This notice informs you about the ways Peak Health, PA and Peak Healthcare, PA (referred to as “we”) may use and disclose your protected health information and your rights concerning your protected health information. Protected health information is information that we have created or received about your past, present, or future medical condition, health care we provide to you, or payment for your health care.

We are required by federal and state laws to protect the privacy of your health information and provide you with this Notice of our privacy practices and our legal duties and your rights concerning your health information. This notice describes the types of uses and disclosures that we may make and gives you some examples.
We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all health information. Should our information practices change, we will make the new Notice available upon written request.
The Federal Privacy Regulations requires that we have written acknowledgement that you have received our privacy notice.

This notice takes effect March 3, 2003 and remains in effect until we replace it. If you have any questions or requests, please contact our Privacy Officer at 252-237-5090 or  P.O. Box 3014, Wilson, NC  27895-3014.

PEAK HEALTH, PA
PEAK  HEALTHCARE, PA
NOTICE OF PRIVACY

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please read it carefully.

This notice takes effect March 3, 2003 and remains in effect until we replace it.

OUR PLEDGE
 We are committed to protecting the privacy of your health information. We create a record of the care and services you receive from our organization. We need this information to provide you with quality care and to comply with certain legal requirements. This notice will tell you how we share your health information. We also describe your rights and certain duties we have regarding protecting your health information.

OUR RESPONSIBILITY
 We have a legal obligation to keep your health information private. We will provide you with a notice as to our legal duties, privacy practices, and your rights regarding your health information. We will abide by the terms of this notice and notify you if we are unable to agree to a restricted request or to accommodate a request you may have made in regards to your health information. We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will make the new notice available upon request. We will not use or disclose your health information without your authorization, except as described in this notice.

OUR SECURITY PROCEDURES
 We maintain safeguards to protect your health information. Our employees are bound by our organizational policies to access your information only for legitimate purposes and to maintain the privacy of your health information.

HOW WE DISCLOSE YOUR INFORMATION
 We may use and disclose your health information for treatment. Information obtained by members of your healthcare team will be recorded in your health record and will be used to provide care and services to you.  We may disclose health information about you to other health care providers that may assist us in providing care to you. For example: You have diabetes. We may communicate with a dietitian to plan your diet. We may communicate with your health care plan to enroll you in a diabetes management program.
We may use and disclose your health information for payment purposes. For example: A bill may be sent to you or a third-party payer. We will provide the payer with the minimum necessary information in order to get your bill paid.

We may use and disclose your health information for our health care operations. This might include measuring and improving quality, evaluating employee performance, conducting training programs, documenting outcomes, and meeting licensure requirements. For example, a nursing supervisor may select your health record to review in order to evaluate the performance of another nurse.
Notification and Marketing: We may contact you to provide appointment reminders or provide you with information about services that may be of interest to you. We may communicate your appointment reminder via email, mail, company interoffice mail, voice mail, personal representative, or work colleague.
Business associates: There are some services provided in our organization through contracts with business associates. For example: We contract with a computer resource company to provide computer support. In performance of their job, your health information may be disclosed. To protect your health information, however, we require the business associate to appropriately safeguard your information

Research: We may use or disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research.

Additional Uses and disclosures. In addition to using and disclosing your health information for the above purposes, we may use and disclose health information for the following purposes. We may disclose to the FDA health information relative to adverse events. As required by law, we may disclose your health information to public health, legal authorities, law enforcement, workers compensation or other similar programs, health oversight agencies, or other government agencies. In addition, we may make other uses and disclosures, which occur as a byproduct of the permitted uses and disclosures described in this notice.

All other uses and disclosures will be made only with your authorization. You have the right to revoke such authorization.

YOUR RIGHTS

            Although your health record is our physical property, the information belongs to you. You have the right to:

• Look at or obtain a paper copy of your health information. You must make your request in writing. We may charge you related fees.
• Receive a listing of times we shared your health information for purposes other than treatment, payment, or health care operations, except as authorized by you. You must make this request in writing.
• Request that we place additional restrictions on our use or disclosure of your health information. You must make your request in writing. We are not required to agree to these restrictions.
• Request that we change your health information.  You must make this request in writing. We may deny that request, but if we do we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed.
• Obtain a paper copy of our privacy practices. You must make your request in writing.
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken. You must make your request in writing.
   

FOR MORE INFORMATION OR TO REPORT A PROBLEM

            If you have questions and would like additional information, you may contact our Privacy Officer at 252-237-5090. If you believe your rights have been violated, you can file a complaint with our privacy officer or contact the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.