NOTICE OF PRIVACY PRACTICES
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION (PHI) ABOUT YOU AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
We understand that information about you, your health, and your health care is personal. We are committed to protecting the security of that information, your protected health information (PHI), and to preventing its disclosure without your authorization, when required. In conducting our business we will create records regarding you and the services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain when providing our services.
The information you provide is strictly voluntary. To protect you, we do not request nor will we allow you to submit your social security number, birth date, or health insurance numbers. We limit the collection of personal information to only the information necessary to provide you with quality services and to comply with certain legal requirements.
We realize that these laws are complicated, but we must provide you with the following important information:
How we may use and disclose your PHI
Your privacy rights in your PHI
Our obligations concerning the use and disclosure of your PHI
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Darla Iuliucci, Director of Partnerships, NavigateCancer Foundation, at 919-267-2059.
C. HOW WE MAY USE AND DISCLOSE YOUR PHI:
1. Treatment: The information we collect is for the sole use of helping to navigate your cancer issue. There are only seven pieces of information on the health profile that is required before your question can be answered. The seven questions necessary to complete are age, gender and a few questions relating to the pending or actual cancer diagnosis. The remaining questions on the profile are not mandatory but the more complete the profile is, the better our team will be able to help you.
To register with the NCF and use our online services, you will create your own login and password. This ensures your confidentiality. All communication is done within your account.
Your health profile is maintained inside your personal account and may be viewed only by you and the NCF personnel who are involved in helping you navigate your cancer.
2. Operations: We may use and disclose protected health information about you for the operation of our organization. These uses and disclosures are necessary to run NavigateCancer Foundation and to make sure that all our patients receive quality care. For example, we may use health information in a general review of our treatments and services or, more specifically, to evaluate the performance of our staff in caring for you. We may also combine the health information of many patients to decide what improvement we could make, what additional services we should offer, what services are not needed, or whether certain new treatments are effective. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning the identity of specific patients.
3. Appointment Reminders: We may use and disclose your PHI to contact you and remind you of an appointment or to schedule follow up appointments.
4. Fundraising Activities: From time to time we may use your protected health information (PHI) to contact you in an effort to raise money for our not-for-profit operations. We may disclose health information to a business associate that may then contact you to raise money for our practice. We only will release contact information, such as your name, address, and phone number. In these instances, as well as in all future fundraising activities, we will give you the option to opt out of the fundraising communication.
5. Research: Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing patients who receive our navigation services with those who do not. All possible PHI will be removed prior to reporting unless we have received your consent to participate in the research study.
6. As Required by Law: We will disclose health information about you when required to do so by federal, state, or local law.
7. To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
8. Military and Veterans: If you are a member of the armed forces or separated or discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans’ Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities.
D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
1. Public Health Risks: We may disclose health information about you for public health activities. These activities generally include the following:
The prevention or control of disease, injury, or disability
The reporting of child abuse or neglect
The reporting of reactions to medications or problems with products
The notification of people about recalls of products they may be using
The notification of a person or organization required to receive information on Food and Drug Administration–regulated products
The notification of a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
The notification of the appropriate government authority, if we believe a patient has been the victim of abuse, neglect, or domestic violence (we will only make this disclosure if you agree or when required or authorized by law)
2. Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
3. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
4. Law Enforcement: We may release health information if asked to do that by a law enforcement official:
In response to a court order, subpoena, warrant, summons, or similar process
To identify or locate a suspect, fugitive, material witness, or missing person (name and address, date of birth or place of birth, social security number, blood type or Rh factor, type of injury, date and time of treatment and/or death, if applicable, and a description of distinguishing physical characteristics)
In emergency circumstances to report a crime; the location of a crime or victims; or the identity, description, or location of a person who committed a crime
5. National Security and Intelligence Activities: We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
6. Protective Services for the President and Others: We may disclose health information about you to authorized federal officials so they may conduct special investigations or provide protection to the President, other authorized persons, or foreign heads of state.
