Notice of Privacy Practices


State and Federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this Notice. We must follow the privacy practices as described below. This Notice will take effect on 4/1/2004 and will remain in effect until it is amended or replaced by us.

It is our right to change our privacy practices provided law permits the changes. Before we make a significant change, this Notice
will be amended to reflect the changes and we will make the new Notice available upon request. We reserve the right to make any changes in our privacy practices and the new terms of our Notice effective for all health information maintained, created and/or received by us before the date changes were made.

You may request a copy of our Privacy Notice at any time by contacting our Privacy Officer, Amanda Kelly. Information on contacting us can be found at the end of this Notice.


We will keep your health information confidential, using it only for the following purposes:

Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary or need to know” standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.

Disclosure: We may disclose and/or share your healthcare information with other health care professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and/or other persons you choose to involve in your care, only if you agree that we may do so.

Payment: We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include insurance organizations or other businesses that may become involved in the process of mailing statements and/or collecting unpaid balances.

Emergencies: We may use or disclose your health information to notify or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death. If possible, we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated, we will use our professional judgment to disclose only that information directly relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, x-rays or other similar forms of health information and/or supplies unless you have advised us otherwise.

Healthcare Operations: We will use and disclose your health information to keep our practice operable. Examples of personnel who may have access to this information include, but are not limited to, our medical records staff, outside health or management reviewers and individuals performing similar activities.

Required by Law: We may use or disclose your health information when we are required to do so by law. (Court or administrative orders, subpoena, discovery request or other lawful process.) We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others.

Public Health Responsibilities: We will disclose your health care information to report problems with products, reactions to medications, product recalls, disease/infection exposure and to prevent and control disease, injury and/or disability.

Marketing Health-Related Services: We will not use your health information for marketing purposes unless we have your written authorization to do so.

National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders, including, but not limited to, voicemail messages, postcards or letters.

Access: Upon written request, you have the right to inspect and get copies of your health information (and that of an individual for whom you are a legal guardian.) There will be some limited exceptions. If you wish to examine your health information, you will need to complete and submit an appropriate request form. Contact our Privacy Officer for a copy of the Request Form. You may also request access by sending us a letter to the address at the end of this Notice. Once approved, an appointment can be made to review your records.
Amendment: You have the right to amend your healthcare information, if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, your request may be denied.

Non-routine Disclosures: You have the right to receive a list of non-routine disclosures we have made of your health care information. (When we make a routine disclosure of your information to a professional for treatment and/or payment purposes, we do not keep a record of routine disclosures: therefore, these are not available.) You have the right to a list of instances in which we, or our business associates, disclosed information for reasons other than treatment, payment or healthcare operations. You can request non- routine disclosures going back 6.

Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We do not have to agree to these additional restrictions, but if we do, we will abide by our agreement. (Except in emergencies.) Please contact our Privacy Officer if you want to further restrict access to your health care information. This request must be submitted in writing.

QUESTIONS AND COMPLAINTS: You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us in writing. Request a Complaint Form from our Privacy Officer. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.


Practice Name: North Raleigh Gastroenterology, P.A.
Privacy Officer: Amanda Kelly, FNP
Telephone: (919) 846-9011 Fax: 844-587-9567

TELEMEDICINE CONSENT: Please review and agree using the consent form below before your telemedicine visit. 

Information about telemedicine

  • Your provider may talk to you about your health history, exams, x-rays, or other tests. Other providers may take part.
  • Non-medical staff may be in the room to help with the technology.
  • Video and/or photo records may be taken, and audio recordings may be made.
  • A report of the session will be placed in your doctor’s medical record. You can get a copy from your doctor.
  • All laws about the privacy of your health information and medical records apply to telemedicine. These laws also apply to the video, photo, and audio files that are made and stored.
  •  It may be hard to diagnose your problem without a “hands-on” exam.
  • A main goal of telemedicine is to make sure you get high quality, personal health care, even though you are not seeing a provider in person.
  • Having a telemedicine session is your choice. Even if you have agreed to the session, you can stop your medical records from being sent – if this has not happened yet. You can refuse or stop the session at any time.
  • You’ll be told about all staff that will take part in the session. You can ask that any of these people leave the room and stop them from seeing or hearing the session.
  • Your session may end before all problems are known or treated. It is up to you to follow up for more care if your health problem does not go away.
  • You may ask how much of the cost will be covered by insurance and how much you may owe before your session.

Risks and common problems

  • Equipment or Internet problems could cause your diagnosis or treatment to be delayed.
  • The records sent for review before the session may not be complete.  It may be hard for the telemedicine provider to use his or her best judgment about your health problem. For instance, you could react to a drug or have an allergic response if the provider does not have all the information that he or she needs.
  • If there is a technology problem, the information from your session may be lost. This would be outside the control of your doctor and telemedicine provider.

EMAIL CONSENT: North Raleigh Gastroenterology would like to communicate with your doctors, other healthcare providers (such as nurses), and administrative services by electronic mail (email).

Risks of Email

● Email may be instantly sent worldwide and be received by many intended and unintended recipients.
● Those who get email can pass on messages to anyone without the original sender’s permission or knowledge.
● Users can easily misaddress an email.
● Backup copies of email may exist even after the sender or the recipient has erased their copy. All emails will be kept in your medical record. This means that all people who have access to the medical record will be able to see the emails.

● You should not use your employer’s email system to send or receive private medical information. If you choose to send or receive an email from your workplace, there is a chance your employer could read the message.

● Email messages may not be answered on the same business day. We will make an effort to read and respond to email as soon as possible, but we cannot guarantee that any email message will be answered within any set period of time. Never use email in an urgent situation or in an emergency.

● Your message should be short. If you feel your message is too long for an email, you may wish to call our office or schedule

● Please write the topic of your email in the subject line.

● Please write your name and patient identification number, if known, in the message.

● It is the policy of North Raleigh Gastroenterology to make all email messages sent or received that are about medical treatment a part of your medical record.

● We will make every effort to protect the privacy of email information. Due to the possibility of technical problems, we cannot guarantee the security of all emails. Your use of email is an acknowledgement of this insecurity and your acceptance of the risk.

● North Raleigh Gastroenterology may forward email messages as needed for diagnosis, treatment, and reimbursement. North Raleigh Gastroenterology will not pass on the email to others without your prior consent.

● Because some medical information is sensitive and the privacy of email is not guaranteed, you should not use email for communications about sensitive information. Some examples are protected diagnoses (such as mental health conditions or substance abuse problems), information about HIV/AIDS, and workers’ compensation injuries.

● You may withdraw consent to the use of email at any time by email or written communication with North Raleigh Gastroenterology.

● Do not send financial information, credit card numbers, checking account numbers, or any similar information to North Raleigh Gastroenterology by email. We will not ask you for this information by email. Any email supposedly from North Raleigh Gastroenterology asking for credit card or checking account information is fraudulent. Please let us know if you receive such an email.

● It is your duty to protect your password or other means of access to email sent or received from North Raleigh Gastroenterology. North Raleigh Gastroenterology is not responsible for breaches of confidentiality caused by the patient.