NOTICE OF PRIVACY PRACTICES OF PREMIER FERTILITY CENTER and HIGH POINT REGIONAL HEALTH SYSTEM
and other health care providers, as noted below, that are subject to federal privacy protections
and that provide treatment and services to patients at our facilities:
Regional Physicians
High Point Surgery Center*
Advanced Home Care*
Spectrum Laboratory Network*
The medical, dental, and other professional practices of the Physicians, Dentists, and Allied Health Professionals who comprise the Medical/Dental Staff at High Point Regional Health System
*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 High Point Regional Health Systems’ Privacy Office at 336-878-6360.
*This notice applies to health care providers who have agreed to abide by this Joint Notice of Privacy Practices with respect to medical information that they create or receive while providing treatment and services to patients in the inpatient and outpatient programs at High Point Regional Health System. The health care providers listed on this page may share health information with each other to carry out treatment, payment and health care operations as explained in this Notice.
NOTICE OF PRIVACY PRACTICES SUMMARY
A federal law, known as the "HIPAA Privacy Rule," requires that we explain how we may use and release health information about you. This summary is being provided only to give you a basic understanding of what our Privacy Notice contains. For more information, you may read the full Notice that follows this summary or contact our Privacy Office.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
We may use and disclose protected health information ("PHI") to you, to your personal representative, and for treatment, payment, and certain business activities called "health care operations."
If we first give you a chance to agree or object/opt-out, we may disclose PHI to individuals involved in your care or payment for your care. We may also include some information about you in our facility directory and we may disclose PHI for facility inspections.
Some examples of how we may also use and disclose PHI without your authorization include
when we disclose for public health reasons; to report abuse, neglect, or domestic violence; for health oversight activities; for lawsuits and other legal proceedings; for research; to avert a serious threat to health or safety; for specialized government functions such as military or national security purposes; and for workers’ compensation.
All other uses and disclosures of protected health information require your authorization.
We will also follow North Carolina law and other federal law that give you more protection of your PHI. For example, North Carolina law gives you more protection of some kinds of PHI including information about communicable diseases, mental health, developmental disability, substance abuse, and pharmacy prescriptions.
YOUR RIGHTS
You have the following rights as described in our Notice:
• Right to ask us to agree to more restrictions on our use or disclosure of PHI about you;
• Right to receive confidential communications from us;
• Right to inspect and copy PHI about you;
• Right to amend PHI about you;
• Right to receive a report about certain disclosures of PHI about you; and
• Right to a paper copy of this Notice.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the United States Department of Health and Human Services. If you have any questions about this Notice, you may contact our Privacy Office at the address and telephone number listed at the end of the Notice.
You may contact our Privacy Office at the following address and phone number:
Privacy Office
High Point Regional Health System
601 N. Elm Street
High Point, NC 27262
Telephone: 336-878-6360
NOTICE OF PRIVACY PRACTICESTHIS 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.
Original Effective Date: April 14, 2003
Last Updated: April 14, 2003
A federal regulation, known as the "HIPAA Privacy Rule," requires that we provide detailed notice in writing of our privacy practices. This Notice is long. The HIPAA Privacy Rule requires us to provide you with information on many things.
I. OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
In this Notice, we describe the ways that we may use and disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information about you and that can be used to identify you. This information is called "protected health information" or "PHI." In addition to the protections under HIPAA, North Carolina Law and other Federal law may also provide additional protections of health information about you in some circumstances. This Notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI under HIPAA and other applicable laws.
We are required by law to:
• Maintain the privacy of PHI about you;
• Give you this Notice of our legal duties and privacy practices with respect to PHI; and
• Comply with the terms of our Notice of Privacy Practices that is currently in effect.
As permitted by the HIPAA Privacy Rule, we reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you. If and when this Notice is changed, we will post a copy in our facility in a prominent location. We will also provide you with a copy of the revised Notice upon your request made to our Privacy Office.
