HIPAA Notice of Privacy Practices 


VeriFi Charlotte, LLC Notice of Privacy Practices 


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


Our Legal Responsibility 

This Notice of Privacy Practices applies to VeriFi Charlotte LLC and all of its subsidiaries and business units, except to the extent that a subsidiary, division, or business unit of VeriFi Charlotte, LLC performs occupational screening, forensic tests, paternity/identity tests, clinical trials tests or other services that do not involve standard electronic transactions for which the Department of Health and Human Services (“HHS”) has adopted standards. 


Your Protected Health Information (PHI) 

Throughout this Notice we will refer to your protected health information as PHI. Your PHI includes data that identifies you and reports about the care and services you get at VeriFi Charlotte, facilities. Examples of PHI include information about your diagnosis, medications, insurance status and policy number, payment information, social security number, address, and other demographic information. 

This Notice about our privacy practices states how, when, and why we use and share your PHI. We may not use or disclose any more of your PHI than is needed for the purpose of the use or disclosure, with some exceptions. 


Changes to This Notice 

We are required to follow the terms of the Notice currently in effect. We have the right to change the terms of this Notice and our privacy policies and practices. Any changes will apply to your past, current, or future PHI. When we make a change to our policies, we will change this Notice and post a new Notice on our website (verificlt.com). We will post the Notice as required by law and will have a copy of the revised Notice in the places where we offer medical services. The Notice will have the effective date on the last page. You may also ask for a copy of our current Notice at any time. 

Uses of Protected Health Information 

We are allowed by law to use and share your health information with others without your authorization for many reasons. These examples describe the categories of our uses and disclosures we may make without your authorization. Please note that not each use or disclosure in each category is listed and these are general descriptions only. Where state or federal law restricts one of the described uses or disclosures, we follow the requirements of such law. 


We may use and disclose PHI about you to physicians, nurses, technicians, physicians in training, or other health care professionals who are involved in your care, such as providing your physician with your laboratory test results.  


We may use and disclose your PHI to bill and collect payment for the services we provided to you. For example, we may provide PHI to a payor to get approval for laboratory or genetic counseling screenings provided. We may also share your health information with another provider that has treated you so that they can bill you. 

Health care operations 

We may use and disclose your PHI as part of our operations. For example, we may use your PHI to evaluate the quality of laboratory testing, accuracy of results, and for operation and management purposes for services you received at VeriFi Charlotte, LLC.  In some cases, we will furnish other qualified parties with your laboratory screening information for their health care operations. 


Business associates 

We may share your health information with others called “business associates,” who perform services on our behalf. The business associate must agree in writing to protect the confidentiality of the information. For example, we may share your Laboratory screening information with a billing company that bills for the services we offer. 

Appointment reminders and health-related benefits or services 

We may use your PHI to give you appointment reminders or information about laboratory and screening services. If you give us your mobile telephone number, we may contact you by phone or text message at that number for treatment and quality-related purposes such as appointment reminders, wellness checks, registration instructions, etc. We will identify VeriFi Charlotte, LLC as the sender of the communication and offer you with a way to “opt out” and not get further communication in this manner. 

Public health activities 

We may disclose medical information about you for public health activities. These activities may include: 

  • Public health authority authorized by law to collect or get such information for the purpose of preventing or controlling disease, injury, or disability; 
  • Appropriate authorities authorized to get reports of child or dependent adult abuse and neglect; 
  • FDA-regulated entities for purposes of monitoring or reporting the quality, safety, or effectiveness of FDA-regulated products; 
  • Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and 
  • With parent or guardian permission, to send proof of required immunization to a school. 

Law enforcement 

We may disclose certain medical information to law enforcement authorities for law enforcement purposes, for example: 

  • As required by law, like reporting certain wounds and physical injuries; 
  • In response to a court order, subpoena, warrant, summons, or similar process; 
  • To identify or locate a suspect, fugitive, material witness, or missing person; 
  • About the victim of a crime if we have the individual’s agreement, or under certain limited circumstances, if we are not able to get the individual’s agreement; 
  • To alert authorities of a death we believe may be the result of criminal conduct; 
  • Information we believe is evidence of criminal conduct occurring on our premises; and 
  • In emergency circumstances to report a crime; the location of the crime or victims or the identity, description, or location of the person who committed the crime. 

