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HIPAA Notice of Privacy Practices & Policies

This notice outlines your protected health information (PHI), how it may be used, and what your rights are. Please review carefully and ask any questions you have, prior to signing it. Please direct all questions to Carolina Personalized Health Solutions at info@cphs.care.


We, Carolina Personalized Health Solutions, understand that PHI about you and your health is very personal. We are committed to protecting your PHI. This notice applies to ALL of the records of your care/coaching generated by Carolina Personalized Health Solutions and our personnel. This notice will explain the ways in which we could use and disclose PHI about you. We also describe your rights and certain obligations we have regarding the use and disclosure of PHI. The law requires us to:

  • make sure that your PHI that identifies you is kept private

  • notify you about how we protect your PHI

  • explain how, when, & why we use and disclose PHI

  • follow the terms of the notice that is currently in effect

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We are required to follow the procedures in this notice. We reserve the right to change the terms of this notice and to make new notice provisions effective for all PHI that we maintain by:

  • providing copies of this notice upon registration as a client of Carolina Personalized Health Solutions* providin

  • providing copies of this notice upon request

  • posting a copy of this notice on our Facebook page or website.

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How we may use and disclose protected health information about you:
The following categories describe different ways that we use and disclose PHI without your written authorization.

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For TREATMENT & Continuity of Care: We may use PHI about you to provide you with, coordinate, or manage your medical or health treatments or associated services. We may disclose PHI about you to health care providers, or other health care team members that are involved in providing your health care. Carolina Personalized Health Solutions may also share PHI in order to coordinate the different parts of your treatment plan you need, such as pharmaceuticals, lab work, and x-rays; this provision of care may also extend to providers outside Carolina Personalized Health Solutions staff as it relates to your health care and continuity of such care.


For PAYMENT: Carolina Personalized Health Solutions may disclose certain health information to others for billing, invoicing, and/or receiving payment for services you receive from Carolina Personalized Health Solutions. Only the minimal information required by such third party will be disclosed.


As required by Law: Carolina Personalized Health Solutions may disclose your health information as required by law as in cases pursuant to legal authority, to report information as related to victims of abuse, neglect or domestic violence, and/or to assist law enforcement officials in standard law enforcement duties.

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For Public Health: Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury or disability or for other health oversight activities.


Your Written Authorization is REQUIRED for other uses & disclosures
 

Including:
Uses & disclosures for PHI for marketing purposes; and
Disclosures that constitute a sale of your PHI.

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Your PHI Rights:

You have the right:

  • to request restrictions to certain uses & disclosures of your PHI; however, Carolina Personalized Health Solutions may not be required to agree to such requested restrictions.

  • Obtain a paper copy of this Notice of Privacy Practices upon request

  • Inspect and obtain a copy of your health record as provided for under the law

  • Amend your health record, according to law, by submitting a written request

  • Request communications of your PHI by alternative means, (i.e. email, fax, etc)

  • Receive an accounting of disclosures made of your PHI

  • Request an electronic copy of your record be provided to you.

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Obligations of Carolina Personalized Health Solutions
Carolina Personalized Health Solutions is required by law to:

  • Maintain the privacy of PHI and notify you in the event of a breach, if the breach poses significant risk to you

  • Provide you with THIS notice of our legal duties & privacy practices with respect to your PHI

  • Abide by the terms of this notice

  • Notify you if we are unable to agree to a requested restriction on how your information is used

  • Accommodate reasonable requests you make to communicate PHI by alternative means

  • Obtain your written consent to use or disclose your PHI for any reason other than listed herein

 

Complaints & Information


You may submit any written complaints regarding potential breaches in privacy or requests for further information by contacting Carolina Personalized Health Solutions at info@cphs.care.

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Carolina Personalized Health Solutions reserves the right to change its information practices & to make new provisions effective for all PHI that we maintain. Revised notices will be made available on our Facebook page and/or website.

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By typing my FULL name below, I acknowledge that I have received and read a copy of this Privacy Notice from Carolina Personalized Health Solutions

CONSENT TO VIDEO CHAT


By signing below, I hereby consent to the use of a video chat for my medical visit via a video conference call. Due to the President’s Emergency Declaration, I understand the media, link, or software used for this video visit may not be fully HIPAA compliant. I understand that Carolina Personalized Health Solutions will take all appropriate and available actions to help keep these visits safe and secure. I release Carolina Personalized Health Solutions, from any and all liability and responsibility associated with any possible and accidental release of personal health information.

INFORMED CONSENT


By signing below, I hereby consent to health care management and treatment by Carolina Personalized Health Solutions. I acknowledge that it is my responsibility as a patient to seek out information needed regarding my diagnosis, management, treatment plan, and medications. I agree to be a partner in my health care and in decisions related to my care.

Thank You!

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© 2024 Carolina Personalized Health Solutions

CONTACT US

Serving SC in York, Lancaster, Chester, and Chesterfield counties.

 

Call or email us to make an appointment.

 

info@cphs.care

T:  803-784-4429

F:  803-262-0198

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PAYMENTS

Venmo

Scan the QR code below with your phone, or in the Venmo app pay Shere-CPHS.

Include Patient Name or Invoice Number.

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