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.
If you have questions about this Notice, or would like to exercise your
Privacy Rights, please contact the facility where you received treatment,
or contact our Corporate Responsibility Office:
CaroMont Health Corporate Responsibility Office
2525 Court Drive Gastonia, NC 28054
1-877-785-0001 Corporate Responsibility Hotline
corporateresponsibility@caromonthealth.org
OUR PLEDGE REGARDING YOUR MEDICAL INFORMATION
CaroMont Health is committed to protecting your medical information. We
strive to use only the minimum amount of your health information necessary
for the purposes described in this Notice. We collect information from
you and use it to provide you with quality care, and to comply with certain
legal requirements. We are required by law to maintain the privacy of
your health information, and to give you this Notice of our legal duties,
our privacy practices, and your rights. We are required to follow the
terms of our most current Notice. When we disclose information to other
persons and companies to perform services for us, we will require them
to protect your privacy. There are other laws we will follow that may
provide additional protections, such as laws related to mental health,
alcohol and other substance abuse, and communicable disease or other health
conditions.
This Notice covers the following sites and people: all healthcare professionals
authorized to enter information into your chart, all volunteers authorized
to help you while you are here, all our associates and on- site contractors,
all departments and units within the hospital, all healthcare students,
all healthcare delivery facilities and providers within the CaroMont Health
system, and your personal doctor and others while they are providing care
at this site. Your doctor may have different policies or notices about
the health information that was created in his or her private office or clinic.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
Treatment
We may use and disclose your health information to provide treatment or
services, to coordinate or manage your healthcare, or for medical consultations
or referrals. We may use and disclose your health information among doctors,
nurses, technicians, healthcare students and other personnel who are involved
in taking care of you at our facilities or with such persons outside our
facilities. We may use or share information about you to coordinate the
different services you need, such as prescriptions, lab work and x-rays.
We may disclose information about you to people outside our facility who
may be involved in your care after you leave, such as family members,
home health agencies, therapists, nursing homes, clergy, and others. We
may give information to your health plan or another provider to arrange
a referral or consultation.
Payment
We may use and disclose your health information so that we can receive
payment for the treatment and services that were provided. We may share
this information with your insurance company or a third party used to
process billing information. If you pay for your healthcare entirely out-of-pocket,
you may request that we not share your information with your insurance
company. We may contact your insurance company to verify what benefits
you are eligible for, to obtain prior authorization, and to tell them
about your treatment to make sure that they will pay for your care. We
may disclose information to third parties who may be responsible for payment,
such as family members, or to bill you. We may disclose information to
third parties that help us process payments, such as billing companies,
claims processing companies, and collection companies.
Healthcare Operations
We may use and disclose your health information as necessary to operate
our facility and make sure that all of our patients receive quality care.
We may use health information to evaluate the quality of services that
you received, or the performance of our staff in caring for you. We may
use health information to improve our performance or to find better ways
to provide care. We may use health information to grant medical staff
privileges or to evaluate the competence of our healthcare professionals.
We may use your health information to decide what additional services
we should offer and whether new treatments are effective. We may disclose
information to students and professionals for review and learning purposes.
We may combine our health information with information from other healthcare
facilities to compare how we are doing and see where we can make improvements.
We may use health information for business planning, or disclose it to
attorneys, accountants, consultants and others in order to make sure we
are complying with the law. We may remove health information that identifies
you so that others may use the de-identified information to study healthcare
and healthcare delivery without learning who you are.
Health Information Exchanges
We may participate in health information exchanges to facilitate the secure
exchange of your electronic health information between and among several
healthcare providers or other healthcare entities for your treatment,
payment, or other healthcare operations purposes. This means we may share
information we obtain or create about you with outside entities (such
as hospitals, doctors offices, pharmacies, or insurance companies) or
we may receive information they create or obtain about you (such as medication
history, medical history, or insurance information) so each of us can
provide better treatment and coordination of your healthcare services.
In addition, if you visit any CaroMont Health facility, your health information
may be available to other clinicians and staff who may use it to care
for you, to coordinate your health services or for other permitted purposes.
Appointment Reminders and Service Information
We may use or disclose your health information to contact you to provide
appointment reminders, or to let you know about treatment alternatives
or other health related services or benefits that may be of interest to you.
