Your information. Your Rights. Our Responsibility.

Your Rights

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communications
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospice home directory
• Market our services
• Raise funds

Our Uses & Disclosures

We may use and share your information as we:

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

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Your Rights

When it comes to your health information, you have certain rights.  This section explains your rights and some of our responsibilities to help you.  To exercise your rights, please talk to staff or contact the Privacy Officer.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations.  For example, you may request that we not share information with a family member or friend.   
• We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.  We will say “yes” unless a law requires us to share that information.

Request confidential communications

• You can ask us to communicate with you in a certain way or at a certain location.  For example, you may ask we only contact you on your cell or home phone or send mail to a different address.
• We will say “yes” to all reasonable requests.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic of paper copy of your medical record and other health information we have about yWe will provide a copy of a summary or your health information, usually within 30 days of your request.  We may charge a reasonable, cost-based fee.
• In limited circumstances, we may deny your request, in which case we will inform you of the basis of the denial, how you may have our denial reviewed, and how you may complain.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect of incomplete.  Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Get a list of those with whom we’ve shared information and get a copy of this privacy notice.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date your ask, who we shared it with, and why.
• We will include all the disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• You can also obtain a copy by going to our website, www.AuthoraCare.org

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian or power of attorney, that person can exercise your rights and make choices about your health information.
• If you have not chosen someone as your representative and you are or become incapacitated, the following persons, in the order listed, are authorized to exercise your rights based on state law: spouse, parents/ adult children, siblings, an individual who has an established relationship with you, who is acting in good faith on behalf of the you, and who can reliably convey your wishes.

File a complaint if you feel your rights have been violated

• You can complain if you feel we have violated your rights by contacting the Privacy Officer in writing (see contact information on page 6).
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/hipaa/filing-a-complaint/index.html
• We will not retaliate against you for filing a complaint.

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Your Choices

For certain health information, you can tell us your choices about what we share.  If you have a clear preference for how we share your information in the situations described below, talk to us.  Tell us what you want us to do and we will follow your instructions.

In these cases, you have both the right and choice to tell us to (or not to):

• Share information with your family, close friends, or other involved in your care.
• Share information in a disaster relief situation.
• Include information in our hospice home directories
• If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health and safety.

In the case of fundraising:

• We may contact you or your caregiver for fundraising efforts, but you both can tell us not to contact you again.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information (AUTHORACARE COLLECTIVE does not sell health information)
• Most sharing of psychotherapy notes (AUTHORACARE COLLECTIVE does not maintain psychotherapy notes)

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Our Uses and Disclosures

How do we typically use or share your health information?  We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you (including referrals). Example: We may refer you to a specialist, which would require sharing your medical information to coordinate care.

Run our organization

We can use and share your health information to run our agency, improve your care, and contact you when necessary. Example: We use your medical information to review the services we provide and the performance of our employees caring for you.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. Example:  We give information about you to your health insurance plan so it will pay us for your services.

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How else can we use or share your health information?  We are allowed or required to share your health information in other ways – usually in ways that contribute to the public good, such as public health and research.  We must meet many conditions in the law before we can share your information for these purposes.  Or more information, see: www.hhs.gov/hipaa/for-individuals/index.html

Help with public health and safety issues

• We can share health information about you for certain situations such as:
• Preventing, reporting, or controlling disease.
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
• To provide proof of immunization, but we must have your verbal permission.

Do research

• We can use or share your information for health research.

Comply with the law

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy laws.

Respond to organ and tissue donation requests

• We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

• We can share health information with a coroner, medical examiner, or funeral director when a person dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

• For workers’ compensation claims.
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and other legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Cone Health Electronic Health Record

When applicable, and to promote quality of care, we use an electronic health record that shares health information among
many providers and that is owned and operated by Cone Health, a North Carolina nonprofit corporation. This computer
system is used by many providers including those not affiliated with us. This electronic health record lets us and other
providers look at and/or add information about you, your health, the care you receive, and other important facts. Not all your
information is kept in the electronic health record. Not every provider that treats you looks at or adds information in the
electronic health record. We cannot remove information once it is placed in the electronic health record.

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Our Responsibilities

• We are required by law to maintain the privacy of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing.  If you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.

For more information see:  www.hhs.gov/ocr/privacy/hipaa/for-individuals/guidance-materials-for-consumers/index.html 

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information that we have about you.  The new notice will be available upon request, in our office, or on our website. The effective date of the notice is stated on the first page of this notice.

This Notice of Privacy Practices covers all of our programs.

All employees, volunteers, students, contracted staff, vendors, and independent health care professionals who treat or care for patients of AUTHORACARE COLLECTIVE at all sites and locations will follow the terms of this notice.  In addition, these persons, entities, sites and locations may share medical information with each other for your treatment or AUTHORACARE COLLECTIVE operations purposes and other purposes described in this notice.  The independent health care professionals, who provide care at AUTHORACARE COLLECTIVE and have agreed to follow the terms of this notice, are not employees or agents of AUTHORACARE COLLECTIVE and AUTHORACARE COLLECTIVE is not responsible for how they fulfill their professional responsibilities.

Contact Person

AUTHORACARE COLLECTIVE contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the Privacy Officer, AUTHORACARE COLLECTIVE, 2500 Summit Avenue, Greensboro, NC 27405, 336.621.2500, [email protected], www.authoracare.org. If you have any questions about this notice, please contact the Privacy Officer.