7. Inmates: We may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
E. YOUR RIGHTS REGARDING YOUR PHI
1. Right to Inspect and Copy: You have the right to inspect and copy health information such as medical records that may be used to provide you with services.
In order to request inspection and copying of health information that may be used to make decisions about you, submit a written request to Darla Iuliucci, Director of Partnerships, 5488 Apex Peakway #328, Apex, NC 27502-3924. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request review of the denial. This review will be conducted by another health care professional chosen by our organization. The person conducting the review will not be the person who denied your request. This practice will comply with the outcome of the review.
2. Right to Request Information in a Form of Your Choosing: You have the right to request the provision of protected health information (PHI) in a form of your choice such as paper or electronic. We will grant or deny the request within 30 days, and we may at times request a 30-day extension period. If any of the protected health information (PHI) is stored off-site, we will respond to your request within 60 days. We may charge you a reasonable, cost-based fee for preparing the information that you request.
3. Right to Request that We Send Information to Other Designated Parties: You have the right to request that we send copies of your protected health information (PHI) to other designated parties, provided that you submit a written signed request, designating the name, identity, and correct address of the designated recipient.
4. Right to Amend: If you believe that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing on the Request for Correction/Amendment of Protected Health Information form and submitted to Darla Iuliucci, Director of Partnerships, 5488 Apex Peakway #328, Apex, NC 27502-3924 . On the form you must include information supporting and the reasons for your request.
We may deny your request for an amendment if it is not in writing or does not include a reason for the request. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
Is not part of the health information kept by or for our practice
Is not part of the information that you would be permitted to inspect and copy
Is accurate and complete
Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.
5. Right to an Accounting of Disclosures: You have the right to request a list of the disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described.
To request this list of disclosures, you must submit your request in writing to Darla Iuliucci, Director of Partnerships, 5488 Apex Peakway #328, Apex, NC 27502-3924. Your request must state a time period that may not be longer than 6 years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in writing within 30 days of your request. If we are unable to provide you with this information within 30 days, we will notify you of that fact and inform you of the date by which we can supply the list. This date will not be more than 60 days from the date you made the request.
6. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we withhold your information from a specified nurse or that we not disclose information to your spouse.
We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively affect the care we provide you.
If we do agree, we will comply with your request, unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request in writing to Darla Iuliucci, Director of Partnerships, 5488 Apex Peakway #328, Apex, NC 27502-3924. to Request Restrictions on the Use and Disclosure of PHI form. In your request, you must tell us what information you want to limit and to whom you want the limits to apply.
7. Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box.
To request confidential communications, you must make your request in writing to Darla Iuliucci, Director of Partnerships, 5488 Apex Peakway #328, Apex, NC 27502-3924. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.
8. Right to Be Notified Should there Be a Breach: You have the right to receive notice from us regarding a breach in disclosure of protected health information (PHI).
9. Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this notice at any time. To obtain a copy, please request it from Darla Iuliucci, Director of Partnerships, 5488 Apex Peakway #328, Apex, NC 27502-3924.
10. Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at each of our sites and on our website.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services in Washington, DC. To file a complaint with us, complete our Patient Comment and Privacy Complaint Form. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
12. Other Uses of Health Information
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information (PHI) about
4about you for the reasons covered by your written authorization. We cannot revoke any disclosures that we have already made with your permission. We are required to retain our records of the care that we provided to you.
13. Acknowledgment of Receipt of This Notice
By selecting to set up an online account with NavigateCancer Foundation you acknowledging that you have received information about how your personal health information may be used and disclosed as required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability act of 1996 (HIPAA).
"At a time when our world had suddenly changed for the worst, our nurse consultant became our guiding light to help us make crucial decisions."
- Bill and Jane N.
Breast Cancer Survivor, North Carolina
Breast Cancer Survivor, North Carolina