In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited also on the basis of religion or political beliefs.
To file a complaint of discrimination, contact USDA or HHS. Write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TTY). Write HHS, Director, Office for Civil Rights, Room 506-F, 200 Independence Avenue, S.W., Washington, D.C. 20201 or call (202) 619-0403 (voice) or (202) 619-3257 (TTY). USDA and HHS are equal opportunity providers and employers.
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.
Randolph County Department of Social Services (DSS) is required by law to maintain the privacy and security of certain confidential health care information, known as Protected Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. DSS is required to abide by the terms of the version of this Notice currently in effect. If a breach occurs that may have compromised the privacy or security of your PHI, DSS will notify you promptly of this breach and the circumstances surrounding it.
Uses and Disclosures of PHI: Randolph County DSS may
use PHI for the purposes of treatment, payment, and health care
operations, in most cases without your written permission.
Examples of our use of your PHI:
- For treatment—DSS will use and share your health information to approve, to deny treatment, and to determine if your medical treatment is appropriate. For example, DSS staff may review your treatment plan by your health care provider for medical necessity.
- For payment—DSS will use and share your health information to pay for Medicaid claims from health care providers and to determine your eligibility to participate in programs provided through our agency. For example, your health care provider sends claims for payment to the Medicaid Fiscal Agent for payment of medical services provided to you.
- For health care operations—DSS will use and share your health information to evaluate a health plan’s performance. For example, contracts with consultants to review hospital and other facilities’ medical records to check on the quality of the care you received
- Other Uses and Disclosures of PHI Without Your Authorization.
Randolph County DSS is permitted to use PHI without your written
authorization, or opportunity to object, in certain situations,
and unless prohibited by a more stringent state law, including:
- For the treatment, payment or health care operations activities of another health care provider who treats you;
- For health care and legal compliance activities;
- To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection, and in certain other circumstances where we are unable to obtain your agreement and believe the disclosure is in your best interests;
- To a public health authority in certain situations as required by law (such as to report abuse, neglect or domestic violence;
- For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system;
- For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process;
- For law enforcement activities in limited situations, such as when responding to a warrant;
- For military, national defense and security and other special government functions;
- To avert a serious threat to the health and safety of a person or the public at large;
- For workers’ compensation purposes, and in compliance with workers’ compensation laws;
- To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;
- If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;
- For research projects, but this will be subject to strict oversight and approvals;
may also use or disclose health information about you in a way
that does not personally identify you or reveal who you are.
Any other use or disclosure of PHI, other than those listed above will only be made with your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.
Client Rights: As a client, you have a number of rights with respect to your PHI, including:
The right to access, copy or inspect
your PHI. This means you may inspect and receive an electronic
or paper copy of most of the medical information about you that
we maintain. We will normally provide you with access to this
information within 30 days of your request. We may also charge
you a reasonable fee for you to copy any medical information
that you have the right to access. In limited circumstances, we
may deny you access to your medical information, and you may
appeal certain types of denials. We have available forms to
request access to your PHI and we will provide a written
response if we deny you access and let you know your appeal
rights. You also have the right to receive confidential
communications of your PHI. If you wish to inspect and copy your
medical information, you should contact our privacy officer.
The right to amend your PHI. You have the right to ask us to
amend written medical information that we may have about you. We
will generally amend your information within 60 days of your
request and will notify you when we have amended the
information. We are permitted by law to deny your request to
amend your medical information only in certain circumstances,
like when we believe the information you have asked us to amend
is correct, but if we do deny a request for amendment, we will
tell you why in writing within 60 days of the request. If you
wish to request that we amend the medical information that we
have about you, you should contact our privacy officer.
The right to request an accounting. You may request an
accounting from us of certain disclosures of your medical
information that we have made in the six years prior to the date
of your request. We are not required to give you an accounting
of information we have used or disclosed for purposes of
treatment, payment or health care operations. We are also not
required to give you an accounting of our uses of protected
health information for which you have already given us written
authorization. If you wish to request an accounting, contact our
The right to request that we restrict
the uses and disclosures of your PHI. You have the right to
request that we restrict how we use and disclose the medical
information that we have about you. Randolph County DSS is not
required to agree to any restrictions you request, but any
restrictions agreed to by Randolph County DSS in writing are
binding upon Randolph County DSS. If you pay for a service or a
health care item out-of-pocket in full, you have the right to
request that we not share that information for the purpose of
payment with your health insurer. We will honor this request
unless we are required by law to share the information.
The right to request confidential communications. You have the
right to ask us to contact you in a specific way (for example by
home or office phone) or to send mail to a different address. We
will honor all reasonable requests.
The right to choose
someone to act for you. If you have given someone medical power
of attorney or if someone is your legal guardian, that person
can exercise your rights and make choices about your health
The right to make certain choices regarding
your PHI. You have both the right and the choice to tell us to
share your information with your family, close friends or others
involved in your care, to share information in a disaster-relief
situation, or to tell us to contact you for fundraising efforts.
If you are not able to tell us your preference, for example if
you are unconscious, we may go ahead and share your information
if we believe it is in your best interest. We may also share
your information when needed to lessen a serious and imminent
threat to health or safety. We will never share your information
without your written permission for marketing purposes nor will
we sell your information nor share psychotherapy notes.
Internet, Electronic Mail, and the Right to Obtain Copy of Paper
Notice on Request. If we maintain a website, we will prominently
post a copy of this Notice on our website. If you allow us, we
will forward you this Notice by electronic mail instead of on
paper, and you may always request a paper copy of this Notice.
Revisions to the Notice. Randolph County DSS reserves the
right to change the terms of this Notice at any time, and the
changes will be effective immediately and will apply to all
protected health information that we maintain. Any material
changes to the Notice will be promptly posted in our facilities
and posted to our web site, if we maintain one. You can get a
copy of the latest version of this Notice by contacting our
Your Legal Rights and Complaints: You
also have the right to complain to us, or to the Secretary of
the United States Department of Health and Human Services,
Office for Civil Rights, if you believe your privacy rights have
been violated. You will not be retaliated against in any way for
filing a complaint with us or to the federal government. Should
you have any questions, comments or complaints you may direct
all inquiries to our privacy officer.
of this Notice:
September 23, 2013
Department of Social Services
Privacy Officer Contact Information:
Privacy Officer: Patrick Skelly
1512 N. Fayetteville St.
Asheboro, NC 27203
Adult Protective Services
Child Protective Services
1512 N Fayetteville St.
Asheboro, NC 27203 map
402 Balfour Drive
Archdale, NC 27263 map
8am - 5pm M-F