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OBSTETRICAL & GYNECOLGICAL ASSOCIATES
OF COLUMBUS, P.C.
NOTICE OF PRIVACY PRACTICES
Effective Date:_April 14, 2003
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.
If you have any questions about this notice, please contact Brenda
Lee, Privacy Officer, (706) 324-4891, OBGYN Associates of Columbus,
P.C..
WHO WILL FOLLOW THIS NOTICE.
This notice describes our practice’s procedures and that
of:
• Any health care professional authorized
to enter information into your medical record.
• All departments and units of our practice.
• Any member of a volunteer group we allow to help you while
you are in our practice.
• All employees, staff and other practice personnel.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION.
We understand that information about you and your health is personal.We
are committed to protecting your health information.We create
a record of the care and services you receive at our practice,
as well as records regarding payment for those services. We need
these records to provide you with quality care and to comply with
certain legal requirements.This notice applies to all of the records
of your care generated by our practice doctors and/or personnel
working for the practice.
This notice will tell you about the ways in which we may use
and disclose medical information about you.We also describe your
rights, and certain obligations we have regarding the use and
disclosure of medical information.
We are required by law to:
• make sure that medical information that identifies you
is kept private;
• give you this notice of our legal duties and privacy practices
with respect to medical information about you; and
• follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use
and disclose health information.For each category of uses or disclosures
we will explain what we mean and try to give some examples.Not
every use or disclosure in a category will be listed.However,
all of the ways we are permitted to use and disclose information
will fall within one of the categories.
• For Treatment.We may use health information about
you to provide you with medical treatment or services.We may disclose
medical information about you to doctors, nurses, technicians, medical
students, or other personnel who are involved in taking care of
you.For instance, we may need to share information about your condition
with another doctor if you have complications and need a specialist.Our
practice also may share medical information about you in order to
coordinate the different things you need, such as prescriptions
and lab work.
• For Payment.We may use and disclose health information
about you so that the treatment and services you receive at our
practice may be billed, and that payment may be collected from you,
an insurance company or another third party.For example, we may
need to give your health plan information about services that you
received at our practice so your health plan will pay us or reimburse
you for the services. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to
determine whether your plan will cover the treatment.
• For Health Care Operations.We may use and disclose
medical information about you for the practice’s health care
operations.These uses and disclosures are necessary to run our practice
and to make sure that all patients receive quality care.For example,
we may use medical information to review our treatment and services
and to evaluate the performance of our staff in caring for you.
We may also combine medical information about many of our patients
to decide what additional services our practice should offer, what
services are not needed, and whether certain new treatments are
effective.We may also disclose information to doctors, nurses, technicians,
medical students, residents, and other practice personnel for review
and training purposes. We may also disclose your information, in
conducting or arranging other business activities of the practice.
We may disclose information as part of a sale, transfer, merger
or consolidation of our practice to another entity covered by the
Privacy Rule.We may also combine the medical information we have
with medical information from other facilities to compare how we
are doing and see where we can make improvements in the care and
services we offer.We may remove information that identifies you
from this set of medical information so others may use it to study
health care and health care delivery without learning who the specific
patients are.
• Appointment Reminders.We may disclose information,
if necessary, to contact you to remind you about appointments.
• Treatment Alternatives.We may use and disclose medical
information to tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
Health Related Benefits and Services.We may use and disclose medical
information to tell you about health related benefits or services
that may be of interest to you.
• Individuals Involved in Your Care or Payment for Your
Care.Unless you object, we may release medical information about
you to a friend or family member who is involved in your medical
care.We may also give information to someone who helps pay for your
care.In addition, we may disclose medical information about you
to an entity assisting in a disaster relief effort so that your
family can be informed about your condition and location.
• As Required By Law.We will disclose medical information
about you when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety.We
may use and disclose medical information about you when necessary
to prevent a serious threat to your health and safety or the health
and safety of the public or another person.Any disclosure, however,
would only be to someone able to help prevent the threat.
SPECIAL SITUATIONS.
• Research.We may also do certain kinds of research
using your records, but only if a legally authorized review board
gives us permission to use your information and provided that the
researcher says he/she will use safeguards to protect your information.
• Organ and Tissue Donation.If you are an organ donor,
we may release medical information to organizations that handle
organ procurement or organ, eye or tissue transplantation or to
an organ donation bank, as necessary to facilitate organ or tissue
donation and transplantation.
• Military and Veterans.If you are a member of the
armed forces, we may release medical information about you as required
by military command authorities.We may also release medical information
about foreign military personnel to the appropriate foreign military
authority.We may use and disclose information to the Department
of Veterans Affairs to determine whether you are eligible for certain
benefits.
• Workers' Compensation.If applicable, we may release
medical information about you for workers’ compensation or
similar programs.These programs provide benefits for work related
injuries or illness.
• Public Health Risks.We may disclose medical information
about you for public health activities. These activities generally
include the following:
• to prevent or control disease, injury or disability;
• to report deaths;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease or condition;
• to notify the appropriate government authority if we believe
you have been the victim of abuse, neglect or domestic violence.We
will only make this disclosure if you agree or when required or
authorized by law.
• Health Oversight Activities.We may disclose medical
information to a health oversight agency for activities authorized
by law.These oversight activities include, for example, audits,
investigations, inspections, and licensure.These activities are
necessary for the government to monitor the health care system,
government programs, and compliance with applicable civil rights
laws.
