Notice of Privacy Practices
Effective date: January 13, 2003
Revision date: November 7, 2025
Our pledge about health information
We understand your health information is personal. We are committed to protecting it. This Notice explains how we may use and share your Protected Health Information (PHI), the rights you have, and our duties. We must follow the terms of this Notice and will let you know if we make material changes.
How we may use and disclose your information
We may use or disclose your health information without your written authorization in these situations:
Treatment, Payment, and Health Care Operations
Treatment: To provide, coordinate, or manage your care with other health care providers. For example, we might use your information to help us reach a diagnosis or disclose your PHI to a pharmacy when we order a prescription.
Payment: To bill and receive payment from you, your insurance, or others. For example, we may contact your health insurer to certify you are eligible for benefits and need to share with them details of your treatment and diagnosis.
Operations: For practice management, quality improvement, training, auditing, and customer service.
Health Information Exchange (HIE)
We participate in secure electronic health information exchanges (currently including Carequality and TEFCA) so other authorized providers can securely access your health information for treatment and care coordination. By receiving care at Vance Family Medicine, your health information is automatically included in these exchanges and any other HIEs we may join in the future.
If we join additional HIEs, we will update this Notice to reflect that participation. Regardless of the specific exchange, you always have the right to opt out of routine HIE sharing. To do so, submit a written request by email to cperkinson@vancefamilymedicine.com. Opting out will not affect any legally required disclosures.
Public health and safety
We may disclose information when required by law, including but not limited to: public health reporting, abuse/neglect reporting, health oversight, court orders, subpoenas, coroners/medical examiners, workers’ compensation, organ/tissue bank services (if participating), or to prevent a serious threat to health or safety.
Research, Grant Applications
We may use or share limited information for approved research projects and eligible grants that meet HIPAA requirements. We will not sell your information. We will not use/share PHI for marketing without your written authorization (except for treatment communications or care coordination). We will obtain your written authorization to use your PHI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your information is being used only for the research and (iii) the researcher will not remove any of your information from our practice; or (c) the PHI sought by the researcher only relates to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the PHI of the decedents.
Special protections
Certain types of records—such as HIV/AIDS status or test results, sexually transmitted disease information, mental health records, genetic testing, and federally protected substance use disorder treatment records—are subject to additional privacy protections. In many cases, these records may not be disclosed without your written authorization, except where disclosure is required by law. Where stricter privacy rules apply, we are obligated to and will comply with those requirements.
Your rights
You have the right to:
Get a copy of your medical record – paper or electronic, including billing records, but not including psychotherapy notes. You must submit your request in writing. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
Ask us to correct your record – you may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at the below address. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you do not submit it with a written reason for amendment. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice.
Request confidential communications – for example, contact you at a different phone number or address.
Request restrictions – You may ask us not to share certain information. We must agree if you pay out-of-pocket in full for a service and ask us not to share it with your health plan. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the Privacy Officer at the contact below. Your request must describe in a clear and concise fashion:
The information you wish restricted;
Whether you are requesting to limit our practice’s use, disclosure or both; and
To whom you want the limits to apply
Get a list of disclosures – All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment or operations purposes. Use of your PHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer at the below address. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Get a paper copy of this Notice – at any time, even if you agreed to receive it electronically.
Choose a representative – if you have given someone medical power of attorney or a legal guardian, they may exercise your rights.
File a complaint – with us or with the U.S. Department of Health and Human Services (HHS) if you feel your rights are violated. You have the right to raise a privacy concern without fear of retaliation or negative consequences. All complaints must be submitted in writing.
Right to Provide an Authorization for Other Uses and Disclosures – Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose the use of your PHI for the reasons described in the authorization. Please note we are required by law to retain records of your care.
Your choices
You can tell us your preferences about:
Allowing email or text for non-sensitive matters (scheduling, reminders). We will honor your documented choice.
Sharing information with family or friends involved in your care.
If you have a preference, let us know in writing. Otherwise, we may share limited information if in your best interest or as required by law.
Our responsibilities
We are required by law to maintain the privacy and security of your health information.
We will notify you without unreasonable delay if a breach of your information occurs.
We will not use or share your information other than as described here unless you give us written authorization. You may revoke that authorization at any time.
We will provide you with a copy of this Notice and make it available on our website.
How we communicate with you
Our preferred method is our FollowMyHealth patient portal. If you request email or text for non-sensitive communications, we will honor your documented preference. Standard message/data rates may apply. Email and text are not fully secure methods of communication. If you request these options, you accept the small risk that your information could be intercepted. For sensitive information we may require phone, mail, or portal communication.
Business Associates
We may share your information with trusted partners, known as Business Associates, who help us with services such as billing, technology support, accountable care organization services, and records management. Each must sign a Business Associate Agreement and protect your information.
Changes to this Notice
We may update this Notice from time to time. When we do, the revised Notice will apply to all of your health information, both past and future. The most current version will always be posted in our office and on our website, and you can request a paper copy at any time.
Contact us if you have questions about this notice
Practice: Vance Family Medicine, P.A.
Address: 381 Ruin Creek Road, Henderson, NC 27536
Phone: (252) 430-0666
Email: privacy@vancefamilymedicine.com
