Notice of Privacy Practices
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.
This Notice of Privacy Practices is provided to you as a requirement of the Federal law named the Health Insurance Portability and Accountability Act (HIPAA). It describes how Fellowship Hall may use or disclose your “Protected Health Information” (PHI), with whom that information may be shared, and the safeguards Fellowship Hall has in place to protect your health information. This notice also describes your rights to access and amend your PHI. You have the right to approve or refuse the release of specific information outside of Fellowship Hall, except when the release is required or authorized by law or regulation. Additional Federal law and regulations specifically protect the confidentiality of drug and alcohol abuse patient records. Fellowship Hall is required to comply with these additional restrictions. This includes a prohibition, with very few exceptions, on informing anyone outside the program that you are or have in the past attended the program, or disclosing any information that identifies you as an alcohol or drug abuser. Fellowship Hall has specific policies and procedures in place to insure that your health information is protected.
How We May Use and Disclose Health Information About You
Listed below are examples of the uses and disclosures that Fellowship Hall may make of your PHI. These examples are not meant to be exhaustive. Rather, they describe types of uses and disclosures that may be made. We are required by law to maintain the privacy of your Protected Health Information, and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. You will be asked to sign an acknowledgement of receipt of this notice. We reserve the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time and will be made available to you.
Uses and Disclosures of PHI for Treatment, Payment and Health Care Operations
Treatment. Your PHI may be used and disclosed by your physician, counselor, program staff and others outside of our program that are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes coordination or management of your health care with a third party, consultation with other health care providers or referral to another provider for health care treatment. For example, we may disclose your Protected Health Information to another physician or health care provider (e.g. a specialist or laboratory) who, at the request of the program, becomes involved in your care.
Payment. With your authorization, we may use and disclose medical information about you so that we can receive payment for the treatment services provided to you. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.
Healthcare Operations. We may use or disclose, as needed, your PHI in order to support the business activities of our program including, but not limited to, Performance Improvement activities, employee review activities, licensing, and conducting or arranging for other business activities. We may share your PHI with third parties that perform various business activities (e.g. typing services) for Fellowship Hall, provided we have a written contract with the business that prohibits it from re disclosing your PHI and requires it to safeguard the privacy of your PHI.
Other Uses and Disclosures That Do Not Require Your Consent
Required by Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. You will be notified of any such uses or disclosures. Under the law, we must make disclosures of your PHI to you upon your request, in accordance with Fellowship Hall policies and procedures. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical personnel only. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
Child Abuse and/ or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect, and for those adults who, by virtue of mental or physical conditions and/ or advanced age, are unable to protect themselves from neglect, hazardous or abusive situations. However, the information we disclose is limited to only that information which is necessary to make the initial mandated report.
Criminal Activity on Program Premises/ Against Program Personnel. We may disclose your PHI to law enforcement officials if you have committed a crime on program premises or against program personnel, or express homicidal or suicidal intention.
Court Order. We may disclose your PHI if the court issues an appropriate order and follows required procedures.
Uses and Disclosures of Personal Health Information with Your Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke this authorization at any time, unless the program or its staff has taken an action in reliance on the authorization of the use or disclosure you permitted.
Your Rights Regarding Your Personal Health Information
- Right of Access to Inspect and Copy
You have the right, which may be restricted in certain circumstances, to inspect and copy PHI that may be used to make decisions about your care, in accordance with Fellowship Hall’s policies and procedures. If we have all or any portion of your health information in an electronic format, you may request an electronic copy of those records or request that we send an electronic copy to any person or entity you designate in writing.
- Right to Amend
If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You will be directed to the Medical Records Department to complete the Request for Amendment form according to the HIPAA Privacy Rule. Only written requests will be accepted, and the request must include the reason for the requested amendment. Fellowship Hall is not required to agree to the amendment.
- Right to an Accounting of Disclosures
You have the right to request an accounting of the disclosures that we make of your PHI. You may request an accounting of disclosures for a period of up to six years, excluding disclosures made to you, made for treatment purposes or made as a result of your authorization.
- Right to Request Restrictions
You have the right to ask us not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care. Your request for restrictions must be in writing and we are not required to agree to such restrictions. You may request that we not disclose your medical information to any persons or entities that may be responsible for paying all or any portion of the charges you incur while a patient of Fellowship Hall. If you pay all such charges in full at the time of such request, we are required to agree to your request.
- 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. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact.
- Right to a Copy of this Notice
You have the right to a copy of this notice.
You have the right to file a complaint in writing to us, or the Secretary of Health and Human Services if you believe we have violated your privacy rights. No retaliation will occur against you for filing a complaint.
Investigations of Breaches of Privacy
We will investigate any discovered unauthorized use or disclosure of your protected health information to determine if it constitutes a breach of the federal privacy or security regulations governing unsecured protected health information. If we determine that such a breach has occurred, we will provide you with notice of the breach and advise you what we intend to do to mitigate the damage (if any) caused by the breach, and about the steps you should take to protect yourself from potential harm resulting from the breach.
Questions and Complaints
If you have questions about your privacy rights, or should you believe we have violated your privacy rights, you may file a complaint in writing by notifying our Privacy Officer:
Attention: Joni Whaley
PO Box 13890
Greensboro, NC 27415
You may also file a complaint with the U.S. Secretary of Health and Human Services,
U.S. Secretary of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201