NOTICE OF PRIVACY PRACTICES

 

This Notice of Privacy describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review it carefully

 

The Charlotte White Center, (CWC) is required by law to maintain privacy/confidentiality of your health care information and to provide you with a notice of CWC’s privacy practices. While required to abide by the terms of the notice that is currently in effect, CWC reserves the right to change CWC’s privacy practices at any time. If CWC’s privacy practices change, CWC will provide you with a revised notice at your next visit following the change.

 Use of your health care information

CWC may use your information for treatment, payment and health care operations. For example:

• Your information may be used to develop a diagnosis and treatment plan, or to coordinate referrals to another health care provider.
• Portions of your information may be submitted to your insurance carrier or other third-party payer to secure payment on your behalf.
• Your information may be used in the course of health care operations, such as for quality assurance, evaluation, training or audit activities.
• Your information may be sent by way of electronic records.

Business associates performing services on CWC’s behalf related to treatment, payment, or health care operations may also have access to your information solely for the purpose of providing such services, provided that the business associate has agreed in writing to maintain the confidentiality of such information.

CWC may disclose information without your authorization as permitted or required by applicable law, including any of the following: to comply with public health statutes and rules; to make any required reports of abuse, neglect or exploitation; to comply with health oversight activities by government agencies, such as licensure; to comply with a court order, government subpoena or other lawful process; for research purposes; in the event of your death to a medical examiner; to avert a serious threat to health or safety, or for workers’ compensation purposes

CWC may use your information to contact you for appointment reminders, or to provide information about treatment alternatives or other health services. Except as described above, CWC will not use or disclose your information, except with your written authorization. You may revoke your authorization at any time by giving written notice of revocation to CWC. Your rights:

• You have the right to receive communications from CWC in a confidential manner. If you would like CWC to use another address or telephone number to contact you, you must so request in writing.
• You have the right to receive an accounting of disclosures of your health care information that you have not authorized. To receive such an accounting, please contact CWC at the address above.
• You have the right to inspect and copy your information. If you wish to do so, you will be provided an opportunity to inspect your information within 30 days of receipt of your request. You may be charged reasonable costs of copying your information, or of preparing any summaries you request.
• You have the right to amend your health care information. If you wish to do so, please submit the proposed amendment in writing to CWC at the address given above.
• You have the right to a copy of this Notice of Privacy Practices upon request.

You have the right to complain to CWC and to the Secretary of the U.S. D.H.H.S if you believe your privacy rights have been violated. To file a complaint, please contact Mary Dunn, CWC’s Privacy Officer at 564-2464. No one is permitted to retaliate against you for filing a complaint.