You will be asked to sign a form that you received this Notice. Even if you do not sign this form, we will still provide you treatment.
II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
A. Uses and Disclosures to You, to Your Personal Representative, and for Treatment, Payment, and Health Care Operations
Subject to other laws that we discuss later in this Notice, the following categories describe the different ways we may use and disclose PHI to you, to your personal representative, and for treatment, payment, or health care operations without your authorization. The examples included in each category do not list every type of use or disclosure that may fall within that category.
Disclosures to You: We may disclose PHI about you to you.
Disclosures to Your Personal Representative: We may make disclosures to your personal representative. Your personal representative is someone who has the authority under state law to act on your behalf in making decisions related to your health care. For example, if you are deceased, your personal representative would be the person who has the authority under state law to act on your behalf or on behalf of your estate.
If you are a minor, your personal representative will be a parent, guardian, or person acting in the place of a parent who has the authority under state law to make decisions related to your healthcare. However, we may only disclose to your parent, guardian, or person acting in the place of a parent where disclosure is permitted or required by state law. For example, under North Carolina law, we generally cannot disclose to the parent of a minor information related to the treatment of the minor that was provided on the minor’s own consent.
Communication From Our Office: We may contact you to remind you of appointments and to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you.
B. Other Uses and Disclosures We Can Make Without Your Written Authorization for Which You Have the Opportunity to Agree or Object/Opt-Out
Individuals Involved in Your Care or Payment for Your Care: We may use and disclose PHI about you in some situations where you have the opportunity to agree or object to (opt-out of) certain uses and disclosures of PHI about you. If you do not object/opt-out, we may make these types of uses and disclosures of PHI.
• We may disclose PHI about you to your family member, close friend, or any other person
identified by you if that information is directly relevant to the person’s involvement in your
care or payment for your care.
• If you are present and able to consent or object (or if you are available in advance), then
we may only use or disclose PHI if you do not object after you have been informed of your
opportunity to object.
• If you are not present or you are unable to consent or object, we may exercise professional
judgment in determining whether the use or disclosure of PHI is in your best interests. For
example, if you are brought to our hospital and are unable to communicate normally with
your physician for some reason, we may find it is in your best interest to give your
prescription and other medical supplies to the friend or relative who brought you in for
treatment.
• We may maintain your name, your location in our facility, your condition described in general
terms, and your religious affiliation in our facility directory. We may disclose the information
in this directory to members of the clergy or to other persons who ask for you by name.
• We may also use and disclose PHI to notify such persons of your location, general condition,
or death. We also may coordinate with disaster relief agencies to make this type of
notification.
• We may also use professional judgment and our experience with common practice to make
reasonable decisions about your best interests in allowing a person to act on your behalf to
pick up filled prescriptions, medical supplies, X-rays, or other things that contain PHI about
you.
Inspection of Facilities: You must be given the opportunity to object before a state licensing inspector can review your PHI during an inspection of certain facilities, such as home care agencies, ambulatory surgical facilities, nursing pools, cardiac rehabilitation certification programs, hospices, and jails. If you object in writing, we will not disclose your PHI to the inspector.
C. Other Uses and Disclosures We Can Make Without Your Written Authorization
or Opportunity to Agree or Object
We may use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.
Required By Law: We may use and disclose PHI as required by federal, state, or local law to the extent that the use or disclosure complies with the law and is limited to the requirements of the law.
Public Health Activities: We may use and disclose PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
• To prevent or control disease, injury, or disability;
• To report disease, injury, birth, or death;
• To report child abuse or neglect;
• To report reactions to medications or problems with products or devices regulated by the
federal Food and Drug Administration (FDA) or other activities related to qualify, safety, or
effectiveness of FDA-regulated products or activities;
• To locate and notify persons of recalls of products they may be using;
• To notify a person who may have been exposed to a communicable disease in order to
control who may be at risk of contracting or spreading the disease; or
• To report to your employer, under limited circumstances, information related primarily to
workplace injuries or illnesses, or workplace medical surveillance.
