HIPAA NOTICE

HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996. The federal government established this act with the primary purpose of improving health insurance accessibility, protect health-related data, and ensure privacy. HIPAA consists of two standards: the security standard and privacy standard.

WHAT IS THE INTENT OF THE SECURITY STANDARD?

To secure all medical records in any form, paper, or electronic.

To improve patients’ rights over both understanding and controlling how their health information may be used.

To require health care providers to give patients clear written explanations of how health information may be used.

To allow patients to see and receive copies of all their records as well as a history of non-routine disclosure.

To require patient consent before information is released.

WHAT IS THE INTENT OF THE PRIVACY STANDARD?

To provide information to patients about their privacy rights.

To adopt written privacy procedures for staff and employees.

To secure patient records containing individual health information

CHARLOTTE PRIMARY CARE

HIPAA

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.

If you have any questions about this notice, please contact Dr. Kim Tam.

OUR OBLIGATIONS UNDER HIPAA:

Maintain the privacy and protect your health information.

Give you this notice of our legal duties and privacy practices regarding your health information

Follow the terms of our notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:

TREATMENT: We may use and disclose health information for your treatment and to provide you with treatment-related health care services. For example, we may disclose health information to doctors, nurses, technicians, or other personnel, including people outside our office who are involved in your medical care.

PAYMENT: We may use and disclose health information so that we may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we give your health plan information so that your insurance will pay for your treatment.

HEALTH CARE OPERATIONS: We may use and disclose health information for health care operation purposes to make sure that all patients receive quality medical care. We also may share information with other entities that have relationship with you (for example, your health plan) for their health care operation activities.

APPOINTMENT REMINDERS: We may use and disclose health information to contact you and to remind you that you have an appointment with us. We also may use and disclose health information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: When appropriate, we may share health information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

SPECIAL SITUATIONS:

AS REQUIRED BY LAW: We will disclose health information when required to do so by international, federal, state or local law.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY: We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.

BUSINESS ASSOCIATES: We may disclose health information to our business associates that perform functions on your behalf if the information is necessary for such functions or services. All of our business associates are obligated to protect the privacy of your information under the same HIPAA guidelines.

MILITARY AND VETERANS: If you are a member of the armed forces, we may release health information as required by military command authorities. We also may release health information to the appropriate foreign military authority if you are a member of a foreign military.

WORKERS’ COMPENSATION: We may release health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

PUBLIC HEALTH RISKS: We may disclose health information for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make disclosure if you agree or when required or authorized by law.

HEALTH OVERSIGHT ACTIVITIES: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance civil rights laws.

LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclosed health information in response to a court or administrative order. We also may disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

LAW ENFORCEMENT: We may release health information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summon or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) what we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victim, the identity, description or location of the person who committed the crime.

CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS:

We may release health information to a coroner or medical examiner. This may be necessary, for example to identify a deceased person or determine the cause of death. We also may release health information to funeral directors as necessary for their duties.

NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES: We may release health information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

INMATES OR INDIVIDUALS IN CUSTODY: If you are an inmate of a correctional institution under the custody of a law enforcement official, we may release health information to correctional institution or law enforcement official. This release would be necessary if the institution is to provide you with health care; (2) to protect your health and safety and health and safety of others, or (3) the safety and security of the correctional institution.

YOUR RIGHTS:

You have the following rights regarding health information we have about you.

RIGHT TO INSPECT AND COPY. You have a right to inspect and copy health information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this health information, you must make your request, in writing, to KIM TAM, MD.

RIGHT TO AMEND. If you feel that the health information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to KIM TAM, MD.

RIGHT TO AN ACCOUNTING OF DISCOUSURES. You have the right to request a list of certain disclosures we made of health information for purposes other than treatment, payment, health care operations, or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to KIM TAM, MD.

RIGHT TO REQUEST RESTRICTIONS. You have the right to request a restriction or limitation of the health information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or the payment for you care, like a family member, or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to KIM TAM, MD. We are not required to agree to your restrictions. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communication, you must make you request, in writing, to KIM TAM, MD. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.

RIGHT TO A PAPER COPY OF THIS NOTICE. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our web site, www.charlotteprimarycare.com. To obtain a paper copy of this notice, you may download it from our web site, come in and pick up a copy or contact our office at 704-342-8115. We can fax or mail you a copy.

CHANGES TO THIS NOTICE:

We reserve the right to change this notice and make the new notice apply to health information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office.

COMPLAINTS:

If you believe your privacy has been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint, contact KIM TAM, MD. All complaints must be made in writing. You will not be penalized for filing a complaint.