| This notice describes
how medical information about you may be used and disclosed and how you
can get access to this information. Please review it carefully.
If you have any questions about this Notice please contact our
Privacy Officer 770 952-8899.
This Notice of Privacy Practices describes how we may use and disclose
your protected health information to carry out treatment, payment or health
care operations and for other purposes that are permitted or required
by law. It also describes your rights to access and control your protected
health information. “Protected health information” is information
about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health
or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice, at any time. The new notice will
be effective for all protected health information that we maintain at
that time. We will provide you with any revised Notice of Privacy Practices
upon your request by calling the office and requesting that a revised
copy be sent to you in the mail or asking for one at the time of your
next appointment.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Treatment, Payment and Healthcare Operations
Your protected health information may be used and disclosed by your physician,
our office staff and others outside of our office that are involved in
your care and treatment for the purpose of providing health care services
to you. Your protected health information may also be used and disclosed
to pay your health care bills and to support the operation of the physician’s
practice.
Following are examples of the types of uses and disclosures of your protected
health care information that the physician’s office is permitted
to make without your specific authorization or consent. These examples
are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our office.
Treatment: We will use and disclose your protected
health information to provide, coordinate, or manage your health care
and any related services. For example, we would disclose your protected
health information, as necessary, to your primary care physician or specialist
who has referred you to us. We will also disclose protected health information
to other physicians or health care providers who may be treating you.
For example, your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician has the necessary
information to diagnose or treat you.
Payment: Your protected health information will
be used, as needed, to obtain payment for your health care services. Quite
simply, a bill may be sent to you or your insurance company for payment.
The information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used.
This may also include activities your insurance company may undertake
before it approves or pays for the health care services we recommend or
perform for you such as determining your eligibility for coverage or medical
necessity for the treatment For example, obtaining an approval for a MRI
diagnostic study may require that your relevant protected health information,
such as name and diagnosis, be disclosed to the insurance company to obtain
approval to perform the MRI.
Healthcare Operations: We may use or disclose,
as-needed, your protected health information in order to support the business
activities of our physicians’ practice. For example, we may use
a sign-in sheet at the registration desk where you will be asked to sign
your name and time of arrival. We may also call you by name in the waiting
room when your physician is ready to see you or when it is time to perform
your test or procedure. Additionally, we may use or disclose your protected
health information, as necessary, to contact you to remind you of your
appointment.
We will also share your protected health information with third party
“business associates” that perform various activities (e.g.
billing, transcription services) for the practice. Whenever an arrangement
between our office and a business associate involves the use or disclosure
of your protected health information, we will have a written contract
that contains terms that will protect the privacy of your protected health
information.
We may use or disclose your protected health information, as necessary,
to provide you with information about expanded services that may be of
interest to you. For example, your name and address may be used to send
you a newsletter or brochure about our practice and the services we offer.
You may contact our Privacy Officer to request that these materials not
be sent to you.
Finally, we may use or disclose your personal health information in the
course of performing quality improvement activities. For example, members
of our staff may use information in your health record to assess the care
and results or outcomes in your case and others like it for quality improvement
activities.
Uses and Disclosures of Protected Health Information Based upon
Your Written Authorization
Other uses and disclosures of your protected health information will
be made only with your written authorization, unless otherwise permitted
or required by law as described below. You may revoke this authorization,
at any time, in writing, except to the extent that your physician or the
physician’s practice has taken an action in reliance on the use
or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May be Made
with your Consent, Authorization or Opportunity to Object
You have the opportunity to agree or object to the use or disclosure
of all or part of your protected health information in the following instances:
- Others involved in your healthcare: Unless
you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your protected health
information that directly relates to that person’s involvement
in your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine
that it is in your best interest based on our professional judgment.
We may use or disclose protected health information to notify or assist
in notifying a family member, personal representative or any other person
that is responsible for your care location, general condition or death.
Finally, we may use or disclose your protected health information to
an authorized public or private entity to assist in disaster relief
efforts.
- Emergencies: We may use or disclose your protected
health information in an emergency treatment situation.
Other Permitted and Required Uses and Disclosures That May Be Made
Without Your Consent, Authorization or Opportunity to Object
- Required by Law: We may use or disclose your
protected health information to the extent that the use or disclosure
is required by law. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements of the
law. You will be notified, as required by law, of any such uses or disclosures.
- Public Health: We may disclose your protected
health information for public health activities and purposes to a public
health authority that is permitted by law to collect or receive the
information. The disclosure will be made for the purpose of controlling
disease, injury or disability.
- Communicable Diseases: We may disclose your
protected health information, if authorized by law, to a person who
may have been exposed to a communicable disease or may otherwise be
at risk of contracting or spreading the disease or condition.
