Privacy Statement
 This notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please read carefully.
Legal Duty
Our practice is required by law to: (1) PROTECT the privacy of your personal health information, (2) PROVIDE this notice about our information practices, and (3) FOLLOW the information practices that are described below.
Understanding Health Information
Each time you visit our practice, a record of the visit is made. Typically, this record contains your history, symptoms, examination and test results, diagnoses, treatment, and a plan for your future treatment. This information, often referred to as your health or medical record, serves as a:
Basis for planning your care and treatment as a means of communication among the health professionals who care for you or your child.
- Legal document describing the care you received.
- Record to prove that services billed, are actually provided.
- Tool in educating health professionals.
- Source of data for medical research.
- Source of information for public health officials.
Understanding what is in your record and how your health information is used helps you to ensure it is correct and how others share it. Moreover, this understanding allows you to make informed decisions when authorizing disclosure to others.
We will not use or disclose your health information without your authorization, EXCEPT as described in this notice.
How We Will Use or Disclosure Health Information
TREATMENT: We will record information we obtain during the visit in the medical record and share this information with other members of the healthcare team.
PAYMENT: A bill may be sent to your insurance that includes information that identifies you, as well as, your diagnosis and services provided.
HEALTH CARE OPERATIONS: We may use the information in your record to assess the care and treatments provided in our practice.
BUSINESS ASSOCIATES: There are services provided in our practice through contracts with business associates. Some examples include our computer hardware vendor and answering service. When these services are provided, we may disclose health information to our business associates so they can perform the job we asked them to do. However, to protect your health information, we require the business associates to appropriately protect your information.
COMMUNICATION WITH FAMILY: Health professionals, using their best judgment, may disclose to a family member, other relative, or any other person you identify, health information relevant to that person’s involvement in your care or the care of your child or payment of services provided.
CONFIRMATION OF PATIENT APPOINTMENTS and FOLLOW UP CALLS: This practice confirms all patient appointments including consultations, follow-ups, and surgical procedures. This practice conducts surgical follow up calls on patients. Confirmation and follow up calls are done via answering machine, personal messages, cellular communication, and any other method deemed appropriate.
RESEARCH: We may disclose information to researchers when an institutional review board has approved the research project. Patient information released will not contain patient name, social security number, date of birth, or address. The institutional review board ensures methods have been established to guarantee the privacy of the medical and / or outcomes information.
FUNERAL DIRECTORS: We may disclose health information to funeral directors and coroners to carry out duties consistent with the law.
ORGAN PROCUREMENT ORGANIZATIONS: In accordance with the law, we may disclose health information to organ procurement organizations for their designated services.
COMMUNICATION AND MARKETING: We may contact you to provide appointment reminders, information about treatment alternatives, or other health related benefits and services that may be of interest to you.
FOOD AND DRUG ADMINISTRATION (FDA): We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
WORKER’S COMPENSATION: We may disclose health information to the extent authorized by state law governing workers compensation health care services.
PUBLIC HEALTH: As required by law, we may disclose health information to public health officials charged with preventing or controlling disease, injury, or disability. For example, we may report communicable diseases.
LAW ENFORCEMENT: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. We may disclose information to correctional facilities as required by law. If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof, health information necessary for your health and the health and safety of other individuals. We may report suspected child or spousal abuse.
REPORTS: We may disclose health information when directed by the appropriate federal oversight agency related to any complaints, surveys, or requests.
Your Health Information Rights
Although your health record is the physical property of the practice, the information in the health record belongs to you or your child. You have the following rights:
- You may request that we not use or disclose information for a particular reason related to treatment, payment, or health care operations to a particular family member or other relative. We ask that a request be made in writing on a form that we will provide. We will consider your request, but please be aware that we are not obligated to accept or abide by it. We will review each request individually to determine if we can honor your request.
- If you would like to receive information from our office in another manner, you may request that we provide it in a different way. These types of requests may be made in writing on a form that we will provide. We will attempt to accommodate all reasonable requests.
- You may request to inspect or obtain a copy of your medical information; we may charge a reasonable fee for copying the record. We will try to provide you with the information within 30 days of your written request.
- You may amend your health record as provided in 45 CFR 164.526. Such request must be made using a form that we will provide. You may request this form at the front desk.
- You may request a written account of all disclosures made of your protected health information. This request may be made for all information we have after April 14, 2003. We will keep an account of these disclosures made OTHER THAN treatment, payment, or health care operations. We will retain this information for six years.
- You have a right to obtain a paper copy of this notice.
- We must obtain a written authorization from you to disclose information for purposes other than treatment, payment, or health care operations. You have the right to revoke this authorization, except to the extent we have already used or disclosed the information.
Concerns and Complaints
If you are concerned that Carolina Oral & Facial Surgery, P.A. may have violated your privacy rights, or if you disagree with any decision we have made regarding access or disclosure of your health information, please contact our privacy officer at the address listed below. You may also send a written complaint to the U.S. Department of Health and Human Services. For further information on our privacy practice, please make the following contact:
Privacy Officer
Carolina Oral & Facial Surgery, P.A.
39 Brendan Way
Greenville, SC 29615
Changes to This Policy
Carolina Oral & Facial Surgery may change or update this policy at any time. When changes are made, a new notice of privacy practices will be posted in the waiting room. You may request an updated copy of our notice at any time.
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