• Lawsuits and Disputes.If you are involved in a lawsuit
or a dispute, we may disclose medical information about you in response
to a court or administrative order.We may disclose medical information
about you in response to a subpoena, discovery request, or other
lawful process by someone else involved in the dispute, but only
if we receive satisfactory assurances that the party seeking the
information has made efforts to tell you about the request or to
obtain an order protecting the information requested.
• Law Enforcement.We may release medical information
if asked to do so by a law enforcement official:
• In response to a court order, subpoena (after we attempt
to notify you), warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness,
or missing person;
• About the victim of a crime if, under certain limited circumstances,
we are unable to obtain your agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at our offices; and
• In emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description or location
of the person who committed the crime.
• Coroners, Medical Examiners and Funeral Directors.We
may release medical information to a coroner or medical examiner.This
may be necessary, for example, to identify a deceased person or
determine the cause of death.We may also release medical information
about patients of our practice to funeral directors as necessary
to carry out their duties.
• National Security and Intelligence Activities.We
may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law.
• Protective Services for the President and Others.We
may disclose medical information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special
investigations.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we
maintain about you:
•Right to Inspect and Copy.You have the right to inspect and
copy medical information that may be used to make decisions about
your care.Usually, this includes medical and billing records, but
does not include psychotherapy notes and other mental health records
in certain cases.
To inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing to
our Privacy Officer or designee.If you request a copy of the information,
we may charge a fee for the costs of copying, mailing or other
supplies associated with your request.
We may deny your request to inspect and copy in certain very
limited circumstances.If you are denied access to medical information,
you may request that the denial be reviewed if the denial is made
for certain reasons.Another licensed health care professional
chosen by our practice will review your request and the denial.The
person conducting the review will not be the person who denied
your request. We will comply with the outcome of the review.
• Right to Amend.If you feel that medical information
we have about you is incorrect or incomplete, you may ask us to
amend the information.You have the right to 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 our Privacy Officer or designee. In addition,
you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing
or does not include a reason to support the request.In addition,
we may deny your request if you ask us to amend information that:
• Was not created by us, unless the person or entity that
created the information is no longer available to make the amendment;
• Is not part of the medical information kept by or for our
practice;
• Is not part of the information which you would be permitted
to inspect and copy; or
• Is accurate and complete.
• Right to an Accounting of Disclosures.You have the
right to request an “accounting of disclosures.”This
is a list of certain disclosures we made of medical information
about you.
To request this list or accounting of disclosures, you must submit
your request in writing to our Privacy Officer or designee.Your
request must state a time period which may not start more than
six years in the past and may not include dates before April 14,
2003.The first list you request within a 12 month period will
be free.For additional lists, we may charge you for the costs
of providing the list.We will notify you of the cost involved,
and you may choose to withdraw or modify your request at that
time before any costs are incurred.
• Right to Request Restrictions.You have the right
to request a restriction or limitation on the medical information
we use or disclose about you for treatment, payment or health care
operations purposes.You may also request a limit on the medical
information we disclose about you to someone who is involved in
your care or the payment for your care, like a family member or
friend. For example, you could ask that we not use or disclose information
to your spouse.
We are not required to agree to your request.If we do agree,
we will comply with your request unless the information is needed
to provide you emergency treatment.
To request restrictions, you must make your request in writing
to the Privacy Officer.In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our
use, disclosure or both; and (3) to whom you want the limits to
apply, for example, disclosures to your spouse.
• Right to Request Confidential Communications.You
have the right to request that we communicate with you about medical
matters in a certain way or at a certain location.For example, you
can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request
in writing to our Privacy Officer.We will not ask you the reason
for your request.We will accommodate your request if it is reasonable.Your
request must specify how or where you wish to be contacted.
• Right to a Paper Copy of This Notice.You have the
right to a paper copy of this notice.You may ask us to give you
a copy of this notice at any time.Even if you have agreed to receive
this notice electronically, you are still entitled to a paper copy
of this notice.
To obtain a paper copy of this notice contact our Privacy Officer
or designee at our address or visit our webpage at www.columbusobgyn.net.
CHANGES TO THIS NOTICE.
We reserve the right to change this notice.We reserve the right
to make the revised or changed notice effective for medical information
we already have about you as well as any information we receive
in the future.We will post a copy of the current notice in our
practice.The notice will contain on the first page, in the top
right hand corner, the effective date.
COMPLAINTS
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 Sharon M. Barfield, Privacy Officer OBGYN
Associates of Columbus, P.C., 2000 Hamilton Road, Columbus, Georgia
31904 All complaints must be submitted in writing.
You will not be penalized in any way for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered
by this notice or the laws that apply to us will be made only
with your written permission.If you provide us permission to use
or disclose medical information about you, you may revoke that
permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical information about you
for the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already
made with your permission, and that we are required to retain
our records of the care that we provided to you.
Acknowledgement of Notice
of Privacy Practices
RECEIPT OF OUR NOTICE OF PRIVACY PRACTICES
Our Notice of Privacy Practices provides information about how
we may use and disclose protected health information about you.
As provided in our notice, the terms of our notice may change.
If we change our notice, you may obtain a revised copy by visiting
our website at www.columbusobgyn.net, by phoning (706)324-4891
or at your next visit.
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