Hipaa Notice Of Privacy Practices Form - North Carolina

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HIPAA Notice of Privacy Practices
First Choice Community Health Centers
Harnett County
40 Autumn Fern Trail
Lillington, NC 27546
(910) 364-0970
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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out
treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also
describes your rights to access and control your protected health information. “Protected health information” is information
about you, including demographic information, that may identify you and that relates to your past, present or future physical or
mental health or condition and related health care services. We are required to provide this notice to you by the Health
Insurance Portability and Accountability Act (“HIPAA”).
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our
office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health
care bills, to support the operation of the physician’s practice, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate or manage your health care and
any related services. This includes the coordination or management of your health care with a third party. For example, we
would disclose your protected health information, as necessary, to a home health agency that provides care to you. For
example, your protected health information may be provided to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For
example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the
health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as-needed, your health information in order to support the business activities
of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review
activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we
may disclose your protected health information to medical school students that see patients at our office. In addition, we may
use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may
also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected
health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third-party “business associates” who perform various activities (for
example, Billing, transcription services) for any health plan. The business associates will also be required to protect your
health information.
We may use or disclose your protected health information in the following situations without your authorization. These
situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight:
Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral
Directors, and Organ Donation: Research: Criminal Activity: Military Activity an National Security: Workers’ Compensation:
Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary
First Choice Community Health Centers, Inc.
Corporate Compliance Program

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