Transcription
Notice ofprivacy practices
This Notice describes how medical informationabout you may be used and disclosed andhow you can get access to this information.Please review it carefully.Our staff are committed to protecting your health information, which is aright you have and one detailed in the federal Health Insurance Portabilityand Accountability Act (HIPAA) of 1996.Effective: April 2003Revised: June 2022If you have any questions or requests, please contact the Novant Health privacyofficial at 704-384-9829 or P.O. Box 33549, Charlotte, NC 28233-3549.
We must protect healthinformation about youWe must protect the privacy of healthinformation about you that can identify you, alsocalled protected health information or “PHI” forshort. PHI includes information about your past,present or future health, the healthcare weprovide to you and payment for your healthcare.This Notice explains Novant Health’s legal dutieswith respect to PHI and how we can use anddisclose PHI about you. In addition, we can makeother uses and disclosures that occur as abyproduct of the uses and disclosures described inthis Notice, and may include information aboutyour race, ethnicity, language, gender identity,sexual orientation, and social risks and needs. ThisNotice also explains your privacy rights, and howyou can file a complaint if you believe those rightshave been violated. In the event that PHI aboutyou is affected by a breach of unsecured PHI,Novant Health will provide notice as required byHIPAA.How we can use anddisclose PHI about you1. When we can use and disclose PHI aboutyou without an authorization. We may useand disclose PHI about you without yourauthorization in the following ways:a. To provide healthcare treatment to you.We use and share PHI with others to provideand coordinate your healthcare treatment. Forexample, a doctor treating you for a broken legmay need to know if you have diabetes becausediabetes may slow the healing process. Differentdepartments may also need your PHI so you canget your medicine, lab work, meals and X-rays.We may also share health information aboutyou with people like home health providers orothers who may be involved in your medicalcare after you leave our care. We may makehealth information about you available to otherhealthcare providers who ask for it throughthe Care Everywhere function of our electronichealth record system, the North CarolinaHealthConnex, or through health informationexchanges. You may ask that your healthinformation not be made available through CareEverywhere or other health informationexchanges that enable other providers to accessyour medical information, as provided in the“Your Privacy Rights” section.b. To obtain payment for services. We use andshare PHI with others (for example, insurancecompanies, health plans, collection agencies,and consumer reporting agencies) to bill andcollect payment for services we provided to you.Before we provide scheduled services to you, wemay share information with your health plan toask whether it will pay for the services or withgovernment agencies to see if you qualify forbenefits. We may also share health informationwith hospital departments that review care to seeif the care and the costs were appropriate. Forexample, if you have a broken leg, we may needto give our billing department and your healthplan information about your condition, thesupplies used (such as plaster for yourcast or crutches), and the services you received(such as X-rays or surgery) so we can be paidor you can be reimbursed.c. For healthcare operations. We may use andshare PHI to perform business activities that wecall “healthcare operations” to help us improvethe quality of care we provide and reducehealthcare costs. For example, we may usePHI to review our services or evaluate theperformance of the people taking care of you.We may share PHI with governmental agencies,so they can review the care we provide. We alsomay share PHI with doctors, nurses, medicaland nursing students, and other personnel (likebilling clerks or assistants) for training purposes.d. To raise money for our organization.We may use and/or disclose PHI about you,including disclosure to a foundation, to contactyou to raise money. Unless you provide anauthorization, we will only share your name,address, telephone number, the dates youreceived treatment or services, the namesof the treating physicians, the outcome andhealth insurance status. If you do not wantto be contacted in this way, you may notifyNovant Health at either 704-384-9829or FdnDataResearch@novanthealth.org.Please provide your full name and address.e. To remind you about appointments. Wemay use and/or disclose PHI to remind youabout an appointment you have with us.f. To tell you about treatment options. Wemay use and/or disclose PHI to tell you abouttreatment options that may interest you. Wemay also use and/or disclose PHI to give yougifts of a small value. For example, if you havediabetes, we may tell you about nutritionalservices that might help you.g. To our business associates. We providesome services through other businesses wecall business associates. We may give businessassociates health information about you sothey can do the job we asked them to perform forus. For example, we might use a copy service tomake copies of requested medical records. Whenwe do this, we require the business associate tosafeguard health information about you.