Individuals Involved In Your Care
We may give your health information to people involved in your care, such
as family members or friends, unless you ask us not to. We may give your
information to someone who helps pay for your care. We may share your
information with other healthcare professionals, government representatives,
or disaster-relief organizations, in emergency or disaster-relief situations
so they can contact your family or friends or coordinate disaster-relief efforts.
Patient Directories
We may keep your name, location in the facility, and your general condition
in a directory to give to anyone who asks for you by name. We may give
this information and your religious affiliation to clergy, even if they
do not know your name. You may ask us to keep your information out of
the directory, but you should know that if you do, visitors and florists
will not be able to find your room. Even if you ask us to keep your information
out of the directory, we may share your information for disaster-relief
efforts or in declared emergency situations.
Fundraising Activities
We depend extensively on private fundraising to support our healthcare
missions. We may use your name and other limited information to contact
you, including the dates of your care, but not your treatment information,
so that we may provide you with an opportunity to make a donation to our
fund raising programs. If we do contact you for fundraising purposes,
you will be told how you may ask us not to contact you in the future.
Research
We may use or disclose your health information for research that has been
approved by an official research review board, which has evaluated the
research proposal and established standards to protect the privacy of
your health information. We may use or disclose your health information
to a researcher preparing to conduct a research project.
Organ and Tissue Donation
We may use or disclose your health information in connection with organ
donations, eye or tissue transplants or organ donation banks, as necessary
to facilitate these activities.
Public Health Activities
We may disclose your health information to public health or legal authorities
whose official activities include preventing or controlling disease, injury,
or disability. For example, we must report certain information about births,
deaths, and various diseases to government agencies. We may disclose health
information to coroners, medical examiners, and funeral directors as allowed
by the law to carry out their duties. We may use or disclose heath information
to report reactions to medications, problems with products, or to notify
people of recalls of products they may be using. We may use or disclose
health information to notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease.
Serious Threat to Health and Safety
We may use or disclose your 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. We will only disclose health information
to someone reasonably able to help prevent or lessen the threat, such
as law enforcement or government officials.
Required by Law, Legal Proceedings, Health Oversight Activities, and Law
Enforcement
We will disclose your health information when we are required to do so
by federal, state and other law. For example, we may be required to report
victims of abuse, neglect or domestic violence, as well as patients with
gunshot and other wounds. We will disclose your health information when
ordered in a legal or administrative proceeding, such as a subpoena, discovery
request, warrant, summons, or other lawful process. We may disclose health
information to a law enforcement official to identify or locate suspects,
fugitives, witnesses, victims of crime, or missing persons. We may disclose
health information to a law enforcement official about a death we believe
may be the result of criminal conduct, or about criminal conduct that
may have occurred at our facility. We may disclose health information
to a health oversight agency for activities authorized by law, such as
audits, investigations, inspections and licensure.
Specialized Government Functions
If you are in the military or a veteran, we will disclose your health
information as required by command authorities. We may disclose health
information to authorized federal officials for national security purposes,
such as protecting the President of the United States or the conduct of
authorized intelligence operations. We may disclose health information
to make medical suitability determinations for Foreign Service.
Correctional Facilities
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release your health information
to the correctional institution or law enforcement official. We may release
your health information for your health and safety, for the health and
safety of others, or for the safety and security of the correctional institution.
Workers Compensation
We may disclose your health information as required by applicable workers
compensation and similar laws.
Your Written Authorization
Other uses and disclosures of your health information not covered by this
Notice, or the laws that govern us, will be made only with your written
authorization. Most uses and disclosures of psychotherapy, marketing and
the sale of protected health information requires your authorization.
You may revoke your authorization in writing at any time, and we will
discontinue future uses and disclosures of your health information for
the reasons covered by your authorization. We are unable to take back
any disclosures that were already made with your authorization, and we
are required to retain the records of the care that we provided to you.
YOUR PRIVACY RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Obtain a Copy of This Notice of Privacy Practices
We will post a copy of our current Notice in our facilities and on our
website, caromonthealth.org. A copy of our current Notice will be available
at our registration areas or upon request. To request a copy of our current
Notice of Privacy Practices, please call 1-704-834-4843.
