Notice of Privacy Practices

This Notice of Privacy Practices (NPP) describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I. We have a legal duty to protect health information about you

We are required to protect the privacy of health information about you and that can be identified with you, which we call “Protected Health Information" (PHI). We must give you notice of our legal duties and privacy practices concerning your PHI. This NPP describes the types of uses and disclosures that we may make regarding your PHI.

We are required to follow the procedures in this NPP. We reserve the right to change the terms of this NPP and to make new provisions effective for all PHI that we maintain. You have the right to receive a copy of any changes made to this NPP. Any changes to this NPP will be posted in our office. You may also receive an updated NPP by making a written request via postal mail or by visiting our website.

II. We may use and disclose PHI about you without your consent in the following circumstances

1. Treatment:

We may use and disclose PHI about you to provide, coordinate, or manage your health care and related services with other health care providers.  We may also use and disclose PHI about you when referring you to another health care provider. The PHI may include information that identifies you (i.e., name, date of birth, social security number, etc.), your diagnosis, or course of treatment.

2. Payment:

We may use and disclose your PHI to other entities for the purposes of billing and collecting reimbursement for the treatment and services provided to you.  The PHI may include information that identifies you (i.e., name, date of birth, social security number, etc.), your diagnosis, or course of treatment.

For example, before you receive scheduled services, we may share PHI and information about these services with your health plan(s) for the purposes of: a) verifying coverage; b) receiving benefit information, i.e., deductible and co-payment information; c) receiving authorization for services.

A couple of examples of some of the entities we may share PHI regarding payment include, but are not limited to: insurance companies, collection agencies, and consumer reporting agencies such as credit bureaus.

3. Health Care Operations:

We may use and disclose PHI about you for the purposes of caring out health care operations. The PHI may include information that identifies you (i.e., name, date of birth, social security number, etc.), your diagnosis, or course of treatment.

Some examples of using and disclosing PHI for health care operations include, but are not limited to: a) working with outside organizations, such as the Joint Commission on Accreditation of Healthcare Organization, for the purpose of assessing the quality of the care we provide; b) conducting business management and general administrative activities related to our organization and the services it provides, including providing information; c) complying with this NPP and with applicable laws.

4. Other Circumstances:

We may use and disclose PHI about you in other circumstance in which you do not have to consent, give authorization for, or otherwise have an opportunity to agree or object to. The PHI may include information that identifies you (i.e., name, date of birth, social security number, etc.), your diagnosis, or course of treatment.

Some examples of these circumstances include, but are not limited to: a) when federal, state, or local law require disclosure with a court order; b) when reporting to public health officials regarding the risk of contracting or spreading communicable disease(s) and to avert a serious threat to health and/or safety towards you or anyone else; c) when reporting abuse, neglect, or domestic violence; d) when reporting to health oversight committees; e) when relating to military or veterans’ activities; f) when relating to correctional institutions and in other law enforcement custodial situations.

III. Contact regarding information about treatment, services, products, or health care providers

We may use and disclose PHI to manage or coordinate your healthcare. This may include telling you about treatments, services, products, and/or other healthcare providers.

IV. Any other use or disclosure of your PHI requires your written authorization

Under any circumstances other than those listed above, we will ask for your written authorization before we use or disclose your PHI. If you sign a written authorization allowing us to use and disclose your PHI you can later cancel your authorization in writing. If you cancel your authorization in writing, we will not use or disclose your PHI after we receive your cancellation, except for uses and disclosures that were being processed before we received your cancellation.

V. Your rights regarding your PHI

1. You have the right to request restrictions on uses and disclosures regarding your PHI:

You have the right to request that we restrict the use and disclosure of your PHI (45 CFR 522). We are not required to agree to your requested restrictions. You must request any restrictions of your PHI in writing.

2. You have the right to request different ways to communicate with you:

You have the right to request how and where we contact you about your PHI. You must request any alternative means of communication in writing.

3. You have the right to see and copy your PHI:

You have the right to request to see and receive a copy of your PHI (45 CFR 164.528). We maintain the right to charge you related fees. You must request a copy (or an explanation) of your PHI in writing.

4. You have the right to request an amendment of your PHI:

You have the right to request that we make amendments to your PHI (45 CFR 164.528). You must request any amendments along with an explanation for the amendment to your PHI in writing.

5. You have the right to a listing of disclosures we have made of your PHI:

You have the right to receive a written list of disclosures of your PHI (45 CFR 164.528). You must request a list of any disclosures of your PHI in writing.

6. You have the right to a copy of this NPP:

You have the right to request a paper copy of this NPP at any time. You may obtain a copy of this NPP via our website, or if you prefer to have our office send you a copy via U.S. Postal Service, then you must make your request in writing.

VI. You may file a complaint about our privacy practices

If you think that we have violated your privacy rights, or you want to complain to us about our privacy practice, you can contact the person listed below:

Harbin and Associates

ATTN: Heidi Peterson, Practice Manager

2411 Robeson St., Ste. 200

Fayetteville, NC 28305

If you file a complaint, we will not take any action against you or change our treatment of you in any way.

You may also send a written or electronic complaint to the United States Department of Health and Human Services.

VII. Effective date of this NPP

The effective date of this Notice of Privacy Practices is 14 April 2003.

2411 Robeson Street, Suite 200
Fayetteville, NC 28305

Phone: 910-609-1990
Fax: 910-609-1993
© 2017 Harbin & Associates. All Rights Reserved.