Best Clinic PLLC (“BCPLCC”) is committed to protecting the privacy and safeguarding the security of your Protected Health Information (“PHI”). Each time you receive services from BCPLCC or one of its affiliates (together, an affiliated covered entity), we record information that identifies you and relates to your medical condition, provision of health care, or payment for your treatment. Typically, this record consists of your medical history, symptoms, examination, observations, test results, diagnosis, care summaries, treatment, and future care plans. Understanding your health information and how it is used is important in maintaining its accuracy and confidentiality. This notice pertains to our workforce members and other health care providers we work with in a clinically integrated setting (e.g., members of our medical and clinical staff) and other participants in our organized health care arrangements, and pertains to uses and disclosures of your protected health information whether made verbally, on paper, or electronically, including through a health information exchange operated by BCPLCC or a business associate.

Your Rights

Although your medical record is the property of BCPLCC, the information belongs to you. You have important rights as a patient called information privacy rights. This Notice explains what those rights are and how you can exercise them.

Use and Disclosure

Federal privacy laws recognize that there is a need to use your information to deliver quality care and to run BCPLCC. Sometimes, we must obtain your permission before using or disclosing your information, for example, if your family member asks for your medical records. Other times, your permission is not needed to disclose your health information, such as, for us to file your billing information to receive payment from your insurance company. This Notice explains these different situations.

Our Obligations

We are required by law to maintain the privacy of PHI, provide you with this Notice of our legal duties and privacy practices with respect to PHI, and to notify you if you are affected by a breach of unsecured PHI.

We are required to abide by the terms of this Notice while it is in effect. We reserve the right to change the terms of our Notice and to make the new Notice provisions effective for all PHI that we maintain. If we change the terms of our Notice, we will make copies of the new Notice available to you and post a copy of the new Notice in a prominent location in our facility and on our website.

Right to Inspect and Copy

You have the right to inspect and receive a copy of your medical record unless your attending physician determines that information in that record, if disclosed to you, would be detrimental to your mental or physical health. If we deny your request to inspect and receive a copy of your PHI on this basis, you may request that the denial be reviewed. Another licensed healthcare professional chosen by BCPLCC will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the reviewer’s decision.

To inspect or receive a copy of PHI that may be used to make decisions about you, you must submit your request in writing to BCPLCC’s Privacy and Security Official. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request and may collect the fee before providing the copy to you.

Right to Amend

If you feel that PHI we have about you in your record is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for BCPLCC.

To request an amendment, your request must be made in writing and submitted to BCPLCC’s Privacy and Security Official. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason that supports your request. In addition, we may deny your request if you ask us to amend information that (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of PHI kept by or for BCPLCC; (3) is not complete. If we deny your request for an amendment, you may submit in writing a statement of disagreement and ask that it be included in your medical record.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of PHI about you during the prior six years. To request this list or accounting of disclosures, you must submit your request in writing to BCPLCC’s Privacy and Security Official and state whether you want the list on paper or electronically. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be at no cost. For additional lists, we may charge you for the costs 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 may collect the fee before providing the list to you.

Right to Request Restrictions

Except where we are required to disclose the information by law, you have the right to request a restriction or limitation on the PHI we use or disclose about you. For example, you could revoke any and all authorizations you had given us relating to disclosure of your PHI. We are not required to agree to your request. However, if you pay out of pocket in full for a healthcare item or service and request that we not share information with your health plan, we are required to agree to your requested restriction. In other situations, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions, you must make your request in writing to BCPLCC’s Privacy and Security Official. If you request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. You may request that we not disclose your PHI to any persons or entities that may be responsible for paying all or any portion of the charges you incur while a patient of BCPLCC. If you pay all such charges in full at the time of such request, we are required to agree to your request.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical 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, or at another mailing address other than your home address. We will accommodate all reasonable requests. We will not ask you the reason for your request. To request confidential communications, make your request in writing to BCPLCC’s Privacy and Security Official and specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice or any revised notice, even if you have agreed to receive this notice electronically. To obtain a paper copy of this notice, request a copy from BCPLCC’s Privacy and Security Official in writing.