2. When we may use and disclose PHIabout you without an authorization oran opportunity to object. In somesituations, we may use and/or disclose PHIabout you without your authorization or anopportunity to object. These situations includewhen the use or disclosure is:a. When it is required by law.b. For public health activities. We may disclosePHI about you for public health activities.These activities generally include disclosingPHI in order to:- Prevent or control disease, injury or disability- Report births and deaths- Report child and disabled adult abuse or neglect- Report reactions to medicine or problems withmedical products- Tell people that a medical product theyare using has been recalled- Support public health surveillance andcombat bioterrorismc. For health oversight activities. We may disclosePHI about you to a state or federal healthoversight agency that is authorizedby law to oversee our operations.d. For a legal proceeding. We may disclose PHI ina legal proceeding as required by a court orderor otherwise by law.e. For law enforcement purposes. We maydisclose PHI about you to report certain typesof wounds, physical injuries or criminal conducton our property.f. To a medical examiner or funeral director.We may disclose PHI about you to a coroneror medical examiner to identify you ordetermine cause of death. We may alsorelease PHI to funeral directors so theycan carry out their duties.g. For organ, eye or tissue donation purposes.h. For medical research. Research done in NovantHealth must go through a special reviewprocess. We will not use or disclose PHI aboutyou unless we have your authorization or wehave determined that your privacy is protected.i. To avoid a serious threat to health or safety.We may disclose health information if it isnecessary to protect the health and safetyof you, the public or someone else.j. For specialized government functions.We may disclose PHI about you for militaryand veterans’ activities, national security andintelligence activities, protective services for thePresident, or medical suitability/determinationsof the Department of State.k. For law enforcement custodial situations.We may disclose PHI about you to acorrectional institution that has custody of you.3. When you can object to a use ordisclosure. Unless you tell us not to, we mayuse or share your PHI:a. To include you in the hospital directory. Ourhospitals include limited information about youin patient directories. We may share your name,room number and condition (fair, stable, etc.)with people who ask for you by name. We alsomay share your religious affiliation with religiousleaders of your faith. If you do not want yourinformation included in the directory, pleasetell registration when you arrive. If you ask notto be included in the patient directory, you will notget any cards or flowers that are sent to the hospitalfor you. Also, we will not tell callers or visitors thatyou are here.b. To people involved in your care or payment forcare. We may share PHI with family membersor others identified by you, who are involved inyour care or payment for your care. We, also,may tell your family and friends about yourcondition. In an emergency, or if you are unableto make decisions for yourself, we will use ourprofessional judgment to decide if it is in yourbest interest to share your PHI with a personinvolved in your care. If you bring familymembers or others to your appointments or forunscheduled care, and do not tell us that youobject to them hearing your PHI, then we areallowed to interpret that as your consent for usto do so.c. To agencies for disaster relief efforts.We may share PHI with agencies like the RedCross for disaster relief efforts. Even if you askus not to, we may share your PHI if we need tofor an emergency.Other lawsIn some cases, other laws require us to give moreprotection to your health information than HIPAAdoes. Even if one of these special rules applies toyour health information, we may still be requiredto report certain things and we will follow theselaws. For example, we are required to reportsuspected cases of child or disabled adult abuseor neglect, and we may share the informationlisted below when we make the report. If you have a communicable disease liketuberculosis, syphilis or HIV/AIDS, we generallywill not share that information unless we haveyour written permission. But, we do not needyour permission to report information aboutyour disease to state and local health officialsor to prevent the spread of the disease.