Abuse, Neglect, or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse, or neglect.
Health Oversight Activities: We may disclose PHI to a health oversight agency for oversight activities including, for example, audits, investigations, inspections, licensure and disciplinary activities, and other activities conducted by health oversight agencies to monitor the health care system, government health care programs, and compliance with certain laws.
Lawsuits and Other Legal Proceedings: We may use or disclose PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested.
Law Enforcement: Under certain conditions, we may disclose PHI to law enforcement officials for the following purposes where the disclosure is:
• About a suspected crime victim if, under certain limited circumstances, we are unable to
obtain a person’s agreement because of incapacity or emergency;
• To alert law enforcement of a death that we suspect was the result of criminal conduct;
• Required by law;
• In response to a court order, warrant, subpoena, summons, administrative agency request,
or other authorized process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About a crime or suspected crime committed at our facility; or
• In response to a medical emergency not occurring at this facility, if necessary to report a
crime, including the nature of the crime, the location of the crime or the victim, and the
identity of the person who committed the crime.
We may not, however, disclose the fact that you have sought treatment for drug dependence to law enforcement.
Coroners, Medical Examiners, Funeral Directors: We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by law, so that they may carry out their jobs.
Organ and Tissue Donation: If you are an organ donor, we may use or disclose PHI to organizations that help procure, locate, and transplant organs in order to facilitate an organ, eye, or tissue donation and transplantation.
Research: We may use and disclose PHI about you for research purposes under certain limited circumstances. We must obtain a written authorization to use and disclose PHI about you for research purposes, except in situations where a research project meets specific, detailed criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI. We may also allow a researcher and/or their designee, to review PHI on our site to prepare for a research project, or to look for persons who may be able to participate in a research project. We will not allow the PHI reviewed by the researcher for this reason to leave our facility.
To Avert a Serious Threat to Health or Safety: We may use and disclose PHI about you in limited circumstances when necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can only be made to a person who is able to help prevent the threat.
Specialized Government Functions: Under certain conditions, we may disclose PHI:
• For certain military and veteran activities, including determination of eligibility for veterans
benefits and where deemed necessary by military command authorities;
• For national security and intelligence activities;
• To help provide protective services for the President of the United States and others;
• For the health or safety of inmates and others at correctional institutions or other law
enforcement custodial situations or for general safety and health related to correctional
facilities.
Workers’ Compensation: We may disclose PHI as authorized by workers’ compensation laws or other similar programs that provide benefits for work-related injuries or illness.
Disclosures Required by HIPAA Privacy Rule: We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose PHI to you, or to someone who has the legal right to act for you, when you request access to PHI or request an accounting of certain disclosures of PHI about you (these requests are described in Section III of this Notice).
Incidental Disclosures: We may use or disclose PHI incident to or naturally arise out of a use or disclosure permitted by the HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information.
Limited Data Set Disclosures: We may use or disclose a limited data set (PHI that has certain identifying information removed) for the purposes of research, public health, or health care operations. This information may only be disclosed for research, public health, and health care operations purposes. The person receiving the information must sign an agreement to protect the information.
Business Associates: We may share PHI with other parties called "business associates" who help us with providing services to you. We are required to sign contracts with these business associates that require them to protect PHI.
Fundraising Activities: We may use, or disclose to a business associate or to a foundation related to our organization, certain limited PHI for the purpose of raising funds for the hospital and its operations. If you do not wish to be contacted for our fundraising efforts, please contact our Privacy Office that is listed at the end of this Notice.
D. Other Uses and Disclosures of Protected Health Information Require Your Authorization
All other uses and disclosures of PHI about you will be made with your written authorization. If you have authorized us to use or disclose PHI about you, you may later revoke your authorization at any time, except to the extent we have taken action based on the authorization.