How We May Use and Disclose Medical Information About Your Treatment

We may use PHI about you without authorization to provide you with medical treatment or services. This means we may disclose PHI about you to doctors, nurses, technicians, medical students, home health providers, volunteers, or other personnel who are involved in taking care of you at BCPLCC. For example, a doctor treating you for a broken hip may need to know if you have diabetes because diabetes may slow the healing process.

Payment

We may use and disclose PHI about you without authorization so that the treatment and services from BCPLCC may be billed by BCPLCC and payment may be collected from you, an insurance company, or a third party. For example, before we provide scheduled services to you, we may share information with your health plan to determine if services we provide to you will be covered by the plan. We also may share your information with government agencies to determine if you qualify for certain benefits. We may need to give your health plan information about treatment you received from BCPLCC so your health plan will pay us or reimburse you for the treatment.

Health Care Operations

We and our business associates may use and disclose PHI about you without authorization for health care operations. Health care operations refers to activities such as healthcare training and education, internal and external auditing functions, budgeting and planning, legal services and compliance programs, credentialing and licensing, bill and collect payment, and other related activities. The purpose for these uses and disclosures is to ensure that BCPLCC can operate effectively and make sure that all of our patients receive quality care.

Health-Related Benefits, Services, and Treatment Alternatives

We may use and disclose PHI to remind you of appointments you have with us. We may also use and disclose PHI to tell you about health-related benefits, services, or treatment alternatives that may be of interest to you. You may elect not to receive any communications from us that encourage you to purchase or use any particular product or service by notifying BCPLCC’s Privacy and Security Official in writing. If we receive direct or indirect payment in exchange for such communications to you, we will obtain your written authorization to use or disclose your health information before advising you in writing about such benefits or services, unless the communication either describes a drug you currently are being prescribed and the payment we receive for that communication is reasonable, or the communication to you is made by a business associate of BCPLCC acting on our behalf and in accordance with a written agreement between the business associate and BCPLCC.

To Our Business Associates

We provide some services through other businesses we call business associates. We may give business associates health information about you so they can do the job we asked them to. For example, we might use a copy service to make copies of requested medical records. When we do this, we require the business associate to safeguard health information about you.

Fundraising Activities

We may use PHI about you to contact you in an effort to raise money for BCPLCC and its operations. You have the right to opt out of receiving fundraising communications from us. We may disclose PHI to a business partner or a foundation related to BCPLCC so that the business partner or the foundation may contact you in raising money for BCPLCC. We would only release contact information, such as your name, address, and phone number, and the dates you received treatment or services from BCPLCC. We will ask you every time we contact you regarding fundraising activities, and if you do not want BCPLCC to contact you for fundraising efforts, you must notify BCPLCC’s Privacy and Security Official in writing. If you opt out of future fundraising communications, we will not disclose your information for fundraising purposes unless in the future we receive your written authorization.

Research

Under certain circumstances, we may use and disclose PHI about you in research purposes or to people to conduct a research project. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition. We will not be permitted to receive any money or any other thing of value in connection with the use or disclosure of your PHI for research purposes unless the money we receive reflects the costs to prepare and transmit the PHI to the researcher or unless we notify you in advance and we obtain your written authorization.

Individuals Involved In Your Care or Payment For Your Care

We may release PHI about you to a friend or family member who is involved in your medical care. This would include persons named in your current HIPAA Release Form or similar document provided to us. We may also give limited information to someone who helps pay for some or all of your care. In addition, we may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. You can object to these releases by telling us that you do not wish any or all individuals involved in your care to receive this information. If you are not present or cannot object, we will use our professional judgment to decide whether it is in your best interest to release information to someone who is involved in your care or to assist in a disaster relief effort.

As Required or Permitted By Law

We will disclose PHI about you when required or permitted to do so by federal, state, or local law. This may include: (1) Pursuant to legal order, such as a subpoena or other lawful order; or (2) Law Enforcement needs; such as a warrant, grand jury demand, or similar process; or (3) To report suspected criminal activity, assist in missing persons issues; or (4) To report name and address in motor vehicle accident cases; or (5) To avert a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to someone who appears able to help prevent the threat and will be limited to the information needed.

BCPLCC′s Obligation To You

Protect Your Health Information

BCPLCC is required by law to maintain the privacy of your protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. We must also abide by the terms of this Notice of Privacy Practices while it is in effect. This Notice will remain in effect until we replace it.

