This oﬀice is required to notify you in writing, that by law, we must maintain the privacy and confidentiality of your Personal Health Information. In addition we must provide you with written notice concerning your rights to gain access to your health information and the potential circumstances under which, by law, or as dictated by our oﬀice policy, we are permitted to disclose information about you to a third party without your authorization. Below is a brief summary of these circumstances. Once you have signed the last page, keep this page for your records.
- Treatment purposes - discussion with other health care providers in your care
- Inadvertent disclosures - open treating area means open discussion. If you need to speak privately to our Doctor(s), please let our staﬀ know so that you can be placed in a private consultation room.
- Payment Purposes - to obtain payment from your insurance company or any other collateral source.
- For workers compensation purposes - to process a claim or aid in investigation
- Emergency - we may notify a family member
- For public health and safety - to prevent or lessen a serious or imminent threat to the health or safety of a person or the general public.
- To Government agencies or Law Enforcement - to identify a suspect, fugitive, material witness or missing person
- For military, national security, prisoner and government benefits purposes
- Deceased persons - with coroners and medical examiners in the event of a patientʼs death.
- Telephone calls or emails with appointment reminders - we may call your home and leave messages regarding a missed appointment or apprize you of changes in hours or upcoming events.
- Change of ownership - in the event this practice is sold, the new owners would have access to your Personal Health Information
- To receive an accounting of disclosures
- To receive a paper copy of the comprehensive Privacy Notice
- To request mailings to an address diﬀerent than residence
- To request restrictions on certain uses and disclosures and with whom we release information to, although we are not required to comply.
- To inspect your records and receive one copy of your records at no charge, with notice in advance (72 hours). X-rays are original records and you are therefore not entitled to them. If you would like us to outsource them to an imaging center, to have copies made, we will be happy to accommodate you. However, you will be responsible for this cost.
- To request amendments to information. However, like restrictions, we are not required to agree to them.
If you wish to file a formal complaint about how we handle your health information, please call Maryjane LaDue at 919-369-0771. If she is unavailable, you may make an appointment to see her within 72 hours or 3 working days. If you are still not satisfied with the manner in which this oﬀice handles your complaint, you may submit a written complaint to:
DHHS, Oﬀice of Civil Rights
200 Independence Ave SW
Room 509F HHH Building
Washington DC 20201