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 a right youhave and one detailed in the federal Health Insurance Portability and AccountabilityAct (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.
A We must protect healthinformation about youWe must protect the privacy of health informationabout you that can identify you, also calledprotected health information or “PHI” for short.PHI includes information about your past, presentor future health, the healthcare we provide to you,and payment for your healthcare. This Noticeexplains Novant Health’s legal duties with respectto PHI and how we can use and disclose PHI aboutyou. In addition, we can make other uses anddisclosures that occur as a byproduct of the usesand disclosures described in this Notice, and mayinclude information about your race, ethnicity,language, gender identity, sexual orientation, andsocial risks and needs. This Notice also explainsyour privacy rights, and how you can file acomplaint if you believe those rights have beenviolated. In the event that PHI about you isaffected by a breach of unsecured PHI, NovantHealth will provide notice asrequired by HIPAA.B How we can use anddisclose PHI about you1. When we can use and disclose PHIabout you without an authorization. Wemay use and disclose PHI about you withoutyour authorization 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 about youwith people like home health providers or otherswho may be involved in your medical care afteryou leave our care. We may make healthinformation about you available to otherhealthcare providers who ask for it throughthe Care Everywhere function of our electronicmedical record system or through healthinformation exchanges. You may ask that yourhealth information not be made available throughCare Everywhere or other health informationexchanges that enable other providers to accessyour medical information as provided in the“Your Privacy Rights” section below.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 toyou. Before we provide scheduled services toyou, we may share information with yourhealth plan to ask whether it will pay for theservices or with government agencies to see ifyou qualify for benefits. We may also sharehealth information with hospital departmentsthat review care to see if the care and the costswere appropriate. For example, if you have abroken leg, we may need to give our billingdepartment and your health plan informationabout your condition, the supplies used (suchas plaster for your cast or crutches), and theservices you received (such as X-rays orsurgery) so we can be paid or you can bereimbursed.c. For healthcare operations. We may use andshare PHI to perform business activities thatwe call “healthcare operations” to help usimprove the quality of care we provide andreduce healthcare costs. For example, we mayuse PHI 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 want tobe contacted in this way, you may notifyNovant Health at either 704-384-9829 orFdnDataResearch@novanthealth.org. Pleaseprovide your full name and address.e. To remind you about appointments. We mayuse and/or disclose PHI to remind you about anappointment 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 provide someservices through other businesses we callbusiness 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 or anopportunity to object. In some situations,we may use and/or disclose PHI about youwithout your authorization or an opportunityto object. These situations include when theuse 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 problemswith medical products- Tell people that a medical productthey are using has been recalled- Support public health surveillanceand combat bioterrorismc. For health oversight activities. We may disclosePHI about you to a state or federal healthoversight agency that is authorized by law tooversee our operations.d. For a legal proceeding. We may disclosePHI in a legal proceeding required by a courtorder or otherwise required by law.e. For law enforcement purposes. We maydisclose PHI in a legal proceeding required bya court order or otherwise required by law.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 inNovant Health 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 or disclosure.Unless you tell us not to, we may use or shareyour PHI:a. To include you in the hospital directory. Ourhospitals include limited information about youin their patient directories. We may share yourname, room number and condition (fair, stable,etc.) with people who ask for you by name. Wealso may share your religious affiliation withreligious leaders of your faith. If you do notwant your information included in the directory,please tell registration when you arrive. If youask not to be included in the patient directory, youwill not get any cards or flowers that are sent tothe hospital for you. Also, we will not tell callersor visitors that you are here.b. To people involved in your care or paymentfor care. We may share PHI with familymembers or others identified by you, who areinvolved in your care or payment for your care.We, also, may tell your family and friends aboutyour condition. In an emergency, or if you areunable to make decisions for yourself, we willuse our professional judgment to decide if it is inyour best interest to share your PHI with aperson involved 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 mayshare PHI with agencies like the Red Cross fordisaster relief efforts. Even if you ask us not to, wemay share your PHI if we need to for an emergency.C 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 vulnerable 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 officials or
to prevent the spread of the disease. If you haveHIV or Hepatitis B, your doctor does not needyour permission to share your status with a layhealthcare giver who is, or will be, providingdirect hands-on healthcare to you. Your doctorwill tell you before and after she or he sharesthis information and with whom she or heshared the information. If we perform certain kinds of neonatal testingon a child, we can only release this informationto the child’s parents or legal guardians, doctor,or the child if the child is 18 or older. Under a special federal law, if you apply for orreceive substance abuse services from us, wegenerally have to get your written permissionbefore we share information that identifies youas a substance abuser or a patient receivingsubstance abuse services. There are someexceptions to this rule. We may shareinformation 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. We generally need your written permissionbefore we can send your prescription druginformation to, or receive it from, someoneelse. There are exceptions to this requirement.Some of these exceptions include sharingthis information to/for: (1) your healthcareproviders; (2) medical research that ismonitored by an institutional review board;(3) for epidemiological studies, research, orstatistical analysis, if the information does notidentify you or is encoded; or (4) the sale ofa business or medical practice. If you are a minor who is at least 16 and havenot been emancipated, we will not reveal anyinformation about treatment that you consentedto receive (unless it involves an operation)without your permission.D Other uses and disclosures1. Use of psychotherapy notes, use of PHI formarketing and sale of PHI. Except as providedin Section 164.508(a)(2) of HIPAA, yourauthorization is required for use or disclosure ofpsychotherapy notes about you. Except asprovided in Section 164.508(a)(3), yourauthorization is required for use or disclosure ofPHI about you for marketing. Your authorization isrequired 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.E Your privacy rightsYou have the following rights about the healthinformation we maintain about you. If you want toexercise 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 have theright to ask us to limit the ways we use anddisclose your PHI for treatment, payment orhealthcare operations. You also have the right toask 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 or for our healthcare operations if thePHI is about an item or service you paid for, in full,out-of-pocket, and disclosure is not otherwiserequired by law. Even if we agree, your restrictionsmay not be followed in some situations such asemergencies or when disclosure is required bylaw.2. Right to ask for different ways tocommunicate with you. You have the right toask us to contact you in a certain way or at acertain location. For example, you can ask us toonly contact you at your work phone number. Ifyour request is reasonable, we will do what youask. In some situations, we may require you toexplain how you will handle payment and giveus another way to reach you.3. Right to see and copy PHI. You have the rightto see and get a copy of the health informationabout you. You must sign a written request foraccess or an authorization. We may charge you afee if you have asked for a copy of records. We candeny your request in some situations. If we deny yourrequest, we will notify you in writing and explainhow you can ask for a 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
us in writing. You must explain why you wantthe change. 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, the disclosures we made ofyour health information. For example, the list willnot include disclosures made for treatment,payment, healthcare operations or disclosuresyou specifically 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, wecan charge 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. Ifyou 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 information systems to share yourinformation, you will need to contact them directly.If you choose not to allow your electronic medicalrecord to be available through Care Everywhere oranother health information exchange, anotherprovider who is involved in your care may not beable to retrieve your full medical historyelectronically.F 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 inSouth Carolina that are treated as an “affiliatedcovered entity” under the federal law known asthe 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 thepeople who provide healthcare services at aNovant Health facility in South Carolina, evenif they are not our employees or agents. Thesepeople provide care along with us as part of an“organized healthcare arrangement.” All of thesehealthcare providers are referred to as “we” in thisNotice. If you would like a listing of the NovantHealth facilities and practices covered by thisNotice, please contact the Novant Health privacyofficial at 704-384-9829 or P.O. Box 33549,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 Services at1-855-526.4411, 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 हɇl 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. 20167/16 Item #75365
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