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 PHI 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 the BCPLCC office. The Notice will contain on the first page, in the top right-hand corner, the effective date. If the Notice changes, a copy will be available to you upon request.

Investigations of Breaches of Privacy

We will investigate any discovered unauthorized use or disclosure of your PHI to determine if it constitutes a breach of the federal or state privacy or security regulations governing unsecured PHI. If we determine that such a breach has occurred, we will provide you with notice of the breach and advise you what we intend to do to mitigate the damage (if any) caused by the breach, and about the steps you should take to protect yourself from potential harm resulting from the breach.

Your Authorization

In addition to our use of your health information for the purposes listed herein, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. Further, you may revoke that authorization in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it is in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except as described in the Notice.

Special Situations

Active Duty Military Personnel and Veterans

If you are an active duty member of the armed forces or Coast Guard, we must give certain information about you to your commanding officer or other command authority so that your fitness for duty or for a particular mission may be determined. We may also release information about foreign military personnel to the appropriate foreign military authority. We may use and disclose to components of the Department of Veterans Affairs PHI about you to determine whether you are eligible for certain benefits.

Workers′ Compensation

In accordance with state law, we may release your PHI about your treatment for a work-related injury or illness or for which you claim workers’ compensation to your employer, insurer, or care manager paying for that treatment under a workers’ compensation program that provides benefits for work-related injuries or illness.

Public Health Risks

We may disclose without your consent PHI about you for public health activities. These activities generally include but are not limited to the following: (1) To prevent or control disease, injury, or disability; (2) To report deaths; (3) To report reactions to medications or problems with products; (4) To notify people of recalls of products they may be using; (5) To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; (6) To report suspected abuse or neglect as required by law.

Health Oversight Activities

We may disclose PHI to a health oversight agency for activities authorized by law without your consent. These oversight activities include, for example, audits, investigations, inspections, and licensure. The government uses these activities to monitor the health care system, government programs, and compliance with civil rights laws.

Decedents

We may disclose health information about a decedent as authorized or required by law to a Coroner or Medical Examiner. Similarly, if you are an organ donor, we may release PHI to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

National Security and Intelligence Activities

We may release without your consent PHI about you as required by applicable law to authorized federal or state officials for intelligence, counterintelligence, or other governmental activities prescribed by law to protect our national security. Similarly, we may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct investigations.

Minors

Generally, a parent or guardian has access to their minor’s health records. However, state law provides that minors can be either emancipated or may consent to certain classes of treatment, including (1) the right to consent to medical health services for the prevention, diagnosis, and treatment of communicable disease as defined by law; (2) pregnancy; (3) abuse of controlled substances or alcohol; and (4) emotional disturbance. If a healthcare provider treats either an emancipated minor or a minor upon their own consent to one of those classes of treatment, then the provider must not disclose information about the treatment to the minor’s parent or guardian. A provider may disclose the minor’s health information if the minor gives permission for the disclosure, the disclosure is essential to protect the life or health of the minor, or the parent contacts the provider and asks about treatment being provided to the minor.

Psychotherapy Notes

Regardless of the other parts of this Notice, psychotherapy notes will not be disclosed outside BCPLCC except as authorized by you in writing, pursuant to a court order, or as required by law. Psychotherapy notes about you will not be disclosed to personnel working within BCPLCC, other than to the person who wrote the notes, except for training purposes or to defend a legal action brought against BCPLCC, unless you have properly authorized such disclosure in writing.

Inmates

If you are an inmate of a correctional institution or in the custody of law enforcement, we may release PHI about you to the correctional institution or law enforcement official who has custody of you, if they represent to BCPLCC that such PHI is necessary: (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) to protect the safety and security of officers, employees, or others at the correctional institution or involved in transporting you; (4) for law enforcement to maintain safety and good order at the correctional institution; or (5) to obtain payment for services provided to you. If you are in the custody of the North Carolina Department of Corrections (“DOC”), and the DOC requests your medical records, we are required to provide the DOC with access.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with BCPLCC or with the Secretary of the United States Department of Health and Human Services. To file a complaint with BCPLCC, please contact BCPLCC’s Compliance and Patient Safety Official by mail

You will not be penalized or retaliated against for filing a complaint.

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, please contact the BCPLCC Privacy and Security Official at: