THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

Effective Date: April 14, 2003

Our Pledge Regarding Your Privacy:

We understand that medical information about you and your health is personal. We are committed to protecting the confidentiality and privacy of your protected health information. We are required to abide by the terms of the notice currently in effect and when changes are made, a new Notice of Privacy Practice will be posted on our website at www.wakenephrology.com, and you may also request an updated copy any time.

How We Will Use or Disclose Your Health Information:

Wake Nephrology Associates uses your protected health information for treatment, obtaining payment for treatment, and conducting its healthcare operations. For example, Wake Nephrology Associates will use your medical information to perform requested consults or treatment services and provide your referring physician with a report of our findings. We may share your protected health information (PHI) with your insurance company, our billing department and collection agencies. We will only use or disclose your private health information in accordance with applicable state and federal laws. Wake Nephrology Associates my contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you, i.e., clinical research trials.

Wake Nephrology Associates may use or disclose your protected health information without authorization for auditing purposes, public health purposes, and for emergency situations. For any other situation, Wake Nephrology Associate’s policy is to obtain your written authorization before disclosing your protected health information. Once authorization is obtained, you may later revoke that authorization to stop any future disclosures.

Patient’s Individual Rights:

You have the right to request to receive, inspect, amend and request restrictions on certain uses and disclosures of protected health information (PHI). You also have the right to request in writing, an accounting of disclosures of your protected health information for reasons other than treatment, payment, or other healthcare operations.

You also may request in writing that Wake Nephrology Associates not use or disclose your protected health information for treatment, payment and administrative purposes except when authorized by you, when required by law or in an emergency situation. Wake Nephrology Associates will review the request on an individual basis, but we are not legally required to accept it.

For More Information or to Report a Problem:

If you believe that Wake Nephrology Associates may have violated your privacy rights, you may file a complaint with us. These complaints must be filed in writing on a form provided by our practice. You may also file a written complaint with the Secretary of the Federal Department of Health and Human Services. There will be no retaliation for filing a complaint. For further information, you may contact our Privacy Officer at (919) 876-7807 ext. 222 or e-mail us at legarret@wakenephrology.com.