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SUBURBAN
HEMATOLOGY ONCOLOGY ASSOCIATES, PC
600 PROFESSIONAL DRIVE, SUITE 210, LAWRENCEVILLE, GA 30045
1700 TREE LANE, SUITE 490, SNELLVILLE, GA 30078
3855 PLEASANT HILL ROAD, SUITE 360, DULUTH, GA 30096
NOTICE
OF PRIVACY PRACTICES
As Required by the Privacy Regulations Created as a Result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT
OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE
REVIEW THIS NOTICE CAREFULLY.
A.
OUR COMMITMENT TO YOUR PRIVACY
Our
practice is dedicated to maintaining the privacy of your individually
identifiable health information (IIHI). In conducting our business,
we will create records regarding you and the treatment and services
we provide to you. We are required by law to maintain the confidentiality
of health information that identifies you. We also are required
by law to provide you with this notice of our legal duties and the
privacy practices that we maintain in our practice concerning your
IIHI. By federal and state law, we must follow the terms of the
notice of privacy practices that we have in effect at the time.
We
realize that these laws are complicated, but we must provide you
with the following important information:
- How we may
use and disclose your IIHI
- Your privacy
rights in your IIHI
- Our obligations
concerning the use and disclosure of your IIHI
The
terms of this notice apply to all records containing your IIHI that
are created or retained by our practice. We reserve the right to
revise or amend this Notice of Privacy Practices. Any revision or
amendment to this notice will be effective for all of your records
that our practice has created or maintained in the past, and for
any of your records that we may create or maintain in the future.
Our practice will post a copy of our current Notice in our offices
in a visible location at all times, and you may request a copy of
our most current Notice at any time.
B.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Candace Hayes, Privacy Officer, 600 Professional Dr. Suite 210,
Lawrenceville, Ga 30045 (770-963-8030)
C.
WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
(IIHI) IN THE FOLLOWING WAYS
The
following categories describe the different ways in which we may
use and disclose your IIHI.
1.
Treatment.
Our practice may use your IIHI to treat you. For example, we may
ask you to have laboratory tests (such as blood or urine tests),
and we may use the results to help us reach a diagnosis. We might
use your IIHI in order to write a prescription for you, or we might
disclose your IIHI to a pharmacy when we order a prescription for
you. Many of the people who work for our practice - including, but
not limited to, our doctors and nurses - may use or disclose your
IIHI in order to treat you or to assist others in your treatment.
Additionally, we may disclose your IIHI to others who may assist
in your care, such as your spouse, children or parents.
2.
Payment.
Our practice may use and disclose your IIHI in order to bill and
collect payment for the services and items you may receive from
us. For example, we may contact your health insurer to certify that
you are eligible for benefits (and for what range of benefits),
and we may provide your insurer with details regarding your treatment
to determine if your insurer will cover, or pay for, your treatment.
We also may use and disclose your IIHI to obtain payment from third
parties that may be responsible for such costs, such as family members.
Also, we may use your IIHI to bill you directly for services and
items.
3.
Health Care Operations.
Our practice may use and disclose your IIHI to operate our business.
As examples of the ways in which we may use and disclose your information
for our operations, our practice may use your IIHI to evaluate the
quality of care you received from us, or to conduct cost-management
and business planning activities for our practice.
4.
Appointment Reminders.
Our practice may use and disclose your IIHI to contact you and remind
you of an appointment.
5.
Treatment Options.
Our practice may use and disclose your IIHI to inform you of potential
treatment options or alternatives.
6.
Health-Related Benefits and Services. Our practice may use and disclose your IIHI to inform you
of health-related benefits or services that may be of interest to
you.
7.
Release of Information to Family/Friends.
Our practice may release your IIHI to a friend or family member
that is involved in your care, or who assists in taking care of
you. For example, a parent or guardian may ask that a friend take
their loved one to the physician's office for treatment. In this
example, the friend or family member may have access to the patient's
condition and/or medication information.
8.
Disclosures Required By Law.
Our practice will use and disclose your IIHI when we are required
to do so by federal, state or local law.
D.
USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The
following categories describe unique scenarios in which we may use
or disclose your identifiable health information:
1.
Public Health Risks.
