Pierre A. Lemaire, MD, P.A.
2410 Montgomery Dr. SW
Wilson, NC 27893-4421

EFFECTIVE: July 1, 2004

NOTICE OF PRIVACY PRACTICES

This notice describes how, according to the Federal Government Health Insurance Portability and Accountability Act (HIPAA), medical information about you may be used and disclosed and also how you can obtain access to this information. Please review it carefully. If you have any questions about this Notice please contact

Suzette Evans, Privacy Contact
TELEPHONE: (252) 291-5940

This Notice of Privacy Practices describes how the office of Pierre A. Lemaire, MD, P.A., may use and disclose your protected health care information to carry out treatment, payment, and health care operations as permitted or required by law. This notice describes your rights to access and control of your protected health care information. “Protected health care information” is information that relates to your past, present, and possible future medical conditions and also relates to the health care services that you have received.

The Federal Government requires Dr. Lemaire’s office to abide by the terms of this Notice of Privacy Practices. In the future, this notice most likely will be revised. Upon your request, we will gladly provide you with any revised “Notice of Privacy Practices.”

1. Uses and Disclosures of Protected health Care Information:
Your protected health care information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health care information may also be used and disclosed to obtain payment for your health care services and on occasion to guide healthcare operations as described below.

The following are examples of the types of uses and disclosures of your protected health care information that our office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health care information. For example, we would disclose your protected health care information, as necessary, to a home health agency that provides care to you. We will also disclose protected health care information to other physicians who may be treating you now or in the future. For example, your protected health care information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose and treat you.

Payment: Your protected health care information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services that we recommend. Some examples would be determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, undertaking utilization review activities and obtaining approval for hospital stay.

Healthcare Operations: We may disclose your records in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, marketing and conduction or arranging for other operation activities.

We may share your protected health care information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health care information, we will have a written contract between our office and the third party that contains terms that will protect the privacy of your protected health care information.

2. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization or Consent.
Other uses and disclosures of your protected health care information will be made only with your written authorization, unless otherwise permitted or required by law as described below. At any time in writing you may revoke this authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object.
We may use and disclose your protected health care information as described in the following paragraphs. You have the opportunity to agree or object to the use or the disclosure of all or part of your protected health care information. If you are not present or able to agree or object to the use or disclosure of the protected health care information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health care information that is relevant to your health care will be disclosed.

Others Involved In Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health care information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary only if we determine that it is in your best interest based on our professional judgment. We do encourage you to communicate with us as to whom you wish information to be revealed and, very importantly, to whom you do not wish health care information to be revealed. We may use or disclose protected health care information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care. Finally, we may use or disclose your protected health care information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care. We may disclose to the proper authorities if domestic violence/abuse is evident.

Emergencies: We may use or disclose your protected health care information in an emergency treatment situation. If this happens, you physician shall try to obtain your consent as soon as possible after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health care information to treat you.

Communication Barriers: We may use and disclose your protected health care information if your physician or another physician attempts to obtain consent from you but is unable to do so due to substantial communication barriers, and if the physician determines, using professional judgment, which you normally would consent to use or to disclose.

3. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object.
We may use or disclose your protected health care information in the following situations without your consent or authorization. These situations include:

Required By Law: We may use or disclose your protected health care inf0ormation to the extent that law requires the use or disclosure. The use of disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health care information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability.

Communicable Diseases: We may disclose your protected health care information, If Authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose your protected health care information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system; government benefits programs, other government regulatory programs, and civil rights laws.

Abuse or Neglect: We may disclose your protected health care information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health care information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, and track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Procedures: We may disclose protected health care information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: For law enforcement purposes, we may also disclose health care protected information so long as applicable legal recommendations are met. These law enforcement purposes include (1) legal processes as required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death had occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected health care information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health care information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his duties. Protected health care information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

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

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health care information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We my also disclose protected health care information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health care information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health care information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Worker’s Compensation: we may disclose your protected health care information as authorized to comply with workers’ compensation laws and other similar legally-established programs.

Inmates: We may use or disclose your protected health care information if you are an inmate of a correctional facility and your physician created or received your protected health care information in the course of providing care to you.

Required Uses and Disclosures: Under the law, we must make disclosures to you as required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

4. Your Rights
You have the right to inspect and copy your protected health care information. This means you may inspect and obtain a copy of protected health care information.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health care information that is subject to law that prohibits access to protected health care information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact Ms. Suzette Evans, our Privacy Contact, if you have questions about access to your medical record.

You have the right to request a restriction of your protected health care information: This means you may ask us not to use or disclose any part of your protected health care information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health care information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restrictions requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of your protected health care information, your protected health care information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health care information unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician and also make this request in writing to Ms. Suzette Evans, our Privacy Contact.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled and ask you to specify an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to Ms. Suzette Evans, our Privacy Contact.

You may have the right to have your physician amend your protected health care information. This means you may request an amendment of protected health care information about you for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of such rebuttal. Please contact Ms. Suzette Evans, our Privacy Contact if you have any questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health care information. This right applies to disclosures for purposed other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions, and limitations.

5. Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying Ms. Suzette Evans, Our Privacy Contact of your complaint.
There will be no repercussions to you for complaints.

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(Rev. 07/2004)

Office: 2410 Montgomery Dr., SW
Wilson, NC 27893-4421
Phone: (252) 291-5940