If you are treated for a mental health condition,a developmental disability or substance abuse,state law generally requires us to get yourwritten consent before we disclose thatinformation. There are some exceptions to thisrule. For example, we may disclose informationif you need a guardian or involuntarycommitment. We also may disclose informationto: (1) a healthcare provider who is treating youin an emergency; (2) a healthcare provider whoreferred you to us, if they ask; and (3) to othermental health, developmental disabilities, andsubstance abuse facilities or professionals whennecessary to coordinate your care or treatment.We may also share information with othercovered entities, such as a pharmacy, orbusinesses associates, such as a softwarevendor, unless you object in writing. Afternotification to you, we are required to tell afamily member or other person substantiallyinvolved in your care that you were admitted to,transferred from, left or discharged from, abehavioral health unit. Under a special federallaw, if you apply for or receive substance abuseservices from us, we generally have to get yourwritten permission before we share informationthat identifies you as a substance abuser or apatient receiving substance abuse services.There are some exceptions to this rule. We mayshare information with medical workers in anemergency. If you commit a crime, or threatento commit a crime, on our property or againstour workers, we may report that to the police. Our pharmacy will only release a copy of yourprescription orders to certain people. Some ofthese people include: (1) you; (2) the providerwho wrote the prescription or who is treatingyou; (3) a pharmacist who is providingpharmacy services to you; (4) a companyresponsible for providing, or paying, for yourmedical care; (5) members and certainemployees of the Board of Pharmacy; and (6)researchers who have been approved by theBoard of Pharmacy, if there are certainprotections in place to keep the informationconfidential. If you are under the age of 18 and are notemancipated, we will not reveal any informationabout treatment that you consented to receivefor pregnancy, venereal disease and othercommunicable diseases, drug or alcohol abuse,or emotional disturbance, without yourpermission. But, we are allowed to reveal thisinformation if: (1) your doctor thinks yourparents need to know because there is a seriousthreat to your life or health, or (2) your parentsor guardian ask your doctor about thetreatment, and your doctor believes that sharingthe information is in your best interest.Other uses and disclosures1. Use of psychotherapy notes, use of PHIfor marketing and sale of PHI. Except asprovided in Section 164.508(a)(2) of HIPAA, yourauthorization is required for use or disclosureof psychotherapy notes about you. Except asprovided in Section 164.508(a)(3), yourauthorization is required for use or disclosureof PHI about you for marketing. Your authorizationis required for a disclosure which is a sale of PHIabout you under Section 164.508(a)(4).2. Other uses and disclosures. In any situationother than those listed above, we may ask for yourwritten authorization before we use or discloseyour PHI. If you sign a written authorizationallowing us to disclose PHI, you can cancel it later.Your cancellation must be in writing and deliveredto the Privacy Official at the address providedbelow, and we will not disclose PHI about youpreviously authorized, after we receive yourcancellation and had a reasonable time toimplement the cancellation.Your privacy rightsYou have the following rights about the healthinformation we maintain about you. If you wantto exercise your rights, you must fill out a specialform. Please contact the Novant Health privacyofficial at 704-384-9829 or at P.O. Box 33549,Charlotte, NC 28233-3549 for the form ormore information.1. Right to ask for restrictions. You havethe right to ask us to limit the ways we use anddisclose your PHI for treatment, payment orhealthcare operations. You also have the rightto ask us to limit the health information we shareabout you to someone involved in your care or thepayment for your care. Your request must be inwriting. We do not have to agree to your requestin most cases. But, we do have to agree if you askus not to disclose PHI to your health plan forpayment of healthcare operations, or for ourhealthcare operations if the PHI is about an itemor service you paid for, in full, out-of-pocket , anddisclosure is not otherwise required by law. Even ifwe agree, your restrictions may not be followed insome situations such as emergencies or whendisclosure is required by law.
