FOR INFORMATION ABOUT VIRGINIA MANDATED
THE SOUTH CAROLINA NOTIFICATION OF
REQUIRED INFORMED CONSENT OUR CHARITABLE POLICY
CLICK THE IMAGE BELOW CLICK THE IMAGE BELOW
FOR OTHER INFORMATION
On-Line Health Centers Patient Registration Form
Medical History Patient Registration Form ( En Español)
On-Line Health Center
To contact your nearest Planned Parenthood Health Center, call
1-800-230-PLAN (7526).
Visit our On-line Health Centers to request an appointment. Or select your health center below.
Click on the city name below for health center address and telephone information. From there, clicking on the health center name will link to our on-line appointment requestor and clicking on the address will bring up a map.
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Raleigh Health Center |
Asheville Health Center |
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Charlotte Health Center |
Charlottesville Health Center Dr. Herbert C. Jones, Jr. Reproductive Health & Education Center 2964 Hydraulic Road Charlottesville, VA 22901 434-296-1000 |
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522 Grand Central Avenue
Vienna, WV 26105 304-295-3331 |
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Payment Options
PPHS accepts payment of cash, check, MasterCard or Visa. In addition, PPHS accepts the following insurance plans. Please contact your local health center or your insurance provider to confirm your coverage.
North Carolina South Carolina Virginia West Virginia Aetna - Out
of NetworkAetna - Out of Network Aetna - In Network and Out of Network Aetna - Out of Network Assurant - Out of
NetworkAssurant - Out of Network Assurant - Out of Network Assurant - Out of
NetworkBlue Cross Blue
Shield - In NetworkBlue Cross Blue Shield - In Network Blue Cross Blue Shield - In Network Blue Cross Blue Shield -
In NetworkCIGNA - In Network
and Out of NetworkCIGNA -
Charleston - Out of NetwokColumbia - In Network
CIGNA - Out of Network CIGNA - In Network Humana - In Network
Humana - In Network Humana - In Network Humana - In Network Medcost Medicaid - Tradtional FP and Select Health Medicaid - Traditional FP and Virginia Premier Medicaid - Traditional FP and Mountain Health
(WV patients).
Unison (OH patients)Medicaid - Traditional FP and Carolina Access Tricare/Champus - Out of Network Southern Health - In Network Tricare/Champus - Out of Network Tricare/Champus - Out of Network United Healthcare - In Network Tricare/Champus - Out of Network United Healthcare - In Network United Healthcare - In Network United Healthcare - In Network Wellpath
Your Rights
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy: You have certain rights to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records. This does not include psychotherapy notes. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing on a form provided by us to the Privacy Official at PPHS. If you request a copy of your health information, we may charge a fee for the costs copying, mailing or other supplies and services associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may in certain instances request that the denial be reviewed. Another licensed healthcare professional chosen by our practice will review your request and the denial. The person conducting the review will not be the person who denied your initial request. We will comply with the outcome of the review.
Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing on a form provided by us and submitted to the Privacy Official at PPHS. We may deny your request for an amendment if it is not the form provided by us and does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the health information kept by or for our practice; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete. Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.
Right to an Accounting of Disclosures. You have the right to request a list (accounting) of any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described.
To request this list of disclosures, you must submit your request on a form that we will provide to you. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The first list of disclosures you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date should not exceed a total of 60 days from the date you made the request.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. For example, you could ask that access to your health information be denied to a particular member of our workforce who is known to you personally.
While we will try to accommodate your request for restrictions, we are not required to do so if it is not feasible for us to ensure our compliance with law or we believe it will negatively impact the care we may provide you. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request on a form that we will provide you. In your request, you must tell us what information you want to limit and to whom you want the limits to apply.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain manner or at a certain location. During our intake process, we will ask you how you wish to receive communications about your health care or for any other instructions on notifying you about your health information. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice at any time upon request.
MINORS AND PERSONS WITH GUARDIANS
Minors have all the rights outlined in this Notice with respect to health information relating to reproductive healthcare, except for abortion and in emergency situations or when the law requires reporting of abuse and neglect. In the case of abortion, if a parent provides consent to your abortion, the parent has all the rights outlined in this Notice, including the right to access the health information relating to abortion. However, if you obtain a judicial bypass of the consent requirement, you have the same rights as an adult with respect to health information relating to your abortion. If you are a minor or a person with a guardian obtaining healthcare that is not related to reproductive health, your parent or legal guardian may have the right to access your medical record and make certain decisions regarding the uses and disclosures of your health information.
Minors have all the rights outlined in this Notice with respect to health information relating to reproductive healthcare, except for abortion and in emergency situations or when the law requires reporting of abuse and neglect. In the case of abortion, if a parent provides consent to your abortion, the parent has all the rights outlined in this Notice, including the right to access the health information relating to abortion. However, if you obtain a judicial bypass of the consent requirement, you have the same rights as an adult with respect to health information relating to your abortion. If you are a minor or a person with a guardian obtaining healthcare that is not related to reproductive health, your parent or legal guardian may have the right to access your medical record and make certain decisions regarding the uses and disclosures of your health information.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the Privacy Official at PPHS at 919-833-7534 or 100 S. Boylan Avenue, Raleigh NC 27603. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the Privacy Official at PPHS at 919-833-7534 or 100 S. Boylan Avenue, Raleigh NC 27603. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain the records of the care that we provided to you.
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain the records of the care that we provided to you.
