THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ("Protected Health Information") ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS
This Notice of Privacy Practices
describes how Cumberland County CommuniCare, Inc. may use and
disclose your protected health information (“PHI”) in accordance
with all applicable law. It also describes your rights regarding how
you may gain access to and control your PHI. We are required by law
to maintain the privacy of PHI and to provide you with notice of our
legal duties and privacy practices with respect to PHI. We are
required to abide by the terms of this Notice of Privacy Practices.
CommuniCare reserves the right to change the terms of our Notice of
Privacy Practices at any time. Any new Notice of Privacy Practices
will be effective for all PHI that we maintain at that time. We will
make available a revised Notice of Privacy Practices by posting a
copy on our website
http://www.cccommunicare.org/, sending a copy to you in the mail
upon request, or providing one to you at your next appointment.
The confidentiality of all medical records including alcohol and
drug abuse consumer/client records is specifically protected by
Federal law and regulations. The confidentiality of mental health
patient records is specifically protected by North Carolina state
law. CommuniCare, Inc. is required to comply with these additional
restrictions. This includes a prohibition, with very few exceptions,
on informing anyone outside the program that you attend the program,
or disclosing any information that identifies you as an alcohol or
drug abuser or mental health patient. The violation of these laws or
regulations by this program is a crime. If you suspect a violation
you may file a report to the appropriate authorities in accordance
with applicable law.
How We May Use and Disclose Health
Information About You
Listed below are examples of the uses and disclosures that
Cumberland County CommuniCare, Inc. may make of your PHI.
These examples are not meant to be exhaustive, but describe the
types of uses and disclosures that may be made.
Uses and Disclosures of PHI for Treatment,
Payment and Health Care Operations
Treatment. Your PHI may be used and disclosed by your
counselor, program staff and others outside of our program who are
involved in your care for the purpose of providing, coordinating, or
managing your health care treatment and any related services. This
includes coordination or management of your health care with a third
party, consultation with other health care providers or referral to
another provider for health care treatment. For example, your
protected health information may be provided to the state agency
that referred you to our program to ensure that you are
participating in treatment. In addition, we may disclose your
protected health information from time-to-time to another physician
or health care provider (e.g., a specialist or laboratory) who, at
the request of the program, becomes involved in your care. Except
for emergency services, we will not send your PHI to an outside
health care provider who is caring for you unless you give us
written authorization to do so.
Payment. Examples of payment-related activities are:
making a determination of eligibility or coverage for insurance
benefits, processing claims with your insurance company, reviewing
services provided to you to determine medical necessity, or
undertaking utilization review activities. If you are in a substance
abuse treatment program, we will not use your PHI to obtain payment
for your health care services without your written authorization. If
you are in a mental health program component, we may use your PHI to
obtain payment for your health care services without your written
Healthcare Operations. We may use or disclose, as needed,
your PHI in order to support the business activities of our program
including, but not limited to, quality assessment activities,
employee review activities, training of students, licensing, and
conducting or arranging for other business activities. For example,
we may use a sign-in sheet at the registration desk where you will
be asked to sign your name and indicate your counselor. We may also
call you by name in the waiting room when it is time to be seen. We
may share your PHI with third parties that perform various business
activities (e.g., billing or typing services) for Cumberland County
CommuniCare, Inc., provided we have a written contract with the
business that prohibits it from re-disclosing your PHI and requires
it to safeguard the privacy of your PHI. We may utilize various
forms of communication including voice, electronic transfer and
email for healthcare operations and payment purposes.
We may contact you to remind you of your appointments or to
provide information to you about treatment alternatives or other
health-related benefits and services that may be of interest to you.
Other Uses and Disclosures That Do Not Require Your
Required by Law. We may use or disclose your PHI to the
extent that the use or disclosure is required by law, made in
compliance with the law, and limited to the relevant requirements of
the law. You will be notified, as required by law, of any such uses
or disclosures. Under the law, we must make disclosures of your PHI
to you upon your request. In addition, we must make disclosures to
the Secretary of the Department of Health and Human Services for the
purpose of investigating or determining our compliance with the
requirements of the Privacy Rule.
Health Oversight. We may disclose PHI to a health
oversight agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this
information include government agencies and organizations that
provide financial assistance to the program (such as third-party
payers) and peer review organizations performing utilization and
Medical Emergencies. We may use or disclose your PHI in a
medical emergency situation to medical personnel only. Our staff
will try to provide you a copy of this notice as soon as reasonably
practicable after the resolution of the emergency.
Child Abuse or Neglect. We may disclose your PHI to a
state or local agency that is authorized by law to receive reports
of child abuse or neglect. However, the information we disclose is
limited to only that information which is necessary to make the
initial mandated report.
