Mid Carolina Cardiology 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.

Our practice is required to maintain the privacy of information related to patients and to follow the terms of our current "Notice of Privacy Practices." This document is our Notice of Privacy Practices (which is simply called our "notice" in this document.)

This notice is effective as of April 14, 2003. We reserve the right to change the notice as we feel is necessary in the future. Notice changes may be applied to all information held by the entity even if it was created or received prior to the effective date of the change. Policy revisions will become effective upon posting the new notice in our office, making the revised notice available upon request, and posting the it on our web page. Upon request, you will be provided with a written copy of the Notice currently in effect. However, the most efficient way to obtain a copy of our current notice will be on the internet at: www.mccardiology.com. The version at this web page will always be the most current notice.

Our practice follows internal policies designed to protect the privacy of protected health information. These policies identify which employees are permitted access to information to carry out their job functions and what assurances are needed prior to disclosing information to associates who carry out functions for the practice.

Privacy regulations detail what healthcare providers can do with information that relates to patient care and the payment of that care. These regulations establish that physician practices can use or disclose information without authorization in the following cases…

• We may use information about you to contact you with appointment reminders, to inform you of treatment alternatives, and to notify you of health-related benefits and services that may be of interest to you.
• We can use and disclose information necessary to provide treatment to patients. For example, we might provide the findings of a diagnostic test to your primary care physician following a service so he or she can stay informed.
• We can use and disclose information needed to obtain payment for the services we render. For example, we routinely submit claims to insurance companies that summarize the services we provided to patients.
• We can use and disclose information for our operational needs. For example, we might analyze billing system data to better manage the practice.
• We may be required to provide records and reports to the Department of Health and Human Services to verify that we are following applicable rules.
• Information may be used or disclosed incident to a permitted or required use as specified in the Privacy Rule.
• We may provide protected health information to the person who is the subject of the information.
• After you've had an opportunity to agree or object (or after we exercise professional judgment in situations that do not allow for you to be consulted) we may disclose information to a family member, friend, or other person identified by you. The information disclosed will pertain to that person's involvement with your care or the payment of that care.
• After you've had an opportunity to agree or object or after we exercise professional judgment in situations that do not allow you to be consulted we may disclose information related to your family member, friend, or other person identified by you to notify them of your location, general condition, or death.
• After you've had an opportunity to agree or object (or after we exercise professional judgment in situations that do not allow for you to be consulted) we may disclose information for use in a facility directory.
• We may share information with an outside agency for use in disaster relief efforts.
• For purposes of research, public health, or health care operations; we may disclose a limited amount of information to an outside entity. The limited set of data will not include many pieces of information that could be used to identify you (such as your name and social security number.) When we make disclosures of this nature we will have a contract in which the receiving entity assures confidentiality. We may also contract with an outside entity to remove the above referenced pieces of information from our records.
• Federal, State, Local, or other law may require a disclosure.
• Many uses and disclosures are necessary for public health activities (for example, product recalls or reporting of communicable diseases.)
• Information related to victims of abuse, neglect, or domestic violence may be disclosed to the appropriate authorities.
• Disclosures necessary for health oversight are permitted in the regulations.
• Disclosures related to judicial and administrative proceedings (for example, in response to a court order) are allowed.
• Disclosures necessary for law enforcement are permitted.
• Disclosures to funeral directors, coroners, or medical examiners are permitted if it is information related to decedents.
• Certain disclosures are permitted and necessary to facilitate organ, eye, or tissue donation and transplantation.
• Some disclosures for research purposes are permitted if certain requirements established in the Privacy Rule have been met.
• Disclosures made to ward off serious threat to anybody's health or safety are permitted by the regulations.
• Disclosures related to specialized government functions (for example, concerns related to national security) are permitted.
• Disclosures necessary for workers' compensation are allowed under the rules.
• Disclosures related to inmates of correctional institutions or other law enforcement custodial situations are permitted without authorization.
• Finally, we may disclose information about you to an outside entity if we remove all pieces of information that could be used to identify you.


Uses and disclosures not mentioned above will require your written authorization. We will provide you with a standard authorization form should one ever be necessary. After you provide authorization you may cancel it with a written request at any time. We will honor your cancellation except for cases in which we already acted in reliance on the authorization.

Right to Request Restrictions

You may request a restriction on what we do with information about you as it relates to treatment, payment, or operational needs. You may also request restrictions on what information we disclose to family members (or other designated individuals) whom we notify of your location, general condition, or death. Restrictions may also be requested on disclosures of information to family members or other designated individuals involved in your care or the payment of your care.

We are not required to agree to requested restrictions. Restrictions that we do agree to may be terminated with or without your approval. If the restriction is terminated without your approval you will be notified and the restriction will be respected for information gathered or generated while the restriction was effective.

Requests for restrictions that are agreed to do not need to be honored in emergency treatment situations, when disclosures are required by the Secretary of the Department of Health and Human Services, or in most situations described in this notice as uses or disclosures not requiring authorization.

Right to Specify Alternative Contact Information

You may request in writing that we contact you through alternative pathways (such as a different mailing address or telephone number.) We will honor reasonable requests as long as we are provided with valid contact information and financial arrangements are made for the payment of your care. Requests for alternative pathways will be honored without requesting an explanation as to why the alternative pathway is requested.

Other Rights

You have the right to inspect and obtain a copy of the medical and billing information we maintain about you. We require requests for this information to be in writing (please ask if there is a special form available.) Prior to providing information of this nature we will collect a fee from you based on the amount of time and resources required to fulfill the request. With your approval we may provide you with a summary of the information we maintain rather than copies of the actual medical and billing information.

In certain cases we may deny requests for access to and copies of medical and billing information we maintain about you. In these instances we will provide you with our reasoning and inform you of your additional rights.

You have the right to request amendments to the clinical information, billing information, and other information we use to make decisions about you if we created and maintain the information. Requests must be in writing and they must include your reasoning for the requested amendment.

In certain cases we may deny your requests for amendment. In these instances we will provide you with our reasoning and inform you of your additional rights.

With few exceptions, you have the right to receive an accounting of certain disclosures we've made of the protected information we maintain that is related to you. This accounting will include disclosures made up to six years prior to your request but will not include disclosures made prior to April 14, 2003.

This accounting will exclude many disclosures permitted by the Privacy Rule including those made for treatment, payment, and operations; made to you; authorized by you; for directory purposes; made for national security or intelligence purposes; made to others if the disclosure is related to their involvement in your care or the payment of your care; made to others specified by you to notify them of your general condition, location, or death; made to correctional institutions or law enforcement officials (if related to an inmate); made as a byproduct of a permitted use or disclosure; made for research, public health, or health care operations if only a limited set of data is disclosed and a confidentiality agreement has been made with the person or entity that receives the data.

If you have one of several specific communicable diseases (for example, tuberculosis, syphilis or HIV/AIDS), information about your disease will be treated as confidential, and will be disclosed without your written permission only in limited circumstances. We may not need to obtain your permission to report information about your communicable disease to State and local officials or to otherwise use or disclose information in order to protect against the spread of the disease.

If you believe your privacy rights have been violated you may file a written complaint with our Privacy Officer at the following address: Privacy Officer, Mid Carolina Cardiology, 1718 East Fourth St., Suite 501, Charlotte, NC 28204. You may also file complaints directly to the Secretary of the Department of Health and Human Services. If you file a complaint we will not retaliate against you in any manner.

If you have questions about this Notice, wish to obtain copies of your records, or exercise the other rights summarized in this notice you may contact our Privacy Officer at the following telephone number: (704) 347-2028.