Notice Of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This notice explains our data practices, specifically how your medical information may be used and shared with our business partners. Also, you will find information on how to access your information. Please read it carefully.

Your Rights

You have the right to:

  • Request for a copy of your medical record in electronic or hardcopy format.
  • Change your medical record saved on paper or electronic devices.
  • Ask for confidential communication.
  • Ask us to control the information we share.
Your Choices

You have some choices in the way that we use and share information as we:

  • Share the information about the condition with family and friends.
  • Provide disaster relief.
  • APromote our products/services and sell your information.
Our Uses and Disclosures

We may use and share your information as we:

  • Treating you or selling our products and services to you.
  • Running our organization.
  • Charging you for products and services.
  • Providing information for public health and safety issues.
  • Performing research.
  • Complying with the law for an investigation.
  • Processing organ and tissue donation requests.
  • Working with a medical examiner or funeral director.
  • Processing workers’ compensation, law enforcement, and other government requests.
  • Responding to lawsuits and legal actions.
Your Rights

When it comes to your health information, you have rights that must be protected. In this section, we review your rights and explain some of our responsibilities to help you.

Obtain an electronic or paper copy of your medical record

  • You have the right to request a hard (paper) or soft (electronic) copy of your medical record and other health data we have about you. Contact us for more information on how to request your information. We are an open book.
  • You can expect a summary or a copy of your health information within 30 days of your request. Kindly note that we may charge a reasonable, cost-based fee to process the information and deliver it to you.

Ask us to correct your medical record.

  • If a piece of information in your health record is incorrect or incomplete, you can ask us to change it. Ask us how to do this. Kindly Note: We may decline your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You have the right to choose a channel for communication. For example, choosing to receive information through your home or office phone or via mail to a different address.
  • We will agree to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share specific health information for treatment, payment, or our operations. We may decline your request if it would affect your care.
  • When you pay for a service or purchase a healthcare item out-of-pocket, you can ask us not to share the details of the purchase or our operations with your health insurer. We will only agree if the law does not require us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a report (accounting) showing the number of times we’ve shared your health information for six years prior to the date of your request. The report will contain the details of who we shared it with and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting report every year for free. Any other request for an accounting report before another 12 months will be charged reasonably.

Get a copy of this privacy notice

You can request a paper copy of this notice, even if you have opted for an electronic copy. Immediately we receive your request, we will process your paper copy promptly.

Choose someone to act for you

  • You can give a trusted relative the medical power of attorney. That relative or individual can exercise your rights and make choices about your health information.
  •  It is our duty to make sure that the person you choose has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You have the right to make a complaint if you believe we have violated your rights by contacting us using the information on page 6.
  • If we do not resolve the issue to your satisfaction, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
  • We will not respond with a counter-complaint. In such situations, our goal is to settle amicably.
Your Choices

For certain health information, you can choose what we share.

In these cases, you have the right and choice to tell us to:

  •  Share health information with your family, guardians, friends, or others involved in your care.
  • Share information in a disaster relief situation
  • Ask for confidential communication.
  • Ask us to control the information we share.

In situations where you are not able to tell us your preference. For example, if you are unconscious, we may share your information if we are confident that it is in your best interest. Also, we may share your information if it will lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
Our Uses and Disclosures

How Do We Typically Use Or Share Your Health Information?

Typically, we use or share your health information in any of these ways:

Treat you

We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you asks us for a list of your current medications.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities
Example: We give information about you to your health insurance plan so it will pay for your services.

How Else Can We Use Or Share Your Health Information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety
  • Reporting to the state immunization registry

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

We can share health information about you with organ procurement organizations.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities
  • We are required by law to maintain the privacy and security of your protected health information.
  • We will inform you when a breach occurs that may have compromised the privacy of your information.
  • We are bound by law to follow the duties and privacy practices stated in this notice and give you a copy of it.
  • We will not use or share your information in a way that is not described in this notice unless you give us written permission. If you tell us we can, you are allowed to change your decision at any time. Let us know in writing if you change your mind.
Changes to the Terms of this Notice

We have the right to modify the terms of this notice, and the change will apply to all your information with us. Anytime we change our notice, you will be notified and can find the new notice on your website or in our office. If you need more information about this Notice or want to exercise any of your rights mentioned in the notice, kindly contact the Privacy Officer at the following address:


725 Cherry Rd., Suite 103, Rock Hill, SC 29732


(803) 327-1640


Effective Date: This notice is effective as of October 1, 2013.

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