Notice of Privacy Practice
We understand that medical information about you and your health is personal. We are committed to protecting
medical information about you. This notice describes how medical information about you may be used and
disclosed and how you can get access to this medical information. Please review it carefully.
WE ARE REQUIRED BY LAW TO:
– Make sure that the medical information that identifies you is kept private.
– Give you this notice of our legal duties and privacy practices with respect to your medical information.
– Follow the terms of this notice.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
– For Treatment – We may disclose medical information about you to doctors, nurses and other health
professionals who
are involved in your medical care.
-For Health Care Operations – We may use this information to provide the best health care based on your
medical condition. Information may have to be discussed with other charitable organizations, government
organizations, businesses and pharmaceutical manufacturers that participate in assistance programs for auditing
purposes only, or individuals from whom you or we may seek to provide assistance or additional help for you.
– Safety – When necessary to prevent a serious threat to the patient’s health and safety or the health and safety
of the public or another person
– Law Enforcement – We may release your information if asked to do so by a law enforcement officer. Examples
would include a subpoena warrant summons, fugitive material witness, missing person, victim of a crime,
criminal misconduct, an emergency situation involving a crime, or about a death.
– All other disclosures require a patient’s written authorization which may be revoked at any time.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
– Right to inspect and copy – you may request this at any time – a charge may be assessed for copying
– Right to amend – you may have us update and change incorrect information.
– Right to Request Restrictions – for example, you may request that we do not give out particular parts of your
medical records to family members.
– Right to Confidential Communication – for example, you may request that we only contact you at home or by
mail.
COMPLAINTS:
– All complaints about privacy violations or any other matter should be made to the Clinic Manager. You will not
be penalized for making any complaints. You have the right to complain to the U.S. Department of Health and
Human Services
about any violations of your privacy at (404)562-7886.
WE RESERVE THE RIGHT TO UPDATE AND CHANGE THIS NOTICE AND POST A CORRECTED VERSION AT ALL TIMES