2. Right to ask for different ways tocommunicate with you. You have theright to ask us to contact you in a certain wayor at a certain location. For example, you canask us to only contact you at your work phonenumber. If your request is reasonable, we will dowhat you ask. In some situations, we mayrequire you to explain how you will handlepayment and give us another way to reachyou.3. Right to see and copy PHI. You havethe right to see and get a copy of the healthinformation about you. You must sign a writtenrequest for access or an authorization. We maycharge you a fee if you have asked for a copyof records. We can deny your request in somesituations. If we deny your request, we will notifyyou in writing and explain how you can ask fora review of the denial.4. Right to ask for changes. You have the rightto ask us to change PHI about you if you do notbelieve it is correct or complete. You must ask usin writing. You must explain why you want thechange. We can deny your request in somesituations. If we deny your request, we will explainwhy in writing and tell you how to give us a writtenstatement disagreeing with our decision.5. Right to ask for an accounting ofdisclosures. If you ask in writing, you can get a listof some, but not all, of the disclosures we made ofyour health information. For example, the list willnot include disclosures made for treatment,payment, healthcare operations or disclosures youspecifically authorized. You may ask fordisclosures made in the last six (6) years. Wecannot give you a list of any disclosures madebefore April 14, 2003. If you ask for a list ofdisclosures more than once in 12 months, we cancharge you a reasonable fee.6. Right to a paper copy of this Notice.We will give you a paper copy of this Noticeon the first day we treat you at our facility (in anemergency, we will give this Notice to you as soonas possible). You can also get a copy of this Noticefrom our website NovantHealth.org.7. Availability of electronic medical recordoutside of Novant Health. Some medicalrecords at Novant Health are maintained within anelectronic medical record system that can allowother unaffiliated healthcare providers to view yourrecords through a health information exchange.Novant Health may make certain information aboutyou available through the North CarolinaHealthConnex, which is a health informationexchange operated by the state of North Carolina.You can opt out of allowing your health informationfrom being available through the North CarolinaHealthConnex by either going to this website https://hiea.nc.gov/patients, or calling919-754-6912.If you are a patient of Novant Health New HanoverRegional Medical Center, you may opt out of allowingyour health information from being available throughan HIE by contacting the Health InformationManagement Department at 910-667-7109 or bycalling the Novant Health Privacy Office at 704-3849829.If you do not want your electronic medical record tobe available to non-Novant Health providersthrough CareEverywhere or other healthinformation exchanges, you may request to opt outby contacting a Novant Health clinic administratoror the medical records department, and requestingto “opt out of Care Everywhere.” Participation in anelectronic health information exchange also lets ussee other providers’ information about you for ourtreatment purposes. Opting out of CareEverywhereat Novant Health will not prevent Novant Healthfrom retrieving information about you from otherhealth care systems. If you do not want thosehealth care systems to share your information, youwill need to contact them directly. If you choose notto allow your electronic medical record to beavailable through Care Everywhere or anotherhealth information exchange, another provider whois involved in your care may not be able to retrieveyour full medical history electronically.You may file a complaintabout our privacy practicesIf you think we have violated your privacy rights,or you want to complain to us about our privacypractices, you can contact the Novant Healthprivacy official at 704-384-9829 or P.O. Box33549, Charlotte, NC 28233-3549. You alsomay write to the United States Secretary of theDepartment of Health and Human Services. If youfile a complaint, we will not take any action againstyou or change our treatment of you in any way.This Notice of Privacy Practices applies only tocare and treatment you receive at this facility orother Novant Health facilities and practices inNorth Carolina that are treated as an “affiliatedcovered entity” under the federal law knownas the Health Insurance Portability andAccountability Act (HIPAA) that protects theprivacy of your health information, and arereferred to as the Novant Health AffiliatedCovered Entities. Terms defined in the HIPAAregulations will have the same meaning in thisNotice. This Notice also applies to all the peoplewho provide healthcare services at a NovantHealth facility in North Carolina, evenif they are not our employees or agents. These
people provide care along with us as part of an“organized healthcare arrangement.” All of thesehealthcare providers are referred to as “we” inthis Notice. If you would like a listing of theNovant Health facilities and practices covered bythis Notice, please contact the Novant Healthprivacy official at 704-384-9829 or P.O. Box33549, Charlotte, NC 28233-3549.