Threats to health or safety 

Under certain circumstances, we may use or disclose your medical information to avert a serious threat to health and safety if we, in good faith, believe the use or disclosure is needed to prevent or lessen the threat and is to a person reasonably able to prevent or lessen the threat (such as the target) or is needed for law enforcement authorities to identify or apprehend an individual involved in a crime. 

Abuse, neglect, or domestic violence 

We may notify the appropriate government authority if we believe you have been the victim of abuse, neglect, or domestic violence. Unless such disclosure is required by law (for example, to report a particular type of injury), we will only make this disclosure if you agree. 

Judicial and administrative proceedings 

If you are involved in a lawsuit or a dispute, we may disclose medical information about you due to a court or administrative order. We may also disclose medical information about you due to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to notify you of the request or to get an order from the court protecting the information requested. 

Health oversight activities 

We may disclose PHI to a health oversight agency for audits, investigations, inspections, licensure, and other activities, as authorized by law. For example, we may disclose PHI to the Food and Drug Administration, state Medicaid fraud control, or the U.S. Department of Health and Human Service Office for Civil Rights. 

Research studies 

Under certain circumstances, we may disclose your PHI to help conduct research, subject to certain safeguards. Research may involve finding a cure for an illness or helping to find out the effectiveness of treatments. In research studies, a Privacy Board or Institutional Review Board ensures that measures are in place to protect your identity from disclosure to organizations outside of University of Iowa Health Care. We may disclose medical information about you to people starting a research project, but the information will stay on site. 

Workers’ compensation purposes 

We may disclose PHI about you to your employer or others as authorized by law for workers’ compensation or other programs that offer benefits for work-related injuries or illness. 

National security and intelligence activities 

We may release PHI to authorized federal officials when required by law. This information may be used to protect the president, other authorized persons, or foreign heads of state, to conduct special investigations, for intelligence and other national security activities authorized by law. 

Incidental uses and disclosures 

There are certain incidental uses or disclosures of your information that happen while we are providing service to you or conducting our business. For example, after surgery the nurse or doctor may need to use your name to find family members that may be waiting for you in a waiting area. Other individuals waiting in the same place may hear your name called. We will make reasonable efforts to limit these incidental uses and disclosures. 

Required by law 

We will use and disclose your information as required by federal, state, or local law. 

Disaster relief 

We may also share medical information about you with an organization helping in a disaster relief effort. 

Uses and Disclosures for Which You Have the Opportunity to Object 

Health care affiliates/alliances 

We are part of electronic health information data sharing agreements with other health care providers, public health organizations, and payors. These data sharing arrangements are to help treatment, improve health care operations, and allow for an analysis of care in all settings. These data sharing arrangements are designed to make sure appropriate protections are in place and stop the inappropriate release of your PHI. If you do not wish to be in these data sharing arrangements, please tell our Privacy Officer at the contact information listed at the end of this Notice. 

Uses and Disclosures Requiring Your Authorization 

There are many uses and disclosures we will make only with your written authorization. These include: 

Uses and disclosures not described above 

We will get your authorization for any use of disclosure of your medical information that is not described in the earlier examples. 


We will not use or disclose your PHI for marketing purposes without your authorization. If we will get any financial remuneration from a third party in connection with marketing, we will tell you that in the authorization form. 

Sale of medical information 

We will not sell your information to third parties without your authorization. Any such authorization will state that we will get remuneration in the transaction. 

