Health Insurance Portability Accountability Act (HIPAA): This notice describes how health information about you may be used and disclosed, how you can get access to this information, your rights concerning your health information and our responsibility to protect your health information. Please review it carefully.
State and Federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this Notice. We are required to abide by the terms of this Notice of Privacy Practices. This Notice will take effect upon signature and will remain in effect until it is amended or replace by us.
We reserve the right to change our privacy practices provided law permits the changes. Before we make a significant change, this Notice will be amended to reflect the changes and we will make the new Notice available upon request.
You may requeat a copy of our Privacy Notice at any time by contacting our Office. Information on contacting us can be found at the end of this Notice.
We will keep your health information confidential, using it only for the following purposes:
Treatment: While we are providing you with health care services, we may share your Protected Health Information (PHI) including electronic Protected Health Information (ePHI) with other health care providers, business associates and their subcontractors or individuals who are involved in your treatment, billing, or administrative support. These business associates and subcontractors through signed contracts are required by Federal law to protect your health information. We have established "minimum necessary" or "need to know" standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.
Payment: We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include insurance organizations, collections or other third parties that may be responsible for such costs, such as family members or other persons you choose to involve in your care via signed Release of Information Authorization.
Disclosure: We may disclose and/or share PHI including electronic disclosure with other health care professionals who provide treatment and/or service to you. These professionals will have signed a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family members or other persons you choose to involve in your care, only if you agree that we may do so via signed Release of Information Authorization. If an individual is deceased, we may disclose PHI to a family member or individual involved in care or payment prior to death. Psychotherapy notes will not be used or disclosed without your written authorization. Uses and disclosures not described in this notice will be made only with your signed authorization.
Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death. If possible, we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated, we will use our professional judgment to disclose only that information directly relevant to your care.
Required by Law: We may use or disclose your health information when we are required to do so by law (Court or administrative orders, subpoena, discovery request or other lawful process). We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement.
National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence, or other national security activities, we may disclose it to authorized Federal officials.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others.
Marketing Health-Related Services: We will not use your health information (ie. email address) for marketing purposes except if you consent to receive our newsletter or emails with company updates.
Appointment Reminders: We may use your health records to remind you of recommended services, treatment, scheduled appointments, or office closings.
Access: Upon written request, you have the right to inspect and get copies of your health information (and that of an individual for whom you are a legal guardian). We will provide access to health information in a form/format requested by you. There will be some limited exceptions. If you wish to examine your health information, you will need to complete and submit an appropriate request form to our Main Office.
Breach Notification Requirements: It is presumed that any acquisition, access, use or disclosure of PHI not permitted under HIPAA regulations is a breach. We are required to complete a risk assessment, and if necessary, inform HHS and take any other steps required by law. You will be notified of the situation and any steps you should take to protect yourself against harm due to the breach.
Questions and Complaints: You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Compliance Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding access to your health information, you can complain to us in writing or request a Complaint Form from our Compliance Officer. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services (HHS).
How to Contact us: Silver Linings - Steve Kozlow, Office Administrator/Compliance Officer
Telephone: (919) 948-7718 Fax: (919) 300-7943 Email: steve@silverliningsnc.com
Physical Address: 1250 SE Maynard Road, Suite 204, Cary, NC 27511
What can you do: If you have concerns or have a complaint, you can contact the North Carolina Social Work Licensing Board at 1-800-550-7009 or P.O. Box 1043, Asheboro, NC 27204 or swboard@asheboro.com .
Acknowledgement of Receipt of Notice of Privacy Practices
Notice to Patient: We are required to provide you with a copy of our Notice of Privacy Practices which states how we may use and/or disclose your health information. Please sign this form to acknowledge receipt of the Notice.
Signature Instructions:
Touch Screen: use finger or stylus to sign
Desktop Monitor: use mouse or touchpad to sign