THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective Date: 12/23/2024  |  Revised Date: 02/16/2026

LifeSource's Role in Your Care:
LifeSource is a healthcare services management organization that acts on behalf of licensed healthcare providers who deliver medical, psychiatric, and psychotherapy services. LifeSource provides administrative, operational, and compliance support to these providers and may access protected health information (PHI) as permitted under HIPAA and applicable law to support treatment, payment, and healthcare operations.

Definitions and Terms

PHI - Protected Health Information; refers to identifying information in your health records.
Treatment - Management and coordination of your health care and related services.
Payment - Reimbursement obtained for health care services.
Health Care Operations - Business and administrative activities necessary to operate LifeSource's practices.
Use - Activities within a particular practice, such as billing or care coordination.
Disclosure - Release of information outside the practice (e.g., insurance providers, referrals).

I. WE ARE REQUIRED BY LAW TO PROTECT YOUR PHI

• Protect all PHI related to your care, payment, and health conditions.
• Notify you how your PHI is protected.
• Explain how, when, and why PHI is used or disclosed.
• Provide you a copy of this notice.
• Notify you of any unauthorized disclosure.

II. USES AND DISCLOSURES WITHOUT AUTHORIZATION

We may use or disclose PHI as permitted under HIPAA, HITECH, 42 C.F.R. Part 2, and North Carolina law.

1. To you or your authorized representative.
2. To the U.S. Department of Health and Human Services for compliance purposes.

III. HOW WE USE AND DISCLOSE PHI

• For treatment and coordination of care.
• For payment and billing purposes.
• For healthcare operations.

Beginning February 16, 2026, records covered under 42 C.F.R. Part 2 may be used and disclosed for treatment, payment, and healthcare operations as permitted by law.

IV. ADDITIONAL PERMITTED DISCLOSURES

These include disclosures related to abuse reporting, health oversight, legal proceedings, serious threats to safety, worker’s compensation, public health activities, and law enforcement as required by law.

V. USES REQUIRING AUTHORIZATION

• Psychotherapy notes
• Marketing or sale of PHI
• Reproductive health care investigations prohibited by law

ALL OTHER USES AND DISCLOSURES REQUIRE WRITTEN AUTHORIZATION UNLESS PERMITTED BY LAW.

VI. YOUR PATIENT RIGHTS

Requests must be submitted in writing to:
Privacy Office
P.O. Box 15390
Wilmington, NC 28408
Fax: 888-746-1787

VII. COMPLAINTS

If you believe your privacy rights have been violated, you may contact the LifeSource Compliance Officer at (910) 742-9243 or the U.S. Department of Health & Human Services Office for Civil Rights.

VIII. BREACH NOTIFICATION

In the event of a breach of unsecured PHI, affected individuals and appropriate authorities will be notified as required by law.

This notice was originally published and becomes effective 5/2010.