Your Rights Regarding PHI 

You have the right to: 

Request restrictions 

You can ask us not to use or share certain PHI for treatment, payment, or health care operations purposes. For example, when you have paid for your services out of pocket in full, at your request we will not share information about those services with your payor (the organization that pays for your medical care), as long as such disclosure is not required by law. For all other requests, we will consider your request, but we are not legally required to accept it. If we accept your request, we will document any limits in writing and follow them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. To request a restriction, write to the Privacy Officer listed at the end of this Notice. 

Request confidential communications 

You can ask that we send PHI to you at a different address or contact you about your health information in a certain way. For example, you may wish to have appointment reminders and test results sent to a PO Box or a different address than your home address. We will say “yes” to reasonable requests that give specific directions of the alternative. To make a request, tell the Privacy Officer at the address listed at the end of this Notice. You do not need to give a reason for your request. 

Inspect and copy 

You have the right to inspect and get a copy of much of the information that we maintain about you, with some exceptions. Normally, this information has the medical record and billing records. There are certain conditions on which we may deny your request. If we maintain the medical information electronically and you ask for an electronic copy, we will give the information to you in the form and format you request, if it is readily producible. If we cannot readily get the record in the form and format you request, we will give it in another readable electronic format or paper copy, we both agree to. If you direct us to send your medical information to another person, we will do so if your signed, written direction clearly states the recipient and location for delivery. To see or get a copy of medical or billing information, please send your request in writing to either: 

  • Release of Information, for medical information; or 
  • Patient Financial Services, for billing, both listed at the end of this Notice. 

Accounting of disclosures 

You have the right to get a list of certain instances in which we have disclosed your PHI. You may ask for this list for the prior 6 months. We will give the times we have shared your PHI, who we shared it with, and why. The list will not have uses or disclosures that you have specifically authorized in writing, for example, copies of records to your attorney or to your employer, or disclosures for treatment, payment, or health care operations and certain other types of disclosures. Please send your request in writing to the Privacy Officer listed at the end of this Notice. We will offer one list a year for free but will charge a reasonable cost-based fee if you ask for another list within 12 months. 


You have the right to ask us to change certain  information that we keep in your records if you think that information is not correct or incomplete. You may ask for an amendment for as long as that record is maintained. You may submit a written request for an amendment to Release of Information listed at the end of this Notice. VeriFi Charlotte, LLC may say “no” to certain requests, but we will tell you in writing within 30 days why we denied your request. 

Paper copy of this notice 

You can ask for a paper copy of this Notice at any time, even if you have asked to get it electronically. You may pick up a copy at our office or ask that a copy be sent to you. 

Notification in the case of breach 

We are required by law to notify you of a breach of your unsecured information. We will give such notification to you without unreasonable delay but in no case later than 60 days after we discover the breach. 

How to exercise these rights 

All requests to exercise these rights must be in writing. We will respond to your request on a timely basis following our written policies and as required by law. Contact the offices noted below in this Notice to get request forms or ask questions. 

Revocation of Authorization 

If you give us authorization to use or disclose your information, you may remove that authorization at any time. Please make your request in writing to Release of Information at the contact information listed at the end of this Notice. 

If you remove your authorization, we will no longer use or disclose information about you for the reasons covered by your written revocation. We are not able to take back any disclosures made before with your authorization. 

Complaints and Questions 

If you believe your privacy rights have been violated, you may file a complaint with VeriFi Charlotte, LLC or with the Secretary of the U.S. Department of Health and Human Services. 


To file a complaint about our privacy practices at VeriFi Charlotte, LLC or questions about this Notice, notify: VeriFi Charlotte, LLC 

 Privacy Officer 
1909 JN Pease Pl #104 
Charlotte, NC 28262 
[email protected] 

You will not be penalized for filing a complaint, and your care will not be compromised. 




  • Requesting a restriction 
  • Requesting an accounting of disclosures 
  • Opting out of data sharing 
  • Inspection and copying of your billing records 
  • Inspection and copying of your record 
  • Revoking your authorization to disclose your information 


 VeriFi Charlotte, LLC 
1909 JN Pease Pl #104 
Charlotte, NC  28262 
[email protected]