- Right to Request Restrictions.
You have the right to request that we restrict the uses or disclosures of medical information about you to carry out treatment, payment, or health care operations. You also have the right to request that we restrict the uses or disclosures we
make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) for to
public or private entities for disaster relief efforts. For example, you could ask that we not disclose medical information
about you to your brother or sister.
To request a restriction, you may do so at any time. If you request a restriction, you should do so to the Privacy Officer
of Well Care 6752 Parker Farm Drive, Suite 210, Wilmington, NC 28405 and tell us: (a) what information you want to
limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example,
disclosures to your spouse).
We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless
the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later
terminate the restriction.
- Right to Receive Confidential Communications.
You have the right to request that we communicate medical information about you to you in a certain way or at a certain
location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why
you are asking for the confidential communication.
If you want to request confidential communication, you must do so in writing to the Privacy Officer of Well Care 6752
Parker Farm Drive, Suite 210, Wilmington, NC 28405. Your request must state how or where you can be contacted.
We will accommodate your request. However, we may, when appropriate, require information from you concerning how
payment will be handled. We also may require an alternate address or other method to contact you.
- Right to Inspect and Copy.
With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of
medical information about you. To inspect or copy medical information about you, you must submit your request in
writing to the Compliance and Quality Department of Well Care 6752 Parker Farm Drive, Suite 210, Wilmington, NC
28405. Your request should state specifically what medical Notice of Privacy Practices – continued information you want
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to inspect or copy. Upon receipt of the request of medical records the record will be provided free of charge either on the
next home visit or within four (4) business days, whichever comes first.
- Right to Amend.
You have the right to ask us to amend medical information about you. You have this right for so long as we maintain
the medical information.
To request an amendment, you must submit your request in writing to the Privacy Officer of Well Care 6752 Parker Farm
Drive, Suite 210, Wilmington, NC 28405. Your request must state the amendment desired and provide a reason in support of that amendment.
We will act on your request within sixty (60) calendar days after we receive your request. If we grant your request, in
whole or in part, we will inform you of our acceptance of your request and provide access and copying.
If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment
with relevant other persons. We also will make the appropriate amendment to the medical information by appending or
otherwise providing a link to the amendment.
We may deny your request to amend medical information about you. We may deny your request if it is not in writing and
does not provide a reason in support of the amendment. In addition, we may deny your request to amend medical information if we determine that the information:
- a. Was not created by us, unless the person or entity that created the information is no longer available to act on the
- b. Is not part of the medical information maintained by us;
- c. Would not be available for you to inspect or copy; or,
- d. Is accurate and complete
If we deny your request, we will inform you of the basis for the denial. You will have the right to submit a statement of
disagreeing with our denial. Your statement may not exceed 2 pages. We may prepare a rebuttal to that statement. Your
request for amendment, our denial of the request, your statement of disagreement, if any, and our rebuttal, if any, will
then be appended to the medical information involved or otherwise linked to it. All of that will then be included with any
subsequent disclosure of the information, or, at our election, we may include a summary of any of that information.
If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our
denial with any future disclosures of the information. We will include your request for amendment and our denial (or a
summary of that information) with any subsequent disclosure of the medical information involved.
You also will have the right to complain about our denial of your request.
Under certain circumstances your right to an accounting of disclosures to a law enforcement official or a health oversight
agency may be suspended. Should you request an accounting during the period of time your right is suspended; the ac- counting would not include the disclosure or disclosures to a law enforcement official or to a health oversight agency.
To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer of Well Care 6752
Parker Farm Drive, Suite 210, Wilmington, NC 28405. Your request must state a time period for the disclosures. It may
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not be longer than six (6) years from the date we receive your request.
Usually, we will act on your request within sixty (60) calendar days after we receive your request. Within that time, we will
either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting
and why the delay is necessary.
There is no charge for the first accounting we provide to you in any twelve (12) month period. For additional accountings,
we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and
give you an opportunity to withdraw or modify your request to avoid or reduce the fee.
- Right to Copy of this Notice.
You have the right to obtain a paper copy of our Notice of Privacy Practices. You may request a copy of our Notice of
Privacy Practices at any time.