HIPAA NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Effective 4/14/2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU AS A PATIENT OF THIS PRACTICE MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future.
USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION
Treatment: We may use your medical information to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your medical information in order to write a prescription for you or to a pharmacy when we order a prescription for care. Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your medical information in order to treat you or to assist others in your treatment. Additionally, we may disclose your medical information to others who may assist in your care, such as your spouse, children or parents.
Payment: We may use and disclose your health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay, for your treatment. We also may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your health information to bill you directly for services and items.
Health Care Operations: We may use and disclose your health information for operations, such as for peer review, performance improvement, risk management, and our compliance requirements. For example, we may disclose your medical information to physicians on our Medical Staff who review information to doctors, nurses, technicians, medical and nursing or other health care students, and personnel for teaching. We may combine medical information about many patients to decide what services our practice should offer, and whether new services are cost-effective and how we compare with other facilities. Sometimes, we may remove identifying information from this medical information so others may use it to study health care and health care delivery without learning who you are. We may disclose information to other health care providers involved in your treatment to permit them to carry out the work of their facility or to get paid. For example, we may provide information about your treatment to an ambulance company that brought you to our facilities so that the ambulance company can get paid for their services.
SPECIAL SITUATIONS
Public Health Risks: We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, disability, to report births and deaths, to report child or adult abuse, neglect or violence, to report reactions to medications or problems with products, to notify people of recalls of products and to notify persons who may have been exposed to a disease or at risk for getting or spreading a disease or condition.
Health Oversight Activities: We may disclose health information to a health oversight agency for activities such as audits, investigations, inspections, and licensure of our facilities, and of the providers who treated you. These activities are necessary for the government to monitor the health care system, government programs and compliance laws.
Lawsuits and Disputes: We may disclose information about you to respond to a court or administrative order or a search warrant. We may also disclose information in response to subpoenas, discovery request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request and you have been provided an opportunity to object or to obtain an appropriate court order protecting the information requested.
Law Enforcement: Subject to certain condition, we may disclose your medical information for a law enforcement purpose upon the request of federal, state or local law enforcement.
Medical Examiner, Coroners, and Funeral Directors: We may disclose your medical information to a coroner, medical examiner or funeral director to carry out their duties. Organ and Tissue Donation: We may release your health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
Research: We may use and disclose your medical information for research, including clinical trials and experimental drugs. Most research projects, however, are subject to a special approval process. Most research projects require your permission if a researcher will be involved in your care or will have access to your name, address or other information that identifies you. However, the law allows some research, including Institution Review Board, to be done using your medical information without requiring your authorization.
Serious Threats to Health or Safety: Consistent with applicable federal and state laws, we may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Veterans: If you are a member of the U.S. or foreign armed forces, we may disclose health information about you as required by military command authorities.
Protecting Services the President, National Security and Intelligence Activities: We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, to conduct special investigations, for intelligence, counterintelligence, and other national security activities authorized by law.
Inmate: If you are an inmate of a correctional institution or under the custody of a law enforcement officer, we may release your medical information to the correctional institution or a law enforcement officer. This release would be necessary to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the law enforcement officer or correctional institution.
Workers’ Compensation: We may disclose health information to provide benefits for work-related injuries and illness to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Confidential Communication: You have the right to request that our practice communicate with you about your health related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to your Center Site Manager specifying the requested method of contact, or the location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request. Our facility uses the following methods for patient identification purposes or to communicate your protected health information:
- Facial identification photos
- Medical photographs to identify treatment area
- Calling your name over the intercom in waiting room
- Use of your name on a dressing room box where your clothes are held during treatment
- Use of patient identification cards for proper ID
- Contact you at home or at work
- Talk to your spouse or next of kin about appointments
- Mail a reminder of follow-up visits to your home
- Mail other business related items, i.e. bills, insurance claims to your home
- Contact you via email or voice mail at home/work
Requesting Restrictions: You have the right to request a restriction in our use of disclosure of your health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. This request must be in writing and given to the Center Site Manager. Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply.
Inspection and Copies: You have the right to inspect and obtain a copy of your health information that may be used to make decisions about, including patient medical records and billing records, but not including psychotherapy notes. This request must be in writing and given to the Center Site Manager. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. Your request must be made in writing and given to the Center Site Manager. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (and the reason supporting your request) in writing.
Also, we may deny your request if you ask us to amend information that is in our opinion; (a) accurate and complete; (b) not part of your health information kept by our practice; (c) not part of your health information which you would be permitted to inspect and copy; (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
Accounting of Disclosures: You have the right to request an “accounting of disclosures” which is a list of certain non-routine disclosures our practice has made of your health information for non-treatment purposes. Use of your health information as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing office using your information to file your insurance claim. You must submit your request in writing to the Center Site Manager to obtain this and state a time period, which may not be longer than (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request with a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer, or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Right to Provide an Authorization for Other Uses and Disclosures: We will obtain your written authorization for uses of health uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your health information for reasons described in the authorization. Please note, we are required to retain records of your care. Again, if you have any questions regarding this notice please contact the HIPAA Privacy Officer at: 770-994-1650.
Note: Georgia and Federal law provides additional protection for certain types of health information, including alcohol or drug abuse, mental health and AIDS/HIV, and may limit whether and how we may disclose information about you to others.