E. Additional Protections of Protected Health Information That Are Provided Under
North Carolina Law or Other Law
Up to this place in this Notice, we have been describing the uses and disclosure of PHI that we may make under the HIPAA Privacy Rule. However, HIPAA does not change some North Carolina laws or other laws that are more protective of patient privacy. This section describes these other laws that give you more protection in certain circumstances or with respect to certain kinds of PHI. Aside from these laws, we believe that HIPAA generally is consistent with North Carolina and other privacy laws and requirements. As government agencies offer more guidance on HIPAA, state, and other laws, we will make appropriate changes to our privacy practices and this Notice.
Communicable Diseases. State law limits when communicable disease information may be disclosed. In certain situations, state law permits disclosure of communicable disease information that relates to you without your authorization. "Communicable diseases" are generally illnesses that can be transmitted from one person to another, such as HIV/AIDS, tuberculosis, hepatitis, and syphilis. North Carolina law allows disclosures of communicable disease information in the following circumstances:
• to health care personnel for the purpose of providing you treatment;
• to the appropriate government agency responsible for the control of communicable diseases
and conditions;
• if a court orders the disclosure;
• if we receive a subpoena that requires a disclosure;
• to the health inspector during an inspection of our facilities; and
• if the disclosure is for statistical purposes and there is no way that you can be identified.
We must disclose your HIV status to the physician treating a health care worker who was exposed to your blood or body fluids. We may also release the name of your physician to a health care worker who was exposed to your blood or body fluids.
If you have been diagnosed with a communicable disease, we may use this information in our facility to assure that you comply with any disease control measures that have been given to you by the local health director. We must notify the local health director if we have reason to believe that you are HIV positive and are not following any of the control measures.
Mental Health, Developmental Disability, and Alcohol and Substance Abuse Records. If we provide services to you through our Mental Health, Developmental Disability or Alcohol or Substance Abuse Programs, we may be subject to certain state and federal laws and regulations that protect the confidentiality of patient records maintained by the program. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as being in such a program unless:
• The patient consents in writing;
• The disclosure is allowed by a court order; or
• The disclosure is made to medical personnel in a medical emergency or to qualified
personnel for research, audit, or program evaluation.
Violation of the state and federal laws and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with state and federal regulations.
State and federal laws and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime. State and federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.
Certified Substance Abuse Professionals. If you are treated by a certified substance abuse professional in our facility, the information related to the provision of those services may not be disclosed without your authorization unless:
• In the good faith opinion of a responsible professional there is imminent danger to your
health or safety or other individual and the disclosure is to a person able to prevent or
lessen the threat.
• Disclosure is required by law; or
• The substance abuse professional is discussing the information obtained in clinical or
consulting relationships in a professional setting and for a professional purpose clearly
concerned with the case. Written and oral reports may only contain data related to the
purpose of the evaluation.
Massage Therapists. If you are treated by a massage therapist in our facility, the information related to the provision of those services may not be disclosed without your authorization unless:
• Disclosure is required by law; or
• Disclosure is ordered by a court.
Speech and Language Pathologists and Audiologists, If you are treated by a speech and language pathologist or audiologist in our facility, the information related to the provision of those services may not be disclosed without your authorization unless:
• Disclosure is required by law; or
• In the good faith opinion of a responsible professional there is imminent danger to your
health or safety or other individual and the disclosure is to a person able to prevent or
lessen the threat.
Social Workers. If you are provided services by a social worker in our facility, the information related to the provision of those services may not be disclosed without your authorization unless:
• disclosure is required by law; or
• failure to disclose would result in clear and imminent danger to you or others.
