You have the right to get an electronic or paper copy of your medical record.
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
- We will provide a copy or a summary of your health information within 30 days of your request.
You have the right to ask us to correct your medical record.
- You can ask us to correct health information about you that you think is incorrect or incomplete.
- We may say “no” to your request, but we’ll tell you why, in writing, within 60 days.
You have the right to request confidential communications.
- You can ask us to contact you in a specific way or to send mail to a different address.
- We will say “yes” to all reasonable requests.
You have the right to ask us to limit what information we use or share.
You have the right to get a list of those with whom we’ve shared your information.
- You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
You have the right to get a copy of this privacy notice.
You have the right to file a complaint if you feel your rights are violated.
- You can file a complaint if you feel we have violated your rights by contacting the resources provided at the end of this notice below.
- You can file a complaint with the US Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue SW, Washington, DC, 20201, calling 877.696.6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
- We will not retaliate against you for filing a complaint.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We will not use or share your information other than as described here, unless you tell us we can in writing.
- You may change your mind about what information to share at any time. Let us know in writing if you change your mind.
Violation of Rights
If you feel any of your rights have been violated, or if you feel you have been the victim of abuse, neglect, or exploitation, please contact your advocate or the Program Director immediately at 336.777.0076. Additionally, if you feel any of the staff or the organization is in violation of any of these rights, or you witness what you believe to be abuse, neglect, or exploitation, you may contact:
Abuse, Neglect or Exploitation
Forsyth County Department of Social Services
Quality of the Enrichment Center’s facility or services
Division of Health Service Regulation
2718 Mail Service Center
Raleigh, NC 27699-2718
800.624.3004 / 919.855.4500
Disability Rights North Carolina
2626 Glenwood Ave, Suite 550
Raleigh, NC 27608
Area Authorities for the Delivery and Accountability of I/DD Services
Alamance, Davidson, Davie, Forsyth, Mecklenburg, Rockingham, and Stokes Counties
Cardinal Innovations Healthcare
800.939.5911 / 704.721.7000
Surry and Yadkin Counties
Partners Behavioral Health Management
800.235.4673 / 704.884.2501
Guilford and Randolph Counties
800.256.2452 / 910.673.9111
828.586.5501 / 828.265.5615