Improving Your Emotional Well Being
3633 Wheeler Road, Suite 100
Augusta, Georgia 30909
Notice of Privacy Practices
As required by the Privacy Regulations Promulgated Pursuant to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
3633 Wheeler Road, Suite 100
Augusta, Georgia 30909
Effective August 2010
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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) 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.
Ways in Which We May Use and Disclose Your Protected Health Information
The following paragraphs describe different ways that we use and disclose your protected health information. We have provided an example for each category, but these examples are not meant to be exhaustive. All of the ways we are permitted to use and disclose your health information falls within one of these categories.
Treatment - We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. We will also disclose your health information to other physicians who may be treating you. Additionally, we may from time to time disclose your health information to another physician whom we requested to be involved in your care. For example – we would disclose your health information to a specialist to whom we have referred you for a diagnosis to help in your treatment.
Payment – We will use and disclose your protected health information to obtain payment for the health care services we provide you. For example – we may include information with a bill to a third-party payer that identifies you, your diagnosis, procedures performed, and supplies used in rendering service.
Healthcare Operations – We will use and disclose your protected health information to support the business activities of our practice. For example – we may use medical information about you to review and evaluate our treatment and services or to evaluate our staff’s performance while caring for you. In addition, we may disclose your health information to third party business associates who perform billing, consulting, transcription, or other services for our practice.
Appointment Reminders – We will use and disclose your protected health information to contact you as a reminder about scheduled appointments and treatment.
Treatment Alternatives – We will use and disclose your protected health information to tell you about or recommend possible alternative treatments or options that may be of interest to you.
Others Involved in Your Care – We will use and disclose your protected health information to a family member, a relative, a close friend, or any other person you identify that is involved in your medical care or payment of care.
Research – We will use and disclose your protected health information to researchers, provided the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
As Required by Law – We will use and disclose your protected health information when required to by federal, state, or local law.
To avert a Serious Threat to Public Health or Safety – We will use and disclose your protected health information to public health authorities permitted to collect or receive the information for the purpose of controlling disease, injury, or disability. If directed by that health authority, we will also disclose your health information to a foreign government agency that is collaborating with the public health authority.
Worker’s Compensation – We will use and disclose your protected health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illness.
Inmates – We will use and disclose your protected health information to a correctional institution or law enforcement official if you are an inmate of that correctional institution or under the custody of the law enforcement official. This information would be necessary for the institution to provide you with health care; to protect the health and safety of others; or for the safety and security of the correctional institution.
Your Health Information Rights
The following is a statement of your rights with respect to your protected health information.
A Paper Copy of This Notice – You have the right to receive a paper copy of this notice upon request.
Inspect and Copy – You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect and copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
Request Amendment – You have the right to request that we amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing to our practice manager, stating exactly what information is incomplete or inaccurate and the reasoning that supports your request.
We are permitted to deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if:
The information was not created by us, or the person who created it is no longer available to make the amendment.
The information is not part of record which you are permitted to inspect and copy.
The information is not part of the designated record set kept by this practice or if it is the opinion of the health care provider that the information is accurate and complete.
Request Restrictions – You have the right to request a restriction of how we use or disclose your medical information for treatment, payment, or health care operations. For example – you could request that we do not disclose information about prior treatment to a family member or friend who may be involved in your care or payment of care.
We are not required to agree to your request if we feel it is in your best interest to use or disclose that information. If we do agree, we will comply with your request except for emergency treatment.
Accounting of Disclosures – You have the right to receive an accounting of disclosures of your health information we have made outside of our practice that were not for treatment, payment, or health care operations.
Request Confidential Communications – You have the right to request how we communicate with you to preserve your privacy. For example – you may request that we call you only at your work number. Your request must be made in writing and must specify how or where we are to contact you. We will accommodate all reasonable requests.
Complaints – If you believe we have violated your medical information privacy rights, you have the right to file a complaint with our practice or directly to the Secretary of Health and Human Services.
You may file a complaint with us by notifying our Privacy Officer about your complaint.
Uses or Disclosures not Covered
Uses or disclosures of your health information not covered by this notice or the laws that apply to us may only be made with your written authorization. You may revoke such authorization in writing at any time and we will no longer disclose health information about you for the reasons stated in your written authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by the revocation.
For More Information
If you have questions or would like additional information, you may contact our Privacy Officer.