Notice of NondiscriminationNovant Health complies with applicable Federal civil rights laws and does not discriminate on thebasisof race, color, national origin, age, disability, or sex. Novant Health does not exclude people or treatthem differently because of race, color, national origin, age, disability, or sex.Novant Health: Provides free aids and services to people with disabilities to communicate effectively withus, such as:o Qualified sign language interpreterso Written information in other formats (large print, audio, accessible electronicformats, other formats) Provides free language services to people whose primary language is not English, such as:o Qualified interpreterso Information written in other languagesIf you need these services, please contact Novant Health Interpreter Servicesat 1-855-526.4411, then select option 3. TDD/TTY: 1-800-735-8262.If you believe that Novant Health has not provided these services or discriminated in another way onthe basis of race, color, national origin, age, disability, or sex, you can file a grievance with:Patient Services DepartmentAttn: Section 1557 Coordinator200 Hawthorne LaneCharlotte, NC 28204Telephone: 1-888-648-7999TDD/TTY: ntact-us.aspxYou may file a grievance by mail, in person at the Novant Health facility where care was provided, orby submitting the form at the link above. If you need help filing a grievance, call 1-888-648.7999 orTDD/TTY 1-800-735-8262.You may also file a civil rights complaint with the U.S. Department of Health and Human Services,Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 202011-800-368-1019, 800-537-7697 (TDD)Complaint forms are available at NTION: Language assistance services, free of charge, are available to you. Call 1-855-5264411. Select option 3. TDD/TTY: 1-800-735-8262.
Español (Spanish) 㧓 ᩥᩥ (Chinese)TiӃng ViӋt (Vietnamese)ଞ ߭ (Korean)Français (French)Δϴ Αήό ϟ (Arabic)Ɋɭссɤɢɣ (Russian)Tagalog (Tagalog –Filipino)̶γ έΎ ϓ (Farsi)λ 0’ (Amharic)Deutsch (German)ϭΩέ (Urdu)lhUm (Hindi)ȤK hSj (Gujarati)ATENCIÓN: Los servicios de asistencia lingüísticos, gratuitos,están disponibles para usted. Llame al 1-855-526-4411. Seleccionela opción 3. TDD/TTY: 1-800-735-8262.