This Notice is effective on April 14, 2003

THIS NOTICE DESCRIBES HOW HEALTH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

PLEASE READ IT CAREFULLY

WE ARE REQUIRED BY LAW TO PROTECT HEALTH INFORMATION ABOUT YOU

We are required by law to protect the privacy of health care information about you and information that identifies you. This may be information about health care services that we provide to you or payment for health care provided to you. It may also be information about your past, present, or future health care condition.

Information regarding your health care at Carolina Center for Counseling and Clinical Services, Inc. is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 USC 1320 et seq., 45 CFR Parts 160 & 164 and, when applicable, Federal Drug an Alcohol Confidentiality, 42 USC 290dd-2, 42 CFR Part 2; and North Carolina Mental Health, Developmental Disabilities and Substance Abuse Laws (NCGS 122C-52 through 122C-56). Under these laws, Carolina Center for Counseling and Clinical Services, Inc. may not say to a person outside Carolina Center for Counseling and Clinical Services, Inc. that you attend the program, nor disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected health information except as permitted by the state and federal laws listed above or with your written authorization.

We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to health care information. We are legally bound to follow the terms of this notice. In other words, we are only allowed to use and disclose health care information in the manner that we have described in this notice.

We may change the terms of this notice in the future. We reserve the right to make changes and to make the new notice effective for all health care information that we maintain. If we make changes to the notice, we will:

1. Post the new notice in our waiting area
2. Have copies of the new notice available upon request (you may also contact our Privacy Officer to obtain a copy of the current notice)

The rest of the Notice will:

1. Discuss how we may use and disclose health information about you
2. Explain your rights with respect to health care information about you
3. Describe how and when you may file a privacy-related complaint

If at any time, you have questions about information in this notice or about our privacy policies, procedures or practices, you may contact the Privacy Officer.

Understanding what information is contained in your medical record and how it is used helps you to:

1. Ensure the accuracy and completeness of the information
2. Understand who, what, where, why and how others may have access to your health information.
3. Make informed decisions about authorizing (or giving permission) disclosure of your information to others
4. Better understanding our health information rights that are detailed later in this notice.

We May Use and Disclose Health Care Information About You in Several Circumstances

We use and disclose health care information about you for treatment, payment and health care operations. For example:

1. Treatment
We may use and disclose health care information about you to provide health care treatment to you in order to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers within Carolina Center for Counseling and Clinical Services, Inc. and with providers Carolina Center for Counseling and Clinical Services, Inc. contracts with to provide services to you regarding your treatment and coordinating and managing your health care. 

2. Payment
We may use and disclose health care information about you with your written consent to obtain payment for health care services that you received. This means that, within the mental health center or contracted agency, we may use health care information about you to arrange for payment (such as preparing billing for services you have received and managing accounts). We also may disclose health care information about you to others (such as insurers, collection agencies) except as mandated by state and federal regulations. In some instances, we may disclose health care information about you to an insurance plan before you receive certain health care services because, for example, we may want to know whether the insurance plan will pay for a particular service.

3. Health Care Operations
We may use and disclose health care information about you in performing a variety of business activities or “health care operations”. These health care operation activities allow us to improve the quality of care we provide and reduce health car costs. For example, we may use or disclose health care information about you in performing the following activities:

Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
Providing training programs for students, trainees, health care providers or non-health care professionals to help them practice or improve their skills.
Cooperating with outside organizations that accredit, evaluate, certify, or license health care providers, staff, services or facilities in a particular field or specialty.

Planning for our organization’s future services.
Resolving complaints, grievances, and appeals within our organization and/or business associates

4. Persons Involved in Your Care
We may disclose information about you to a relative, close personal friend or any other person you identify and consent to in writing if that person is involved in y our care and the information in relevant to your care.

You may ask us at any time not to disclose health care information about you to persons involved in your care. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the consumer is a minor. If the consumer is a minor, we may or may not be able to agree with your request.

5. Required by Law
We will use and disclose health care information about you whenever we are required by law to do so. There are many states and federal laws that require us to use and disclose health information. For example, state law requires us to report gunshot wounds and other injuries to the police and to report known or suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with other applicable laws.

6. National Priority Uses and Disclosures
When permitted by law, we may use or disclose health care information about you without your permission for various activities that are recognized as “national priorities”. In other words, the government has determined that under certain circumstances, it is so important to disclose health care information that it is acceptable to disclose health care information without the individual’s permission. We will only disclose health care information about you in the following circumstances when we are permitted to do so by law. For more information on these types of disclosures, contact the Privacy Officer.

1. Threat to health and safety
2. Public health activities
3. Abuse, neglect or domestic violence
4. Health oversight activities
5. Court proceedings
6. Law Enforcement
7. Coroners and others
8. Worker’s compensation
9. Research organizations
10. Authorizations

You Have Rights with Respect To Health Care Information About You

This section of the notice will briefly mention each of these rights. If you would like to know more about your rights, please contact our Privacy Officer.

1. Right to a copy of this notice
You have the right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this notice will be posted in clear and prominent locations. Copies are available upon request.

2. Right of Access to inspect and copy
You have the right to review and to receive a copy of health information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of health care information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out the Request To Access Protected Health Information form, a copy of which is available from the Privacy Officer. Our agency must act on this request no later than 30 days after receipt of the request.

3. Right to have health care information amended
You have the right to question the accuracy and completeness of health care information about you that we maintain in certain groups of records and have the right to have us amend (correct or add to) the health care information. If you believe we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. We may deny your request in certain circumstances and you have the right to grieve the decision.

4. Right to accounting of disclosures we have made
You have the right to receive an accounting (a detailed listing) of disclosures we have made for the previous six (6) years beginning April 14, 2003. If you would like to receive an accounting of disclosures, you may send us a letter requesting an accounting or fill out a Request for an Accounting of Disclosures form.

5. Right to request restrictions on uses and disclosures
You have the right to request that we limit the use and disclosure of health care information about you for treatment, payment, and health operations.

We are not required to agree to your request.

6. Right to request an alternative method of contact
You have the right to be contacted at a different location or by a different method. We will agree to any reasonable request for alternative methods of contact.

YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any way if you file a complaint.

To file a written complaint with Carolina Center for Counseling and Clinical Services, Inc., you may bring your complaint to your provider, his/her supervisor, the Privacy Officer or you may mail it to the following address:

Carolina Center for Counseling and Clinical Services, Inc.
227 Wilmot Drive
Gastonia, NC 28054

You may also send a written complaint to the United States Secretary of the Department of Health and Human Services for suspected violations of the Health Insurance Portability and Accountability Act (HIPAA)

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, DC 20201

1-866-627-7748
1-866-788-4989 (tdd)

Suspected violations of Federal Drug and Alcohol Law may be reported to the United States Attorney in the district where the violation occurs.
Our internet Privacy Policy: At CCCCS we would like you to know, protection of your personal information is highly important to us. By interacting with Carolina Center for Counseling through our website, your information is not collected, stored or tracked. If you email us and include personal information, we may use that information in responding to your request. You will not receive a response via email, but instead will be contacted by phone. We maintain administrative, technical and physical safeguards to protect your personal information. However, no website, mobile application, database system is completely secure or “hacker proof”. You are responsible for taking reasonable steps to protect your personal information against unauthorized disclosure or misuse.