11650 Alpharetta Hwy, Suite 100, Roswell, GA 30076
Phone number _______________________
Office hours ____________________
We look forward to helping you feel better in our Roswell office!
11650 Alpharetta Hwy, Suite 100, Roswell, GA 30076
Phone number _______________________
Office hours ____________________
This Privacy Notice 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 in some cases. Your “protected health information” means any written and oral health information about you, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health or condition.
I. Uses and Disclosures of Protected Health Information
Georgia Spine and Orthopaedics of Atlanta, LLC may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations and other purposes allowed by law.
A. Treatment. We may use your protected health information to provide you with medical treatment or services. We may disclose information about you to our doctors, nurses, technicians or other people who are taking care of you. We may also share your protected health information with other health care providers to assist them in caring for you. For example, a doctor in any of our offices may also share this information with another doctor to whom you have been referred for further care.
B. Payment. We may use your protected health information or share it with others for payment purposes. For example, we may share information about you with your insurance company in order to obtain pre- approval before providing you with treatment.
C. Operations. We may use your protected health information or share it with others in order to conduct our normal business operations. This may include measuring and improving quality, evaluating performance, conducting training and getting accreditation certificates, licenses and credentials we need to serve you. For example, we may also share your protected health information with another company that performs business services for us, such as billing companies. If so, we will have a written contract to ensure that this company also protects the privacy of your protected health information.
D. Other Uses and Disclosures. We may use your protected health information when we contact you regarding your services. We may also use your protected health information in order to recommend possible treatment alternatives, health-related benefits, health education and services that may be of interest to you.
II. Uses and Disclosures beyond Treatment, Payment and Health Care Operations Permitted without Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose your protected health information without your permission or authorization for several reasons including the following:
A. As Required By Law. We may use or disclose your protected health information if we are required by law to do so. We will notify you of these uses and disclosures if notice is required by law.
B. 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. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
C. 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.
D. Health Oversight. We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefits programs, other government regulatory programs and civil rights laws.
E. Abuse or 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 government 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.
F. 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 deviations, track products, to enable product recalls, to make repairs or replacements, or to conduct marketing surveillance as required.
G. Legal Proceedings. We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or any other lawful process.
H. Law Enforcement. We may also disclose your protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include legal processes and otherwise required by law, limited information requests for identification and location purposes, pertaining to victims of a crime, suspicion that death has occurred as a result of criminal conduct, in the event that a crime occurs on the premises of any of the practices, and medical emergency (not on the practice premises) and it is likely that a crime has occurred.
I. Coroners, Funeral Directors, and Organ Donation. We may disclose your 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 as authorized by law. We may also disclose your protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. Your health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
J. Criminal Activity. Consistent with applicable federal and state laws, we may disclose 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 the person or the public. We may also disclose your protected health information if it is necessary to law enforcement authorities to identify or apprehend an individual.
K. National Security and Intelligence Activities or Protective Services. We may disclose your protected health information to authorized federal officials who are conducting national security and intelligence activities or providing protective services to the President or other important officials.
L. Military and Veterans. If you are in the Armed Forces, we may disclose protected health information about you to appropriate military command authorities for activities they deem necessary to carry out their military mission. We may also release health information about foreign military personnel to the appropriate foreign military authority.
M. Worker’s Compensation. Your protected health information may be disclosed by us as authorized to comply with worker’s compensation laws and other similar legally established programs, as previously described herein.
N. Research. We may disclose your protected health information to researchers when their research has been approved by an institutional board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
III. USES AND DISCLOSURES PERMITTED WITHOUT AUTHORIZATIONS BUT WITH OPPORTUNITY TO OBJECT
We may disclose your protected health information to your family member if it is directly relevant to the person’s involvement in your care or payment related to your care if permitted by law. We may also disclose your information in connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death. If you do not wish for us to speak with a particular person about your care, you should notify the receptionist or a nurse.
IV. USES AND DISCLOSURES WHICH YOU AUTHORIZE
Other than stated above, we will not disclose your health information other than with your written authorization. You may revoke your authorization in writing at any time except to the extent that we have acted in reliance upon the authorization. We specifically require your written authorization for marketing or the sale of your protected health information. If our practice maintains psychotherapy notes, we will require your written authorization for the use or disclosure of psychotherapy notes other than by the creator of those notes, by the practice for its training programs or for the practice to defend itself in a legal action brought by you.
V. YOUR RIGHTS
You have the following rights regarding your health information:
A. The right to inspect and copy your protected health information. You may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your surgeon and the practice uses for making decisions about you. If information in a “designated record set” is maintained electronically, you may request an electronic copy in a form and format of your choice that is readily producible or, if the form/format is not readily producible, you will be given a readable electronic copy.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. Depending on the circumstances, you may have the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy your protected health information if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.
To inspect and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last page of this Privacy Notice. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing and other costs incurred by us in complying with your request.
Please contact our Privacy Officer if you have questions about access to your medical record.
B. The right to request a restriction on uses and disclosures of your protected health information. You may ask us not to use or disclose certain parts of your protected health information for the purposes of treatment, payment or health care operations. You may also request that we not disclose your health information to family members or friends who may be involved in your care or for notification purposes as described in this Privacy Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply.
The practice is not required to agree to a restriction that you may request unless your request related to a disclosure to a health plan for items or services that were paid in full by you or someone other than the health plan and the disclosure is not required by law. We will notify you if we deny your request to a restriction. If the practice 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. Under certain circumstances, we may terminate our agreement to a restriction. You may request a restriction by contacting the Privacy Officer.
C. The right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We may 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. We will not require you to provide an explanation for your request. Requests must be made in writing to our Privacy Officer.
D. The right to request amendments to your protected health information. 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 us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendment.
E. The right to receive an accounting. You have the right to request an accounting of certain disclosures of your protected health information made by the facility. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Privacy Notice. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a practice directory, to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time sought for the accounting. Accounting requests may not be made for periods of time more than six years. We will provide the first accounting you request in any 12-month period without charge, Subsequent accounting requests may be subject to a reasonable cost-based fee.
F. The right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.
VI. OUR DUTIES
The practice is required by law to maintain the privacy or your health information and report to you any breach of unsecured protected health information. We are also required to provide you with this Privacy Notice of our duties and privacy practices. We are required to abide by terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all future protected health information that we maintain. If the practice changes this Notice, we will post the revised Notice on our website and at registration desks within our offices.
You have the right to express complaints to the practice and to the Secretary of the U.S. Department of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the practice by contacting the Privacy Officer verbally or in writing, using the contact information below. You will not be retaliated against in any way for filing a complaint.
VIII. CONTACT PERSON
The facility’s contact person for all issues regarding patient privacy and your rights under the federal privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer. If you feel that your privacy rights have been violated by this practice you may submit a complaint to our Privacy Officer at the following address: Georgia Spine and Orthopaedics, LLC; Attn: Privacy Officer, 11650 Alpharetta Hwy, Ste 100, Roswell, GA 30076. The Privacy Officer can also be contacted by telephone at 404.456.5670.
Revision date: November 15, 2018