Patient Privacy

Hickory Allergy, Asthma & Sinus Clinic, P.A.
Hickory Allergy, Asthma & Sinus Clinic
220 18th Street Circle SE
Hickory, NC 28602
(828) 322-1275


This notice describes how information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.


Hickory Allergy, Asthma & Sinus Clinic is here to serve your health care needs. We appreciate the trust you have placed in us, and we are committed to using protected health information about you responsibly.




Each time you visit Hickory Allergy, Asthma & Sinus Clinic, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as:


  • A basis for planning your care and treatment
  • A means of communication among the many health professionals who contribute to your care
  • A legal document describing the care you received
  • A means by which you or a third-party payer can verify that services billed were actually provided
  • A tool in educating health professionals
  • A source of data for medical research
  • A source of information for public health officials charged with improving the health of the nation
  • A source of data for our practice planning and marketing
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve


An understanding of what is in your record and how your health information is used will help you to (1) ensure its accuracy, (2) better understand who, what, when, where, and why others may access your health information, and (3) make more informed decisions when authorizing disclosure to others.


Although your health record is the physical property of Hickory Allergy, Asthma & Sinus Clinic, the information belongs to you. As provided for in the HIPAA Privacy Regulation, 45 CFR Part 160, you have the right to:


  • Request a restriction on certain uses and disclosures of your information
  • Obtain a paper copy of this Notice of Privacy Practices upon request
  • Inspect and copy your health record
  • Request an amendment to your health record
  • Receive a list of non-medical agencies who have been given your health information as required by law
  • Receive your health information in different ways, including fax, mail, and telephone
  • Receive your health information at alternative locations
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken




Maintain the privacy of your health information


Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you


Abide by the terms of this notice


Notify you if we are unable to agree to a requested restriction


Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations


We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post a copy in our office in a prominent location. We will provide you with a copy of the revised Notice upon your request.


We will not use or disclose your health information without your authorization, except as described in this notice.



If you have questions and would like additional information, you may contact the Privacy Officer of Hickory Allergy, Asthma & Sinus Clinic at (828) 322-1275.


If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer of Hickory Allergy, Asthma & Sinus Clinic or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.



We will use your health information for treatment.


For example: information we receive from you or a health care provider will be recorded in your chart. We will use this information to help us determine the best treatment plan for you. Our staff will document any observations or action taken.


We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you.


We will use your health information for payment.


For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.


We will use your health information for regular health operations.


For example: Members of our staff may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.


Business Associates: There are some services provided in our practice through contacts with Business Associates. Examples include diagnostic services, certain laboratory tests, and a transcription or other service we may use for documenting your record. When these services are contracted, we may disclose your health information to our Business Associates so that it can perform the job we’ve asked it to do. To protect your health information, however, we require the Business Associate to appropriately safeguard your information.


Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.


Communication with family: Our staff, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.


Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.


Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.


Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.


Marketing: We may 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.


Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.


Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.


Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.


Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.


Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.


Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority, or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.


EFFECTIVE DATE: April 14, 2003