EFFECTIVE DATE: AUGUST 1, 2017. 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.
The health insurance Portability and Accountability Act of 1966 (HIPAA) is a federal program that requires all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
1. HOW THE PRACTICE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your medical records only for each of the following purposes: Treatment, Payment, and Health Care Operations.
We may also create and distribute de-identified health information by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.
There are times we may be required by law to disclose information for law enforcement or public health reasons without additional authorization from the patient.
2. WHEN THE PRACTICE MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION
Except as described in this Notice of Privacy Practices, the practice will not use or disclose health information which identifies you without your written authorization. If you do authorize the practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. We are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
3. YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to your protected health information (PHI), which you can exercise by presenting a written request to the Privacy Officer using Practice forms:
We are required by law to maintain the privacy of your PHI and to provide you with the notice of our legal duties and privacy practices with respect to PHI.
4. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all PHI that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from the Practice.
If you believe there has been a problem with our collection, use, or disclosure of your PHI, you have the right to file a complaint with our Privacy Officer. If we do not respond to your complaint in a satisfactory manner, you may file a complaint with the U.S. Office of Civil Rights. We will not retaliate against you for filing a complaint.
Our Privacy Officer :
Leslie Perry 404-446-0600 1505 Northside Blvd Suite 4000 Cumming GA 30041
For more information about HIPAA or to file a complaint contact:
The U.S. Department of Health & Human ServicesOffice of Civil Rights61 Forsyth Street, SW, Suite 3B70Atlanta, GA 30303-8909Telephone: (404)562-7866Fax: (404)562-7881
If you have any questions about this notice, please contact:
4150 Deputy Bill Cantrell Memorial RoadSuite 290 • Cumming, GA 30040
Call For Appointment:1.404.446.0600
3400-C Old Milton ParkwaySuite 555 • Alpharetta, GA 30005
Call For Appointment:1.470.533.2750
200 Dawson Commons Cir.Suite 230 • Dawsonville, GA 30534
Call For Appointment:1.470.533.2747
4749 Nelson Brogdon BlvdBldg. 300 – Ste. 102 • Sugar Hill, GA 30518