Pharmacy Records. Under North Carolina law, there are limitations on when information about you contained in a written prescription for drugs may be disclosed. The following are the circumstances in which we may disclose this kind of information about you without your written authorization. We may disclose this information:
• To you or your personal representative;
• To the doctor who wrote the prescription or to the doctor treating you for the purposes of
treatment, payment, or health care operations as explained earlier in this Notice;
• To the pharmacist who is providing pharmacy services to you for the purposes of treatment,
payment, or health care operations as explained earlier in this Notice;
• If we receive a subpoena that requires a disclosure;
• If a court orders the disclosure;
• To a business that has the responsibility of paying for your medical care for the purposes of
payment;
• To the Board of Pharmacy for the purpose of the Board’s supervision of pharmacists;
• To researchers when the Board of Pharmacy has approved and when certain detailed criteria
specified by the HIPAA Privacy Rule are met; and
• When, in the good faith opinion of the pharmacist, there is an imminent danger to the life or
health of any person and the disclosure is to a person able to prevent or lessen the threat.
III. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
Under the HIPAA Privacy Rule law, you have the following rights regarding PHI about you:
Right to Request Restrictions: You have the right to request additional restrictions on the PHI that we may use or disclose for treatment, payment and health care operations. You may also request additional restrictions on our disclosure of PHI to certain individuals involved in your care that otherwise are permitted by the Privacy Rule. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Office. In your request, please include (1) the information that you want to restrict; (2) how you want to restrict the information; and (3) to whom you want those restrictions to apply. If you prefer, we have a form that you can complete and which will serve as your written request. If you would like to use this form, please contact our Privacy Office.
Right to Receive Confidential Communications: You have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. You must make your request in writing. You must specify how you would like to be contacted (for example, by regular mail to your post office box and not your home). We are required to accommodate only reasonable requests. If you prefer, we have a form that you can complete and which will serve as your written request. If you would like to use this form, please contact our Privacy Office.
Right to Inspect and Copy: You have the right to request the opportunity to inspect and receive a copy of PHI about you in certain records that we maintain. This includes your medical and billing records but does not include psychotherapy notes or information gathered or prepared for a civil, criminal, or administrative proceeding. We may deny your request to inspect and copy PHI only in limited circumstances. To inspect and copy PHI, please contact our Privacy Office. If you request a copy of PHI about you, we may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request. Your request must be in writing. We have a form that you can complete and which will serve as your written request. If you would like to use this form, please contact our Privacy Office.
Right to Amend: You have the right to request that we amend PHI about you as long as such information is kept by or for our health care system. To make this type of request, you must submit your request in writing to our Privacy Office. You must also give us a reason for your request. We may deny your request in certain cases, including if it is not in writing or if you do not give us a reason for the request. If you prefer, we have a form that you can complete and which will serve as your written request. If you would like to use this form, please contact our Privacy Office.
Right to Receive an Accounting of Disclosures: You have the right to request an "accounting" of certain disclosures that we have made of PHI about you. This is a list of disclosures made by us during a specified period of up to 6 years, but these do not include disclosures made: for treatment, payment, and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative; for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes); as incidental disclosures that occur as a result of otherwise permitted disclosures; as part of a limited data set of information that does not directly identify you; and disclosures made before April 14, 2003. If you wish to make such a request, please contact our Privacy Office identified on the last page of this Notice. Your request must be in writing. We have a form that you can complete and which will serve as your written request. If you would like to use the form, please contact our Privacy Office. The first list that you request in a 12-month period will be free, but we may charge you for our reasonable costs of providing additional lists in the same 12-month period. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred.
Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice at any time. You are entitled to a paper copy of this Notice even if you have previously agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact our Privacy Office listed in this Notice.
IV. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the United States Department of Health and Human Services. To file a complaint with us, please contact our Privacy Office at the address and number listed below, or by calling our Privacy Hotline at 336-878-6970. We will not retaliate or take action against you for filing a complaint.
V. QUESTIONS
If you have any questions about this Notice, please contact our Privacy Office at the address and telephone number listed below.
VI. PRIVACY OFFICE CONTACT INFORMATION
You may contact our Privacy Office at the following address and phone number:
Privacy Office
High Point Regional Health System
601 N. Elm Street
High Point, NC 27262
Telephone: 336-878-6360
This Notice was published and first became effective on April 14, 2003.