Right to See and Copy Your Health Record
You have the right to look at and receive a copy of your health record
or your billing record. To do so, please contact the facility where you
received treatment, or the Corporate Responsibility Office listed below.
You may be required to make your request in writing. If you would like
a copy of your health record, a fee may be charged for the cost of copying
or mailing your record, as permitted by law. In certain situations, we
may deny your request. If we do, we will tell you, in writing, our reasons
for the denial and explain your right to have the denial reviewed.
Right to Update Your Health Record
If you believe that a piece of important information is missing from your
health record, you have the right to request that we add an amendment
to your record. Your request must be in writing, and it must contain the
reason for your request. To submit your request, please contact the facility
where you received treatment, or the Corporate Responsibility Office listed
below. We may deny your request to amend your record if the information
being amended was not created by us, if we believe that the information
is already accurate and complete, or if the information is not contained
in records that you would be permitted by law to see and copy. Even if
we accept your amendment, we will not delete any information already in
your records.
Right to Get a List of the Disclosures We Have Made
You have the right to request a list of the disclosures that we have made
of your health information. The list will not contain disclosures from
paper medical records that we have made for the purposes of treatment,
payment and healthcare operations. It will not contain disclosures that
were authorized by you, and certain other disclosures excluded by law.
The list will not contain disclosures that were made before April 14,
2003. Your request must be in writing. To request a list of disclosures,
please contact the facility where you received treatment, or the Corporate
Responsibility Office listed below. The first list you request in a 12-month
period is free. For additional lists, we may charge a fee, as permitted by law.
Right to Request a Restriction on Certain Uses or Disclosures
You have the right to request that we limit how we use and disclose your
health information. We are legally required to accept certain requests
to not disclose health information to your health plan for payment or
healthcare operations purposes if you have paid in full out of your own
pocket for the item or service. We are not legally required to accept
any other request for a restriction, but we will consider your request.
If we do accept it, we will comply with your request, except if you need
emergency treatment. Your request must be in writing. To submit a request,
please contact the facility where you received treatment, or the Corporate
Responsibility Office listed below.
Right to Choose How You Receive Your Health Information
You have the right to request that we communicate with you in a certain
way, such as by mail or fax, or at a certain location, such as a home
address or post office box. We will try to honor your request if we reasonably
can. Your request must be in writing, and it must specify how or where
you wish to be contacted. To submit a request, please contact the facility
where you received treatment, or the Corporate Responsibility Office listed below.
Notification of Breach of Unsecured Protected Health Information
CaroMont Health is required by law to maintain the privacy of protected
health information and provide you with notice of its legal duties and
privacy practices with respect to protected health information and to
notify you following a breach of unsecured protected health information.
CONTACT PERSON
If you believe your privacy rights have been violated, you may file a complaint
in writing with the contact person listed below. We will take no retaliatory
action against you if you file a complaint about our privacy practices.
If you would like to file a complaint with us or with the Secretary of
the Department of Health and Human Services, please contact our Corporate
Responsibility Office listed below.
If you have questions about this Notice, or would like to exercise your
Privacy Rights, please contact the facility where you received treatment,
or contact our Corporate Responsibility Office:
CaroMont Health Corporate Responsibility Office
2525 Court Drive
Gastonia, NC 28054
1-877-785-0001 Corporate Responsibility Hotline
corporateresponsibility@caromonthealth.org
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
We reserve the right to change this notice. We reserve the right to make
the revised notice effective for medical information we already have about
you as well as any information we receive in the future.
Footnote: CaroMont Health System, located in Gastonia, North Carolina,
includes CaroMont Regional Medical Center, Courtland Terrace, Gaston Hospice
and CaroMont Medical Group. The mission of CaroMont Health is to provide
exceptional healthcare to the communities we serve. In working to achieve
this goal, it is the responsibility of each CaroMont Health workforce
member to enforce its privacy policies and to take appropriate disciplinary
or other actions for employee violations. Please note that for purposes
of this Notice of Privacy Practices, CaroMont Health and its affiliate
companies and all of its subsidiaries will be referred to collectively
as “CaroMont Health.” For privacy purposes only, CaroMont
Health is organized as an Affiliated Covered Entity, as described in 45
CFR §164.504(d)(1); legally separate entities that are affiliated
may designate themselves as a single covered entity.
Effective Date: 12/08/15