Your Privacy Matters
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. This notice takes effect January 1, 2018 and remains in effect until we replace it.
We respect your privacy. We promise to keep your information safe and secure.
1. OUR PLEDGE REGARDING MEDICAL INFORMATION
The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe to you rights and certain duties we have regarding the use and disclosure of medical information.
2. OUR LEGAL DUTY
The law requires us to:
a) Keep your medical information private.
b) Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
c) Follow the terms of the notice that is now in effect.
We Have the Right to:
a) Change our privacy practices and the terms of this notice at any time, provided that law permits the changes.
b) Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
Notice of Change to Privacy Practices:
a) Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
3. USES AND DISCLOSURE OF YOUR MEDICAL INFORMATION
The following section describes different ways that we use and disclose medical information. Not every use of this disclosure will be listed. However, we have listed all the different ways we are permitted to use and disclose medical information. We will not disclose your medical information for any purpose not listed below, without you specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us.
For Treatment: We may use medical information about you to provide you with medical treatment or services. We disclose medical information about you to doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist them in treating you.
For Payment: We may use and disclose your medical information for payment purposes.
For Health Care Operations: We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.
Additional Usage and Disclosures: In addition to using and disclosing your medical information for treatment, payment, and health care operations, we may use and disclose medical information for the following purposes.
Notification: Medical information to notify or help notify: a family member, your personal representative, or another person responsible for your care. We will share information about your location, general condition, or death. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for you health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, x-ray or medical information for you.
Funeral Director, Coroner, and Medical Examiner: To help them carry out their duties, we may share the medical information of a person who has died with a coroner, medical examiner, funeral director, or an organ procurement organization.
Court Orders and Judicial and Administrative Proceedings: We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances.
Workers Compensation: We may disclose health information when authorized and necessary to comply laws relating to workers compensation or other similar programs. Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws such as the reporting of certain types of wounds, pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement officiate, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.
4. YOUR INDIVIDUAL RIGHTS
You Have a Right to:
a) Look at or get copies of your medical information. You must make your request in writing. You may get the form to request access by using the contact information listed at the end of this notice. If you request copies, we will charge for each page, and postage if you want the copies mailed to you.
b) Receive a list of all the times our business associates or we shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions.
c) Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
d) If you wish to receive a paper copy of this notice, you have the right to obtain a paper copy by making a request in writing to the Privacy Officer.
5. QUESTIONS AND COMPLAINTS
If you have any questions about this notice or if you think that we may have violated your privacy rights please contact:
Surgical Associates of Metro Atlanta, LLC
2151B West Spring Street
Monroe, GA 30655
You May also submit a written complaint to the U.S. Department of Health and Human Services:
Timothy Noonan, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Voice Phone (800) 368-1019
FAX (404) 562-7881
TDD (800) 537-7697