Our practice may disclose your IIHI to public health authorities
that are authorized by law to collect information for the purpose
of:
- maintaining
vital records, such as births and deaths
- reporting
child abuse or neglect
- preventing
or controlling disease, injury or disability
- notifying
a person regarding potential exposure to a communicable disease
- notifying
a person regarding a potential risk for spreading or contracting
a disease or condition
- reporting
reactions to drugs or problems with products or devices
- notifying
individuals if a product or device they may be using has been
recalled
- notifying
appropriate government agency(ies) and authority(ies) regarding
the potential abuse or neglect of an adult patient (including
domestic violence); however, we will only disclose this information
if the patient agrees or we are required or authorized by law
to disclose this information
- notifying
your employer under limited circumstances related primarily to
workplace injury or illness or medical surveillance.
2.
Health Oversight Activities.
Our practice may disclose your IIHI to a health oversight agency
for activities authorized by law. Oversight activities can include,
for example, investigations, inspections, audits, surveys, licensure
and disciplinary actions; civil, administrative, and criminal procedures
or actions; or other activities necessary for the government to
monitor government programs, compliance with civil rights laws and
the health care system in general.
3.
Lawsuits and Similar Proceedings.
Our practice may use and disclose your IIHI in response to a court
or administrative order, if you are involved in a lawsuit or similar
proceeding. We also may disclose your IIHI in response to a discovery
request, subpoena, or other lawful process by another party involved
in the dispute, but only if we have made an effort to inform you
of the request or to obtain an order protecting the information
the party has requested.
4.
Law Enforcement.
We may release IIHI if asked to do so by a law enforcement official:
- Regarding
a crime victim in certain situations, if we are unable to obtain
the person's agreement
- Concerning
a death we believe has resulted from criminal conduct
- Regarding
criminal conduct at our offices
- In response
to a warrant, summons, court order, subpoena or similar legal
process
- To identify/locate
a suspect, material witness, fugitive or missing person
- In an emergency,
to report a crime (including the location or victim(s) of the
crime, or the description, identity or location of the perpetrator)
5.
Deceased Patients.
Our practice may release IIHI to a medical examiner or coroner to
identify a deceased individual or to identify the cause of death.
If necessary, we also may release information in order for funeral
directors to perform their jobs.
6.
Organ and Tissue Donation.
Our practice may release your IIHI to organizations that handle
organ, eye or tissue procurement or transplantation, including organ
donation banks, as necessary to facilitate organ or tissue donation
and transplantation if you are an organ donor.
7.
Research.
Our practice may use and disclose your IIHI for research purposes
in certain limited circumstances. We will obtain your written authorization
to use your IIHI for research purposes except when: (a) our use
or disclosure was approved by an Institutional Review Board or a
Privacy Board; (b) we obtain the oral or written agreement of a
researcher that (i) the information being sought is necessary for
the research study; (ii) the use or disclosure of your IIHI is being
used only for the research and (iii) the researcher will not remove
any of your IIHI from our practice; or (c) the IIHI sought by the
researcher only relates to decedents and the researcher agrees either
orally or in writing that the use or disclosure is necessary for
the research and, if we request it, to provide us with proof of
death prior to access to the IIHI of the decedents.
8.
Serious Threats to Health or Safety.
Our practice may use and disclose your IIHI when necessary to reduce
or prevent a serious threat to your health and safety or the health
and safety of another individual or the public. Under these circumstances,
we will only make disclosures to a person or organization able to
help prevent the threat.
9.
Military.
Our practice may disclose your IIHI if you are a member of U.S.
or foreign military forces (including veterans) and if required
by the appropriate authorities.
10.
National Security.
Our practice may disclose your IIHI to federal officials for intelligence
and national security activities authorized by law. We also may
disclose your IIHI to federal officials in order to protect the
President, other officials or foreign heads of state, or to conduct
investigations.
11.
Inmates.
Our practice may disclose your IIHI to correctional institutions
or law enforcement officials if you are an inmate or under the custody
of a law enforcement official. Disclosure for these purposes would
be necessary: (a) for the institution to provide health care services
to you, (b) for the safety and security of the institution, and/or
(c) to protect your health and safety or the health and safety of
other individuals.
12.
Workers' Compensation.
Our practice may release your IIHI for workers' compensation and
similar programs.
E.
YOUR RIGHTS REGARDING YOUR IIHI
You
have the following rights regarding the IIHI that we maintain about
you:
1.
Confidential Communications.
