Patient Notices

NOTICE OF PRIVACY PRACTICE FOR PROTECTED HEALTH INFORMATION

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully! 

If you consent, the office is permitted by federal privacy laws to make uses and disclosures of your health information for the purposes of treatment, payment, and healthcare operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

Examples of uses of your health information for treatment purposes are: 

- A nurse obtains treatment information about you and records it in a health record.

- During the course of treatment, the physician determines he/she will need to consult with another specialist in the area. He/She will share the information with which such specialists and obtain his/her input.

Example of use of your health information for payment purposes:

- We submit requests for payment to your health insurance company. The health insurance company requests information from us regarding the medical care given. We will provide information to them about you and the care given.   

Example of your information for healthcare purposes:   

- We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol, and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.     

The health and billing records we maintain are the physical property of the doctors’ office. The information in it, however, belongs to you. You have the right to: 

- Request a restriction on certain uses and disclosures of your health information by delivering a request in writing to our office. We are not required to grant the request, but we will comply with any requested granted; 

- Obtain a paper copy of the Notice of Privacy Practices for protected health information by making a request at our office; 

- Request that you be allowed to inspect and copy your health record and billing record. You may exercise this right by delivering the request in writing to our office using the form we provide to you upon request; 

- Appeal a denial of excess to your protected health information except in certain circumstances;  

- Request that your healthcare record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request. The physician is not required to make such amendments; 

- File a statement of disagreement if your amendment is denied, and require that the request for amendment in any denial be attached in all future disclosures of your protected health information; 

- Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care; 

- Request that communications of your health information be made by alternative means or at an alternative location by delivering a written request to our office using the form we provide to you upon request; and 

- Revoke authorization that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.     

If you want to exercise any of the above rights, please contact Ashley Bader, Office Manager, in person or in writing, during normal office hours. She will provide you with assistance with the steps to take to exercise your right.     

You have the right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment and healthcare operations purposes.     
 

OUR RESPONSIBILITIES

The office is required to:   

- Maintain the privacy of your health information as required by law; 

- Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you; 

- Abide by the terms of this notice;

- Notify you if we cannot accommodate requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our Notice or by visiting our office and picking up a copy.

To request information of file a complaint:   If you have any questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Ashley Bader, Office Manager at (706) 376-3850.   Additionally, if you believe your privacy rights have been violated, you may file a written complaint in your office by delivering the written complaint to Ashley Bader, Office Manager. You may also file a complaint by mailing it to the Secretary of Health and Human Services at 200 Independence Ave, SW, Washington, DC 20201, telephone number (877) 696-6775.    

- We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from our office

- We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

Other Disclosures and Uses

Notification- Unless you object, we may use or disclose your protected health information to notify, or assist in notifying a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death. 

Communication with Family- Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.   

Research- We may use and disclose your protected health information to assist in disaster relief efforts.   

Funeral Directors or Coroners- We may disclose your protected information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.   

Organ Procurement Organizations- Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.   

Food and Drug Administration- If you are seeking compensation through Worker’s Compensation, we may disclose your protected health information to the extent necessary to comply with the law relating to Worker’s Compensation.   

Public Health- As required by law, we may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.   

Abuse and Neglect- We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.  

Correctional Institutions- If you are an inmate of a correctional institution, we may disclose to the institution or its agents the protected health information necessary for your health and the health and safety of other individuals.    

Law Enforcement- We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony, prosecutions, or to the extent an individual is in the custody of law enforcement.   

Health Oversight- Federal law allows us to release your protected health information in the course of any judicial or administrative proceedings as allowed or required by law, with your consent, or as directed by a proper court order.  

Serious Threat to Health or Safety- To avert a serious threat to health of safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, eminent threat to the health and safety of a person or the public.   

For Specialized Governmental Functions- We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program.    

Other Uses- Other uses and disclosures besides those identified in the Notice will be made only as otherwise authorized by law or with written authorization and you may revoke the authorization as previously provided.