Your Information. Your Rights. Our Responsibilities.
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. DATE: June 1, 2020
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.
Information regarding your health care, including payment for health care, is protected by the two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. 290dd-2, 42 C.F.R. Part 2. Under these laws, SouthLight (Southlight, Inc.) may not say to a person outside SouthLight that you attend the program, nor may SouthLight disclose any information identifying you as an alcohol or drug abuser, nor disclose any other protected information except as permitted by federal law.
SouthLight must obtain your written consent before it can disclose information about you for payment purposes. For example, SouthLight must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written authorization before SouthLight can share information for treatment purposes or for health care operations. However, federal law permits SouthLight to disclose information without your written permission:
- Pursuant to an agreement with a business associate;
- For research, audits, or program evaluations;
- To report a crime committed on SouthLight, Inc. premises or against SouthLight, Inc.’s personnel;
- To medical personnel in a medical emergency;
- To appropriate authorities to report suspected child abuse or neglect;
- As allowed by a court order.
In addition to the two federal laws, SouthLight must also comply with North Carolina law, SL 2015-41 as amended by SL 2017-57, that requires health care providers who receive state funds for the provision of medical services to submit clinical and demographic patient data to NC HealthConnex.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. SouthLight is not required to agree to any restrictions you request, but if it does agree, then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency, or as required by law, for example, an authorized court order. You may terminate the restriction at any time by contacting us. Also, SouthLight may terminate the restriction by contacting you.
You have the right to request that we communicate with you by alternative means or at an alternative location, for example an alternative address or alternative method of contact. SouthLight, Inc. will accommodate such requests that are reasonable. We may ask you to make the request in writing, but will not request an explanation from you as to the reason.
Under HIPAA you also have the right to inspect and request a copy of your own health information maintained by SouthLight, except to the extent it contains information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances. SouthLight may impose a reasonable fee to be paid by you for the copies you request.
You also have the right to receive an accounting of disclosures of your health related information made by SouthLight during the six years prior to your request. This list would not include certain disclosures, for example, disclosures made for payment, health care operations, and treatment functions within SouthLight. You may receive this accounting of disclosures free-of-charge in any 12 month period. You may be charged a reasonable fee for subsequent requests within the same 12 month period.
In order to exercise your rights concerning your health care information, you may contact your program director or counselor. To exercise your rights concerning your payment for health care information, you may contact the office staff at your program site.
You also have the right to receive a paper copy of this notice.
Disclosure to Health Information Exchanges
SouthLight participates in the North Carolina Health Information Exchange Network, called NC HealthConnex, which is operated by the North Carolina Health Information Exchange Authority (NC HIEA). SouthLight will share your protected health information, or PHI, with the NC HIEA and may use NC HealthConnex to access your PHI to assist us in providing health care to you.
We are required by law to submit clinical and demographic data pertaining to services paid for with funds from North Carolina programs like Medicaid and State Health Plan. We may also share other patient data with NC HealthConnex not paid for with State funds.
If you do not want NC HealthConnex to share your PHI with other health care providers who are participating in NC HealthConnex, you must opt out by submitting a form directly to the NC HIEA. Forms and brochures about NC HealthConnex are available in our offices and online at NCHealthConnex.gov. You may also contact our Compliance Office at (919) 787-6131 X 1130. Again, even if you opt out of NC HealthConnex, we still will submit your PHI if your health care services are funded by State programs. Your patient data may also be exchanged or used by the NC HIEA for public health or research purposes as permitted or required by law. For more information on NC HealthConnex, please visit NCHealthConnex.gov/patients.
SouthLight is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. SouthLight is required by law to abide by the terms of the notice currently in effect.
SouthLight reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. Revised notices will promptly be available at the program sites for clients requesting a copy.
Complaints and Reporting Violations
You may complain to SouthLight, Inc., Wake County Human Services, and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA.
You may contact the program director or counselor regarding how to file a compliant or grievance. In addition, SouthLight’s “YOUR RIGHTS” client brochure provides information regarding how to file a compliant and the grievance procedure. The “YOUR RIGHTS” brochure is provided to you at your client orientation upon admission to SouthLight, but you may also request a copy of it at any time from a staff member. In addition, SouthLight’s compliance line is Client Advocacy Office is at (919) 787-6131 X 1130.
You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
For further information regarding this Notice, you may contact SouthLight’s Compliance Officer at 787-6131 Ext. 1130.
Effective Date: June 1, 2020
I, the undersigned, fully understand all the NOTICE OF PRIVACY PRACTICES information as I have read it or had it explained to me. I acknowledge receiving a copy of the NOTICE.