriction by contacting the person listed on the cover page of this Notice.

2. You have the right to request different ways to communicate with you.

You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests, but, when appropriate, may condition that accommodation on your providing us with information such as how payment, if any, will be handled. You may request confidentiality in our communications to you by contacting the person listed on the cover page of this Notice.

3. You have the right to access and copy PHI about you.

You have the right to request access and receive a copy of PHI contained in clinical, billing and other records used to make decisions about you. Your request must be in writing. In some instances (i.e., multiple requests in a 12 month period), we may charge you a reasonable fee for copying your records. The requested information will be provided to you within 30 days (60 days if the information is maintained offsite). We may obtain a single 30-day extension to do so if we provide you with a written statement advising you of the reason for the delay and when the information will be provided to you. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial and a description of how you may complain to the Secretary of the U. S. Department of Health and Human Services. You may obtain a form to request access to and receive a copy of PHI by contacting the Office Manager where you are being seen.

4. You have the right to request a change of PHI about you.

You have the right to request that we make changes to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the change. We have 60 days to act on your request. We may obtain a single 30-day extension to do so, if we provide you with a written statement advising you of the reason for the delay and when the information will be provided to you. We may deny your request if: 1) the information was not created by us (unless you prove the creator of the information is no longer available to change the record); 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct and complete; or 4) you would not have the right to see and copy the record as described in Section C item 3 above. We will tell you in writing the reasons for the denial, in whole or in part, of your request and describe your rights to give us a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI. If we accept your request to change the information, we will make reasonable efforts to inform others of the change, including persons you name who have received PHI about you and who need the change. You may obtain a form to request a change in your PHI by contacting the person listed on the cover page of this Notice or the Office Manager where you are being seen.

5. You have the right to a listing of disclosures we have made.

You have the right to receive a written list of certain of our disclosures of PHI about you. The request must be in writing. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures except the following:

For your treatment; For billing and collection of payment for your treatment; For our health care operations; Made to or requested by you, or that you authorized, about you; Occurring as a byproduct of permitted uses and disclosures about you; Made to individuals involved in your care, for directory or notification purposes, or for other purposes (please see Section B item 5 above); Allowed by law when the use and/or disclosure relates to certain specialized government functions or relates to correctional institutions and in other law enforcement custodial situations (please see Section B item 4 above); and NotiAs part of a limited set of information (de-identified) which does not contain certain information which would identify you.

The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the PHI, a brief description of the PHI information disclosed, and the purpose of the disclosure. If, under permitted circumstances, PHI about you has been disclosed for certain types of research projects, the list may include different types of information.

We have 60 days to act on your request. We may obtain a single 30-day extension to do so if we provide you with a written statement of the reason for the delay and when the information will be provided to you. If you request a list of disclosures more than once in 12 months, we can charge you a reasonable fee for each subsequent listing of disclosures. You may obtain a form to request a listing of disclosures by contacting the Office Manager where you are being seen.

6. You have the right to a copy of this Notice.

You have the right to request a paper copy of this Notice at any time by contacting the staff at the location where you are being seen.


D. YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES


If you think we have violated your privacy rights, or you want to complain to us about our privacy practices, you can contact the person listed on the cover page of this Notice to obtain a form to file your complaint.

You may also send a written complaint to the United States Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C., 20201.

If you file a complaint, we will not take any action against you or change our treatment of you in any way.


E. EFFECTIVE DATE OF THIS NOTICE

This Notice of Privacy Practices is effective on April 14, 2003.

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