This notice describes how health information about you may be used and disclosed and how you can get access to this information.

PLEASE REVIEW THIS INFORMATION CAREFULLY. The privacy of your health information is important.

LEGAL DUTY

We are required by federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect April 14, 2003 and will remain in effect until we replace it.

You may request a copy of our Privacy Practice Notice at any time. For more information or additional copies of this Notice, please contact us at the telephone number listed in the Company Information section at the top of this Notice. If and when permitted by applicable, we have the right to change our privacy practices; if we do so, we will notify you in writing of these changes.

USE AND DISCLOSURES OF HEALTH INFORMATION

We are permitted, by law, to use and disclose health information about you for reasons concerning treatment, payment and healthcare operations. Examples:

Treatment: We may disclose your health information to a physician or other healthcare provider that is providing treatment or other health services to you.

Payment: We may use and disclose your health information to obtain payment for services that we provide you.

Operations: We may use and disclose your health information in connection with our healthcare operations, which include administration and planning and other tasks that help us improve that quality.

Family and Friends: We may disclose your health information to a family member, relative or a friend that has been identified by you while you are present. If you are not present, professional judgment will be utilized to determine whether a disclosure is required or in your best interest. We will only disclose information that is believed to be relevant to the person's involvement with your health care or payment related to your health care. We may also disclose your health information in order to notify such persons of your location, general condition or death.

Requirements of the Law: We may use or disclose your health information when we are required to do so by Law.

Victim of Abuse or Neglect: We may disclose your health information to authorities if reasonable belief is that you are a possible victim of abuse, neglect or domestic violence. We may disclose information to the extent necessary to avert additional serious threat to your health or safety or the health or safety of others.

Public Health Activities: We may disclose your health information to public health authorities for the purpose of preventing or controlling disease or preventing injury; to alert a person who may have been exposed to a communicable disease; to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; to report information to a health oversight agency that is responsible for ensuring compliance with governmental rules and regulations, such as Medicare and Medicaid.

National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counter intelligence and other national security activities.

Appointment Reminders: We may contact you to provide you with appointment reminders, such as voice messages; including essential information such as time, location and the name of the company/provider.

Worker's Compensation: We may use or disclose your health information to the extent necessary to comply with state laws relating to workers' compensation.

Disclosures Requiring your Authorization: For any reasons other than those listed in this notice, we may only use or disclose your health information with your written authorization. Your authorization must also be obtained prior to using your health information for any marketing activity.

YOUR RIGHTS TO YOUR PERSONAL HEALTH INFORMATION

Access to Record: You may have access to your health information, with limited exceptions. Request must be made in writing, utilizing our Record Access Request Form. We may charge a reasonable fee to compensate for time and materials.

Revocation of your Authorization: You may revoke your authorization to disclose your health information at any time. Request must be made in writing, using our Authorization Revocation form.

Restriction of Information: You may request that we place restrictions on our use or disclosure of your health information. You must make your request in writing by sending a letter that specifies the type of information to be restricted and to whom the information is to be restricted from. Requests should be sent directly to the address listed in the heading of this Notice. We will consider all requests; however are not required to agree to the request. We will respond to all such requests in writing.

Disclosure Accounting: You may request a list of instances in which we (or our business associates) Disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. You must make your request in writing by sending us a letter that specifies the type of information and the time period involved. Requests should be sent directly to the address listed in the heading of this Notice. If you request this information more than once in a 12-month period, we may charge you a reasonable fee to compensate for our time and materials.

Alternative Communication: You may request that we communicate with you about your health information by alternative means or to an alternative location. You must make your request in writing by sending a letter that specifies the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative means or location you have requested. Requests should be sent directly to the address listed in the header of this Notice.

Amendment: You have the right to request that we amend your health information. You must make your request in writing by sending us a letter that explains why the information should be amended.
Requests should be sent directly to the address listed in the header of this Notice. We will comply to your request unless we believe that the information to be amended is accurate and complete.

Right to Receive Paper Copy of this Notice: Upon request, you may obtain a paper copy of this notice.

QUESTIONS OR COMPLAINTS

If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we have made about a request for access to your health information, a request you have made to amend or restrict the use or disclosure of your health information or a request you have made for us to communicate with you by alternative means or locations, you may complain to us using the contact information listed in the header of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to the U.S. Department of Health and Human Services upon request. 1-800-HHS-TIPS or ACHC Customer Service 8 am to 5pm EST 919-785-1214.

If you have any questions, concerns or complaints about this Notice, please contact us 800-408-1480.

PRIVACY AND YOUR HEALTH INFORMATION

Your Privacy Is Important to All of Us.

Most of us feel that our health and medical information is private and should be protected, and we want to know who has this information.

Now, Federal law:

  • Gives you rights over your health information
  • Sets rules and limits on who can look at and receive your health information

The Law Gives You Rights Over Your Health Information Providers and health insurers who are required to follow this law must comply with your right to:

  • Ask to see and get a copy of your health records
  • Have corrections added to your health information
  • Receive a notice that tells you how your health information may be used and shared
  • Decide if you want to give your permission before your health information can be used or shared for certain purposes, such as for marketing
  • Get a report on when and why your health information was shared for certain purposes
  • If you believe your rights are being denied or your health information isn't being protected, you can:
    - File a complaint with your provider or health insurer
    - File a complaint with the U.S. Government

You should get to know these important rights, which help you protect your health information. You can ask your provider or health insurer questions about your rights. You also can learn more about your rights, including how to file a complaint, from the website at www.hhs.gov/ocr/hipaa/

Your Health Information Is Protected By Federal Law. Who must follow this law?

  • Most doctors, nurses, pharmacies, hospitals, clinics, nursing homes, and many other health care providers
  • Health insurance companies, HMOs, most employer group health plans
  • Certain government programs that pay for health care, such as Medicare and Medicaid

What information is protected?

  • Information your doctors, nurses, and other health care providers put in your medical record
  • Conversations your doctor has about your care or treatment with nurses and others
  • Information about you in your health insurer's computer system
  • Billing information about you at your clinic
  • Most other health information about you held by those who must follow this law

PRIVACY

The Law Sets Rules and Limits on Who Can Look At and Receive Your Information.
To make sure that your information is protected in a way that does not interfere with your health care, our information can be used and shared:

  • For your treatment and care coordination
  • To pay doctors and hospitals for your health care and help run their businesses
  • With your family, relatives, friends or others you identify who are involved with your health care or your health care bills, unless you object
  • To make sure doctors give good care and nursing homes are clean and safe
  • To protect the public's health, such as by reporting when the flu is in your area
  • To make required reports to the police, such as reporting gunshot wounds

Your health information cannot be used or shared without your written permission unless this law allows it. For example, without your authorization, your provider generally cannot:

  • Give your information to your employer
  • Use or share your information for marketing or advertising purposes
  • Share private notes about your mental health counseling sessions

The Law Protects the Privacy of Your Health Information Providers and health insurers who are required to follow this law must keep your information private by:

  • Teaching the people who work for them how your information may and may not be used and shared
  • Taking appropriate and reasonable steps to keep your health information secure

For More Information

This is a brief summary of your rights and protections under the federal health information privacy law. You can learn more about health information privacy and your rights in a fact sheet called "Your Health Information Privacy Rights." You can get this from the website at www.hhs.gov/ocr/hipaa/

Other privacy rights

Another law provides additional privacy protections to patients of alcohol and drug treatment programs. For more information, go to the website at www.samhsa.gov.