You have the right to request that our practice communicate with
you about your health and related issues in a particular manner
or at a certain location. For instance, you may ask that we contact
you at home, rather than work. In order to request a type of confidential
communication, you must make a written request to Candace Hayes,
Privacy Officer, 600 Professional Drive, Suite 210, Lawrenceville,
GA 30045 (770) 963-8030 specifying the requested method of contact,
or the location where you wish to be contacted. Our practice will
accommodate reasonable requests. You do not need to give a reason
for your request.
2.
Requesting Restrictions.
You have the right to request a restriction in our use or disclosure
of your IIHI for treatment, payment or health care operations. Additionally,
you have the right to request that we restrict our disclosure of
your IIHI to only certain individuals involved in your care or the
payment for your care, such as family members and friends. We are
not required to agree to your request; however, if we do agree,
we are bound by our agreement except when otherwise required by
law, in emergencies, or when the information is necessary to treat
you. In order to request a restriction in our use or disclosure
of your IIHI, you must make your request in writing to Candace Hayes,
600 Professional Drive, Suite 210, Lawrenceville, Ga 30045 (770)
963-8030. Your request must describe in a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice's use, disclosure
or both; and
(c) to whom you want the limits to apply.
3. Inspection and Copies. You have
the right to inspect and obtain a copy of the IIHI that may be used
to make decisions about you, including patient medical records and
billing records, but not including psychotherapy notes. You must
submit your request in writing to Candace Hayes, Privacy Officer,
600 Professional Drive, Suite 210, Lawrenceville, Ga 30045 (770)
963-8030 in order to inspect and/or obtain a copy of your IIHI.
Our practice may charge a fee for the costs of copying, mailing,
labor and supplies associated with your request. Our practice may
deny your request to inspect and/or copy in certain limited circumstances;
however, you may request a review of our denial. Another licensed
health care professional chosen by us will conduct reviews.
4.
Amendment.
You may ask us to amend your health information if you believe it
is incorrect or incomplete, and you may request an amendment for
as long as the information is kept by or for our practice. To request
an amendment, your request must be made in writing and submitted
to Candace Hayes, Privacy Officer, 600 Professional Drive, Suite
210, Lawrenceville, Ga 30045 (770) 963-8030. You must provide us
with a reason that supports your request for amendment. Our practice
will deny your request if you fail to submit your request (and the
reason supporting your request) in writing. Also, we may deny your
request if you ask us to amend information that is in our opinion:
(a) accurate and complete; (b) not part of the IIHI kept by or for
the practice; (c) not part of the IIHI which you would be permitted
to inspect and copy; or (d) not created by our practice, unless
the individual or entity that created the information is not available
to amend the information.
5.
Accounting of Disclosures.
All of our patients have the right to request an "accounting
of disclosures." An "accounting of disclosures" is
a list of certain non-routine disclosures our practice has made
of your IIHI for non-treatment or operations purposes. Use of your
IIHI as part of the routine patient care in our practice is not
required to be documented. For example, the doctor sharing information
with the nurse; or the billing department using your information
to file your insurance claim. In order to obtain an accounting of
disclosures, you must submit your request in writing to Candace
Hayes, Privacy Officer, 600 Professional Drive, Suite 210, Lawrenceville,
Ga 30045 (770) 963-8030. All requests for an "accounting of
disclosures" must state a time period, which may not be longer
than six (6) years from the date of disclosure and may not include
dates before April 14, 2003. The first list you request within a
12-month period is free of charge, but our practice may charge you
for additional lists within the same 12-month period. Our practice
will notify you of the costs involved with additional requests,
and you may withdraw your request before you incur any costs.
7.
Right to File a Complaint.
If you believe your privacy rights have been violated, you may file
a complaint with our practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with our practice,
contact Candace Hayes, Privacy Officer, 600 Professional Drive,
Suite 210, Lawrenceville, Ga 30045 (770) 963-8030. All complaints
must be submitted in writing. You will not be penalized for filing
a complaint.
8.
Right to Provide an Authorization for Other Uses and Disclosures.
Our practice will obtain your written authorization for uses and
disclosures that are not identified by this notice or permitted
by applicable law. Any authorization you provide to us regarding
the use and disclosure of your IIHI may be revoked at any time in
writing. After you revoke your authorization, we will no longer
use or disclose your IIHI for the reasons described in the authorization.
Please note, we are required to retain records of your care.
Again,
if you have any questions regarding this notice or our health information
privacy policies, please contact Candace Hayes, 600 Professional
Drive Suite 210, Lawrenceville, Ga 30045 (770) 963-8030.
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