You have the right to:

Inspect and receive copies of your medical information, based on office polices and procedures. Request, in writing, changes to your health information. Your request will be reviewed based on office policy and procedure, however the office has the right to deny the request. A written statement will be provided regarding the decision.

Request, in writing, that we limit how we use or share health information about you. However, we may not be able to comply with all requests.

Withdraw, in writing, any authority you have given to share your information. However, we won’t be able to take back information we have previously given out. Request, in writing, and receive a record of times when we have shared your health information without your written permission except when related to treatment, payment, or heath-care-operations.

Our Responsibilities

The law requires us to:

  • Maintain the privacy of health information about you;
  • Provide the privacy notice of our duties, your rights, and our privacy practices;
  • Follow the terms of our notice; and
  • Notify you if we cannot continue honoring your request.

To exercise your rights

If you have questions about this brochure or the privacy notice or would like to exercise your rights, you may contact:

Patient Relations Representative
704-866-7576

Privacy Representative
704-866-7576

959 Cox Road
Gastonia, NC 28054
704-866-7576
Fax: 704-866-0106