Pulmonary Clinic of the Carolinas
New Patients

Patient Information

Forms & Information for Our New Patients

Patient Forms

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All appointments to see the Doctor must be scheduled.

Request an Appointment

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Insurance & Credit Cards

We accept all major insurance and Visa credit card.

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Hospital Privileges

  • Gaston Memorial Hospital
  • Kings Mountain Hospital
  • Lincoln Medical Center
  • Presbyterian Hospital - Huntersville

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Medical Resource Links

American College of Chest Physicians
American Lung Association
American Thoracic Society
American College of Allergy, Asthma and Immunology



Our HIPPA & Patient Confidentiallty Policy



Uses and Disclosures

Treatment: Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health care operations: Your health information may be used as necessary to support the day-to-day activities and management of Pulmonary Clinic of the Carolinas, Pc. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.

Public health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.

Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information

Appointment reminders: Your health information will be used by our staff to send you appointment reminders.

Information about treatments: Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you.

Fund raising: Unless you request us not to, we will use your name and address to support our fund-raising efforts. If you do not want to participate in fund-raising efforts, please check off the following box.

Please do not use my information for fund raising purposes.

Individual Rights

You have certain rights under the federal privacy standards. These include:

  • the right to request restrictions on the use and disclosure of your protected health information
  • the right to receive confidential communications concerning your medical condition and treatment
  • the right to inspect and copy your protected health information
  • the right to amend or submit corrections to your protected health information
  • the right to receive an accounting of how and to whom your protected health information has been disclosed
  • the right to receive a printed copy of this notice

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Requests to Inspect Protected Health Information

You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Front Office Specialists or Administrator. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.


If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Pulmonary Clinic of the Carolinas, PC.
206 Gamble Drive, Ste. D, Lincolnton, NC 28092
442 East Long Avenue, Gastonia, NC, 28054
10135 Hickorywood Hill Avenue, Huntersville, NC 28078

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.

This Notice is effective on or after April 1, 2003!




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Pulmonary Medical Services
Sleep Disorder Services
Allergy Treatment Services

Lincolnton, N.C.
(704) 736-9959
206 Gamble Drive
Suite D
Lincolnton, N.C.
Gastonia, N.C.
(704) 867-8742
442 E. Long Avenue
Gastonia, N.C.
Huntersville, N.C.
(704) 875-6330
10135 Hickorywood Hill
Huntersville, N.C.