Deceased Patients. We may disclose PHI regarding deceased
patients for the purpose of determining the cause of death, in
connection with laws requiring the collection of death or other
vital statistics, or permitting inquiry into the cause of death.
Research. If you are in a substance abuse treatment
program, we may disclose PHI to researchers if (a) you have signed
an authorization or (b) the Board and management of CommuniCare,
Inc. reviews and approves a waiver to the authorization requirement
(such as in cases where clinical outcomes are being researched and
no identifying data/information will be released to the researcher).
If you are in a mental health program component, information may be
disclosed for research purposes only with your authorization.
Criminal Activity on Program Premises/Against Program
Personnel. We may disclose your PHI to law enforcement officials
if you have committed a crime on program premises or against program
Court Order. We may disclose your PHI if the court issues
an appropriate order and follows required procedures.
Interagency Disclosures. Limited PHI may be disclosed for
the purpose of coordinating services among government programs that
provide substance abuse and/or mental health services where those
programs have entered into an interagency agreement.
Public Safety. If you are in one of our treatment or case
support programs, we may disclose PHI to avert a serious threat to
health or safety, such as physical or mental injury being inflicted
on you or someone else.
Uses and Disclosures of PHI With Your
Other uses and disclosures of your PHI will be made only with
your written authorization. You may revoke this authorization at any
time, unless the program or its staff has taken an action in
reliance on the authorization of the use or disclosure you
Your Rights Regarding Your Protected Health
Your rights with respect to your protected health information are
explained below. Any requests with respect to these rights must be
in writing. A brief description of how you may exercise these rights
You have the right to inspect and copy your Protected Health
You may inspect and obtain a copy of PHI that is contained in a
designated record set for as long as we maintain the record. A
“designated record set” contains medical and billing records and any
other records that the program uses for making decisions about you.
Your request must be in writing, except if you are in a mental
health treatment program component in which case we will accept a
verbal request but record such reviews in the actual medical record.
We may charge you a reasonable cost-based fee for the copies. We can
deny you access to your PHI in certain circumstances. In some of
those cases, you will have a right to appeal the denial of access.
Please contact our Privacy Officer if you have questions about
access to your medical record.
You may have the right to request amendment of your Protected
You may request, in writing, that we amend PHI that has been
included in a designated record set. 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 it. Please contact the Cumberland County
CommuniCare, Inc. Privacy Officer if you have questions about
amending your medical record.
You have the right to receive an accounting of some types of
Protected Health Information disclosures.
You may request an accounting of disclosures for a period of up
to six years (excluding disclosures made to you, made for treatment
purposes, made as a result of your authorization, and certain other
disclosures). We may charge you a reasonable fee if you request more
than one accounting in any 12-month period. Please contact our
Privacy Officer if you have questions about accounting of
You have a right to receive a paper copy of this notice.
You have the right to obtain a copy of this notice from us. Any
questions should be directed to our Privacy Officer.
You have the right to request added restrictions on
disclosures and uses of your Protected Health Information.
You have the right to ask us not to use or disclose any part of
your PHI for treatment, payment or health care operations or to
family members involved in your care. Your request for restrictions
must be in writing and we are not required to agree to such
restrictions. Please contact our Privacy Officer if you would like
to request restrictions on the disclosure of your PHI.
You have a right to request confidential communications.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative
location. We will accommodate reasonable, written requests. We may
also condition this accommodation by asking you for information
regarding how payment will be handled or specification of an
alternative address or other method of contact. We will not ask you
why you are making the request. Please contact your clinician or
community support provider/worker if you would like to make this
If you believe we have violated your privacy rights, you may file
a complaint in writing to us by notifying our Privacy Officer:
Yvonne Smith, M.A., Substance Abuse
Services Program Manager
711-B Executive Place, Fayetteville,
We will not
retaliate against you for filing a complaint. You may also file a
complaint with the U.S. Secretary of Health and Human Services by
contacting the regional Office of Civil Rights (OCR) to learn more
regarding HIPAA and to learn about specific instructions as to how
to file a complaint:
Region IV - AL, FL, GA, KY,
MS, NC, SC, TN
Office for Civil Rights
U.S. Department of Health & Human Services
61 Forsyth Street, SW. - Suite 3B70
Atlanta, GA 30323
(404) 562-7886; (404) 331-2867 (TDD)
(404) 562-7881 FAX
From the OCR's web site, the following text is
"Anyone can file written complaints with OCR by mail, fax, or
email. If you need help filing a complaint or have a question
about the complaint form, please call this OCR toll free number:
1-800-368-1019. OCR has ten regional offices, and each regional
office covers certain states. You should send your complaint to the
appropriate OCR Regional Office, based on the region where the
alleged violation took place."
Instructions for how to file a
complaint can also be found at this web address:
The effective date of this Notice is August 1, 2006 and is