Notice of Privacy Practices For Albemarle Pediatrics


If you have any questions about this Privacy Policy please contact the:

Privacy Officer or Office Manager

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This Privacy Policy describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations for our business. This policy also describes your rights regarding your protected health information.

"Protected health information" is defined as, any information that relates to the past, present or future physical or mental condition of an individual; the provision of healthcare to the individual; or the past present or future payment for the provision of healthcare to an individual.

Uses and Disclosures
Your confidential healthcare information may be used or disclosed to assist us with the treatment, payment or healthcare operations of our office:

Treatment---Information will be shared with healthcare professionals, within our office, to provide you with quality healthcare. Information may be shared with healthcare providers outside our office (specialists, laboratories, radiologists) when another provider is needed to assist your physician with diagnosis or treatment of a condition.
Payment---Information will be released to your insurance company to assist in the payment for services provided. Information may also be shared to verify eligibility, obtain authorizations, or prove medical necessity for services provided.
Healthcare Operations---Information may be shared with contracted business associates that provide additional support to our office. Examples of some business associates may include auditors, consultants, accountants or accreditation services.
Your confidential healthcare information may be used or disclosed for other reasons without your authorization:

Required Uses and Disclosures: Your protected health information must be disclosed as required by law, when requested by you and when required by the Secretary of the Department of Health and Human Services to investigate our compliance with the privacy requirements.

Public Health Activities: As permitted by law, for the purpose of controlling disease, injury or disability.
Communicable Disease: As authorized by law, to notify another person that may have been exposed to or at risk of spreading a communicable disease.
Health Oversight: As authorized by law, for the purpose of audits, investigations and inspections.

Abuse or Neglect: As authorized by law, to a health authority that deals with child abuse or neglect. (Example: Stanly County Child Fatality and Prevention Team)
Food and Drug Administration: As required, to report adverse events, product defects or problems and to enable product recalls.
Legal Proceedings: In response to a subpoena or court order.
Law Enforcement: Legal processes required by law, Requests for information for identification/ location, Pertaining to victims of crime, Suspicion of death as related to a crime, Crimes occurring on the premises of our office.

Coroners, Funeral Directors and Organ Donations: As requested, for identification purposes, to assist in determining cause of death, or other duties required by law or authorized by law.
Research: When approved by an institutional review board.
Criminal Activity: Following state and federal laws, to prevent or lessen a serious threat to the health or safety of a person or the public.

Military Activity/ National Security: Under certain situations, if you are Armed Forces personnel. (Examples: to determine eligibility for benefits, to conduct national security and intelligence activities)
Workers Compensation: As authorized, to comply with workers' compensation laws.
Inmates: As necessary, if you are an inmate of a correctional facility.

Emergency Situations: As needed, when authorization can not be provided.

Family Members/ Others: When family member or others have been identified by you as involved in your care. You have the right to object to this type of disclosure.

Marketing/Other Uses/ Disclosures: Communications involving face-to-face discussions of treatment alternatives, appointment reminder cards mailed to your home.
Your confidential healthcare information may be used or disclosed for other reasons, only after we receive written authorization from you.

Example: To post a picture of your child (that you have provided to us) on our office bulletin board or to use your child's picture for maternity fair/public health fair events:
1-You may revoke your authorization at any time by submitting a written request to our office.
2-Any services provided before this request will still be based on the prior authorization. We will continue to use/ disclose information to receive payment and perform healthcare operations for these services.

Patient Rights
The following is a list of your rights with respect to your protected health information:

You have the right to inspect and copy your protected health information.
You may review and request copies of your protected health information held by our office by providing a written request. This includes medical and billing information. Your request to review your information may be approved or denied by the physicians, depending on the circumstances.

You have the right to request a restriction of your protected health information.
You may request that parts of your information not be released to family members or others involved in you care. Your written request must state the specific restriction requested and to whom you want the restriction to apply. Our office is not required to agree to all restrictions.

You have the right to receive confidential communications from us by alternative means or at alternative locations.
You may request to be contacted at a different phone number or different address. You will not be required to explain your reasoning for the request. We will attempt to comply with your request when the alternative means of communication is reasonable and our resources permit the type of communication.

You have the right to request amendments to your protected health information.
Requests must be provided in writing and the reason for the request must be included. This request may be denied if your physician maintains that the information is accurate. Any disagreements with a denial should be communicated to our Privacy Officer. Any information released to us by another provider will not be amended.

You have the right to receive an accounting of certain disclosures of your protected health information.This release record will not contain releases related to treatment, payment, healthcare operations or releases made to you or your family members. You have a right to receive information on disclosures that occur after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations. (Note: Cost-based fees may be added to accounting requests that occur more than once per 12-month period)

You have a right to obtain a paper copy of this Privacy Notice or you may visit our website at

If you believe that your privacy rights have been violated by us, you may note your complaint to our office directly or to the Secretary of Health and Human Services. You may notify our office, in writing, by contacting our Privacy Officer at:

Albemarle Pediatrics
Attn: Privacy Officer
1420 US Highway 52 North Suite A
Albemarle, NC 28001
(704) 982-5437
(Uwharrie Medical Commons beside of Gold's Gym)

We will not retaliate against you for filing a complaint. We want to continue to maintain a confidential environment and notification of any potential violations will assist us in achieving maximum privacy standards. We will notify you, in writing, regarding our decision and/ or actions taken regarding your complaint.

We are required by law to maintain the privacy of your protected health information. Our office will abide by the terms of this notice and continue to maintain the confidentiality of our patient's healthcare information. We reserve the right to make changes to this notice. You will be informed of any substantial changes to the notice and you may request a copy of the updated notice at any time.


This notice was published and became effective on April 14, 2003