Patient Rights & Privacy

Your Rights

We have a legal duty to protect health information about you. This notice describes how medical information about you may be used and disclosed as well as how you can get access to this information. When it comes to your health information, you have certain rights. You have the right to:

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information upon your request. We may charge a reasonable fee.

Ask us to correct your medical record

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

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. 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.

Get a copy of this privacy notice

  • 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.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • If you feel that we have violated your rights please contact us: Phone (919) 933-8494 ext. 1448
  • You can also 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:
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share.

  • 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.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Provide mental health care.

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

  • Marketing purposes
  • Sale of your information

In the case of fundraising:

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


If you have a clear preference for how we share your information in the situations described above, talk to us and we will follow your instructions.

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.

To treat you

  • We can use your health information and share it with other professionals who are treating you.  

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Disclose Health Information Related to mental health and substance use disorder

  • North Carolina law generally requires that we obtain your written consent before we may disclose health information related to your mental health, developmental disabilities, or substance abuse services. There are some exceptions to this requirement. We can disclose this health information to members of our workforce, our professional advisors, and to agencies or individuals that oversee our operations or that help us carry out our responsibilities in serving you. We also may disclose information to the following people:
  1. a health care provider who is providing emergency medical services to you and 
  2. other mental health, developmental disabilities, and substance abuse facilities or professionals when necessary to coordinate your care or treatment.

Run our organization

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

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 for your services.


How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information:

NC Health Information Exchange

Your health care provider has chosen to be a part of NC Health Information Exchange because of the many benefits of sharing health information electronically. You may choose not to participate (“opt-out”). Your choice to opt-out will not affect your ability to access medical care. For more information, you can call 919-754-6912, or you can opt out online at or by filling out the opt-out form available in your health care provider’s office.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing outbreaks of disease
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research with consent.

Comply with the law

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

Respond to organ and tissue donation requests

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

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual 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

Our Responsibilities

  • We are required by law to maintain the privacy and security 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.

Changes to the Terms of this Notice 

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. This Notice of Privacy Practice is effective 8/8/2018

For More Information

If you have, questions please contact:

Privacy Officer

88 Vilcom Center Drive Suite 110

Chapel Hill, NC 27514

Phone: (919) 933-8494 Ext. 1448     or

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