㲐シ烉 ぐ ẍṓ 屣䘬婆妨 㚵 ˤ婳㑍ㇻ 1-855-526-4411ˤ怠㑯怠枭 3ˤTDD/TTY烉1-800-735-8262ˤCHÚ Ý: Có các dҷch vӅ hҽ trӄ ngôn ngӋ miҴn phí dành cho quý vҷ. Gọi 1855-526-4411. Chọn tùy chọn 3. TDD/TTY: 1-800-735-8262.㭒㦮: ⶊ 㠎㠊 㰖㤦 ゚㓺 㧊㣿䞮㔺 㑮 㧞㔋 . 1-855-5264411 㦒 㩚䢪䞮㕃㔲㡺. 㢋 3㦚 䌳䞮㕃㔲㡺. TDD/TTY: 1-800735-8262.IMPORTANT : Des services dʼassistance linguistique gratuits sont àvotre disposition. Appelez le 1 855 526 4411. Sélectionnezlʼoption 3. Dispositif de télécommunication pour sourds etmalentendants : 1 800 735 8262.1-855-526-4411 ϡϗέϟ ϰϠϋ ϝλΗ .ϙϟ ΔΣΎΗϣ ΔϳϧΎΟϣϟ ΔϳϭϐϠϟ ΓΩϋΎγϣϟ ΕΎϣΩΧ :ΔυΣϼϣ.1-800-735-8262 :ϲλϧϟ ϑΗΎϬϟ /ϲΑΎΗϛϟ ϝΎλΗϻ ίΎϬΟ .3 έΎϳΧϟ έΗΧ ʦʻʰʺʤʻʰʫ: ʪ̣́ ̭̌̏ ̨̭̯̱̪̦̔̌ ̭̯̱̪̦̖̭̪̣̌́̍ ̣̭ ̐̌ ̨̨̣́̏̔.̔ ʿ̨̨̯̱̪̦̏ ̨ ̣ ̨̯̱̪̦ 1-855-526-4411. ʦ̯̱̪̦ ̖̭̪̣̯̱̪̦̍ ̏̌ 3. ̡̨̨̖̭̯̼̜̯̱̪̦̭̏̏ ̣ ̨̯̱̪̦/̯̱̪̦̣ ̌: 1-800-735-8262.̯̱̪̦ATENSYON: May mga libreng serbisyo ng tulong sa wika na available saiyo. Tumawag sa 1-855-526-4411. Piliin ang opsyon 3. TDD/TTY: 1-800735-8262.ϩέΎϤη ΎΑ .Ωέ Ω έ ήϗ ϥΎΗέΎϴΘΧ έΩ ϥΎ̴ϳ έ έϮρ ϪΑ ϪϤΟήΗ ΕΎϣΪΧ :ϪΟϮΗ 1-855-526-4411ϪϨϳΰ̳ .Ϊϧήϴ̴Α αΎϤΗ3 .ΪϴϨ̯ ΏΎΨΘϧ έ TDD/TTY :1-800-735-8262ሳΩLF ÕL2L 20ßn λô ù eE [‡ 9 Fô’ ł [ 1-855-526-4411 SF FÜø łλ % 32 F cጡł TDD/TTY 1-800-735-8262.HINWEIS: Es stehen Ihnen kostenlose Sprachassistenzdienste zurVerfügung. Wählen Sie 1 855 526 4411. Wählen Sie Option 3 aus.TDD/TTY: 1 800 735 8262.1-855-526- ؐل ϴ٫ ΏΎϴΘγΩ Ζϔϣ ˬΕΎϣΪΧ ̶̯ ΖϧΎϋ ϖϠόΘϣ ف γ ϥΎΑί ف ϴϟ ̟ ̯ف : ؟ ΟϮΗ ف ήΑ ل 1-800-735-8262 :TDD/TTY ؐل ϴϨ̩ 3 έΎϴΘΧ ؐل ϳή̯ ϥϮϓ ή̡ 4411Ú Y“ दɅ : ]” f› f f“ :ž ǐ —YŸ Y हYY YfȲ 7” › ÞS ह lɇ 1-855-526-4411ो Ȩ› š Ʌl f ǐ” 3 Ч “ Ʌl TDD/TTY: 1-800-735-8262.dhaVhW: S\h h \hN [hch deh] dpahB, iaWh Ⱥƣ],p ;X ƞV Jp . 1-855526-4411 X Dr D s. iaDƣX 3 X d U5 D s. TDD/TTY: 1-800-735-8262.ćĘĂđĘĈđñ ĒĀĂ: WăĂđĉ öĂƟ ĒąĂđćĘĊƟ ĆđČđ čĎđĠωđ ăĒĉĘČąđ ĊĆƟ WĘõl 1-855ČĘèđĘ (Bengali)526-4411 Ă Ęĉ ĺĄđĂ ï Ăl Ēąïɤ 3 ĒĂąŪđôĂ ï Ăl TDD/TTY: 1-800-7358262l Novant Health, Inc. 20165/18 Item #83531
g. To our business associates. We provide some services through other businesses we call business associates. We may give business associates health information about you so they can do the job we asked them to perform for us. For example, we might use a copy service to make copies of requested medical records. When