- Health Oversight: We may disclose protected
health information to a health oversight agency, such as Medicare, Medicaid,
Department of Health and Human Services, Office of Civil Rights or a
managed care company for activities authorized by law, such as audits,
investigations, and inspections.
- Abuse and Neglect: We may disclose your protected
health information to a public health authority that is authorized by
law to receive reports of child abuse or neglect. In addition, we may
disclose your protected health information if we believe that you have
been a victim of abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information. In this case,
the disclosure will be made consistent with the requirements of applicable
federal and state laws.
- Food and Drug Administration: We may disclose
your protected health information to a person or company required by
the food and Drug Administration to report adverse events, product defects
or problems, biologic product deviations, track products; to enable
product recalls; to make repairs or replacements, or to conduct post
marketing surveillance, as required.
- Legal Proceedings: We may disclose protected
health information in the course of any judicial or administrative proceeding,
in response to an order of a court or administrative tribunal (to the
extent such disclosure is expressly authorized), in certain conditions
in response to a subpoena, discovery request or other lawful process,
and according to Georgia state law.
- Law Enforcement: We may also disclose protected
health information, so long as applicable legal requirements are met,
for law enforcement purposes. This includes disclosing your protected
health information, if we believe that the use or disclosure is necessary
to prevent or lessen a serious and imminent threat to the health or
safety of a person or the public. We may also disclose protected health
information if it is necessary for law enforcement authorities to identify
or apprehend an individual.
- Coroners, Funeral Directors and Organ Donation:
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or
for the coroner or medical examiner to perform other duties authorized
by law.
- Military Activity and National Security: When
the appropriate conditions apply, we may use or disclose protected health
information of individuals who are Armed Forces personnel (1) for activities
deemed necessary by appropriate military command authorities; (2) for
the purpose of a determination by the Department of Veterans Affairs
of your eligibility for benefits, or (3) to foreign military authority
if you are a member of that foreign military service.
- Workers Compensation: Your protected health
information may be disclosed by us as authorized to comply with workers’
compensation laws and other similar legally established programs.
YOUR RIGHTS
Following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise these
rights
You have the right to inspect and copy your protected health
information. This means you may inspect and obtain a copy
of protected health information about you that is contained in a designated
record set for as long as we maintain the protected health information.
All requests for copying or inspection of your medical record will be
fulfilled within 7 days of the request. A “designated record set”
contains medical and billing records that your physician and the practice
use for making decisions about you.
Under federal law, however, you may not inspect or copy information compiled
in reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding. Depending on the circumstances, a decision to deny
access may be reviewable. In some circumstances, you may have a right
to have this decision reviewed. Please contact our Privacy Officer if
you have questions about access to your medical record.
You have the right to request a restriction of your protected
health information. This means you may ask us not to use
or disclose any part of your protected health information for the purposes
of treatment, payment or healthcare operations. You may also request that
any part of your protected health information not be disclosed to family
members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request
must state the specific restriction requested and to whom you want the
restriction to apply.
Your physician is not required to agree to a restriction that you may
request. If physician believes it is in your best interest to permit use
and disclosure of your protected health information, your protected health
information will not be restricted. If your physician does agree to the
requested restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction
you wish to request with your physician.
You have the right to request to receive confidential communications
from us by alternative means or at an alternative location.
This request must be in writing and we will accommodate reasonable requests.
We may also condition this accommodation by asking you for information
as to how payment will be handled or specification of an alternative address
or other method of contact.
You may have the right to have your physician amend your protected health
information. This means you may request an amendment of protected health
information about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request for an amendment.
If we deny your request for amendment, you have the right to file a statement
of disagreement with the Privacy Officer and we may prepare a rebuttal
to your statement and will provide you a copy of any such rebuttal.
You have a right to receive an accounting of certain disclosures
we have made, if any, of your protected health information.
This right applies to disclosures for purposes other than treatment, payment
or healthcare operations as described in this Notice of Privacy Practices.
It excludes disclosures we may have made to you, to family members or
friends involved in your care, or for notification purposes. You have
the right to receive specific information regarding these disclosures
that occurred after April 14, 2003. You may request a shorter timeframe.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
You have the right to obtain a paper copy of this notice from us at any
time upon request.
COMPLAINTS
You may complain to us or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated by us. You may file
a complaint with us by notifying our privacy contact of your complaint.
We will not retaliate against you for filing a complaint.
You may contact our Privacy Officer, at 770-952-8899 for further information
about the complaint process.
This notice was published and becomes effective on April 14, 2003 |
