Raleigh Ear, Nose, and Throat, Head and Neck Surgery, Inc.
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. The privacy of your health information is important to us.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.

We are required by law to follow the practices described in this Notice. We may change the terms of this Notice at any time. The new Notice will be effective for all protected health information we maintain at that time including health information we created or received before we made the changes.

You may obtain a copy of our Notice of Privacy Practice at any time by accessing our web site at www.raleighent.net, calling the office and requesting that a copy be mailed to you, or asking for one at the time of an appointment.

Uses and Disclosures of Health Information

Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physicians’ practice, and any other use required by law.

Following are some examples of the types of uses and disclosures of your protected health information that the physicians’ office is permitted to make. These examples are not meant to be all inclusive, but to serve as examples of uses and disclosures that may be made by our office.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you and physicians to whom you may have been referred so that they have the necessary information to diagnose or treat you.

Payment: We may use and disclose your protected health information to obtain payment for services we provide you. This will include providing protected health information to your health insurance plan to obtain approval for any procedures that we recommend for you and to obtain approval for any inpatient or outpatient procedures and hospital stays.

Healthcare Operations: We will use and disclose your health information to conduct the business activities of this office. These activities include, but are not limited to, quality assessment and improvement activities, review of performance and qualifications of employees, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities, or arranging for other business activities.

You will be asked to check in at our front desk by giving us your name. We may also ask you to verify your address and insurance information at that time. We will call you by name when we are ready to begin your treatment.

We may use or disclose your protected health information, as necessary, to call to remind you of your appointment or to advise you that certain medical supplies or items you may have ordered or left with us are ready to be picked up. If you are not available when we call the information will be left with whoever answers the phone or on an answering machine. Our office mails out appointment reminder cards when a physician requests that you come back for a return visit and the appointment has not been made.

We will share your protected health information with third party "business associates" that perform various activities (e.g. billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you. We may also use your name and address to send you a newsletter about our practice and services that we offer.

Others Involved in Your Healthcare: We may disclose your health information to a family member or other person to the extent necessary to help with your healthcare or payment for your healthcare. If we determine it is in your best interest based on our professional judgment or experience with common practices, we may allow another person to pick up prescriptions, medical supplies, hearing aids, allergy serum, x-rays, or other forms of health information. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition, or death.

Other permitted and required uses and disclosures that may be made without your authorization or opportunity to object: We may use or disclose your protected health information in the following situations without your authorization. These situations include: as required by law, Public Health issues as required by law, communicable diseases, health oversight, abuse or neglect, Food and Drug Administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, criminal activity, military activity and national security, worker’s compensation, inmates. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Your Rights

You have a right to obtain a copy and/or inspect your health information. Health information includes treatment records, billing records, and any other records used by us to make decisions about your treatment. You may obtain a form from our office to request access. A reasonable cost based fee will be charged for expenses. Contact us as indicated at the end of this notice to obtain information about our fees or if you have any questions about your access.

You have a right to request a restriction on the use and disclosure of your protected health information. You may ask us not to use or disclose some part of your protected health information for the purposes of treatment, payment, or operations. You may also request that we not disclose some part of your information to family and others who may be involved in your care or for notification purposes as otherwise described in this notice. We are not required to agree to the restrictions. You may request a restriction by sending your request in writing to the address at the end of this notice.

You have a right to request to receive confidential communications by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. This request must be made in writing and directed to the address at the end of this notice.

You have the right to request an amendment to your protected health information. You may request that we amend protected health information about you. Your request must be in writing with an explanation as to why the information should be amended. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right excludes disclosures for treatment, payment, or healthcare operations as described in this Notice of Privacy Practices, to you, to family members or friends involved in your care, for notification purposes or as a result of an authorization signed by you. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003 for up to the previous six years. The right to receive this information is subject to certain exceptions, restrictions, and limitations.
You have the right to obtain a paper copy of this notice from us even if you have agreed to accept this notice electronically.

Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our office of your complaint. We will not retaliate against you for filing a complaint. You may contact our office at (919) 787-7171 for further information about the complaint process. Written requests should be directed to:
Privacy Officer
Raleigh Ear, Nose, and Throat, Head and Neck Surgery, Inc
3010 Anderson Drive
Raleigh, North Carolina 27609

This notice was published and becomes effective on or before April 14, 2003.