Notice of Privacy Policies

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

INTRODUCTION

At Atlanta Midtown Gynecology, we are committed to treating and using protected health information about you responsibly. This notice of Health Information Practices describes the personal information we collect from you, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective October 1st, 2008 and applies to all protected health information as defined by federal regulations.

UNDERSTANDING YOUR HEALTH RECORD

Each time you visit Atlanta Midtown Gynecology, a record of your visit is made. Typically, this record contains your symptoms, diagnoses, treatment, and a plan for future care. This information is often referred to as your health or medical record and serves as a:

• Basis for planning your care and treatment
• Means of communication among many health professionals who contribute to your care
• Legal document describing the care you received
• Means by which you or a third party payer can verify that services billed were provided
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to better understand who, what, when, where and why others may access your health information.

YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of Atlanta Midtown Gynecology, the information it contains belongs to you. You have the right to:

• Obtain a paper copy of this notice of information practices upon request.
• Request a copy of your health record
• Obtain an accounting of disclosures of your health information
• Request communications of your health information by alternative means or at alternative locations
• Request a restriction on certain issues and disclosures of you information
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken

OUR RESPONSIBILITIES

Atlanta Midtown Gynecology is required to:

• Maintain the privacy of your health information
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provision effective for all protected health information we maintain or disclose.

Should our information practices change, we will post a copy of the revised notice in our office We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions and would like additional information, you may contact Atlanta Midtown Gynecology at 404-685-8867

If you believe your privacy rights have been violated, you can file a complaint with:

Atlanta Midtown Gynecology
842 N. Highland Ave
Suite 250
Atlanta, Ga 30306

If you feel your privacy issue was not resolved, you may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services. We will provide the address upon request

There will be no retaliation for filing a complaint with either our office or the Office for Civil Rights

EXAMPLES OF DISCLOSURES FORTREATMENT, PAYMENT AND HEALTH OPERATIONS

We will use your health information for treatment

For example: information obtained by a nurse, physician or other member or your health care team will be recorded in your record and used to determine the course of the treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of you health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to your treatment.

We will use your health information for regular health operations

For example: members of the medical staff may use information in your health record to assess the care and outcomes in your case and other cases like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

Business associates: There are some services provided in our organization through contacts with business associates. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third party payer for services rendered. To protect your health information, however, we require our business associate to appropriately safeguard your information.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health record information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public

Revision number 1
October 1, 2008