Notice of Privacy Practices.
ALPHARETTA WELLNESS CLINIC
Notice of Privacy Practices
This notice describes how
health information about you may be used and disclosed and how you can get
access to this information. It is
effective October 23, 2016, and applies to all protected health information
contained in your health records maintained by us. We have the following duties regarding the
maintenance, use and disclosure of your health records:
We are required by law to maintain the privacy of the protected health
information in your records and to provide you with this Notice of our legal
duties and privacy practices with respect to that information.
(2) We are required to abide by the terms of this
Notice currently in effect.
(3) We reserve the right to change the terms of
this Notice at any time, making the new provisions effective for all health
information and records that we have and continue to maintain. All changes in this Notice will be
prominently displayed and available at our office.
There are a number of situations
in which we may use or disclose to other persons or entities your
confidential health information. Certain
uses and disclosures will require you to sign an acknowledgement that you
received this Notice of Privacy Practices.
These include treatment, payment, and health care operations. Any use or disclosure of your protected
health information required for anything other than treatment, payment or
health care operations requires you to sign an Authorization. Certain disclosures that are required by law,
or under emergency circumstances, may be made without your Acknowledgement or
Authorization. Under any circumstance,
we will use or disclose only the minimum amount of information necessary from
your medical records to accomplish the intended purpose of the disclosure. We
will attempt in good faith to obtain your signed Acknowledgement that you
received this Notice to use and disclose your confidential medical information
for the following purposes. These
examples are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our office once you have provided Consent.
Treatment: We will use
your health information to make decisions about the provision, coordination or
management of your healthcare, including analyzing or diagnosing your condition
and determining the appropriate treatment for that condition. It may also be necessary to share your health
information with another health care provider whom we need to consult with respect
to your care. These are only examples of
uses and disclosures of medical information for treatment purposes that may or
may not be necessary in your case.
Payment: We may need
to use or disclose information in your health record to obtain reimbursement
from you, from your health-insurance carrier, or from another insurer for our
services rendered to you. This may
include determinations of eligibility or coverage under the appropriate health
plan, pre-certification and pre-authorization of services or review of services
for the purpose of reimbursement. This
information may also be used for billing, claims management and collection
purposes, and related healthcare data processing through our system.
Operations: Your health
records may be used in our business planning and development operations,
including improvements in our methods of operation, and general administrative
functions. We may also use the
information in our overall compliance planning, healthcare review activities,
and arranging for legal and auditing functions.
There are certain
circumstances under which we may use or disclose your health information without
first obtaining your Acknowledgement or Authorization. Those circumstances generally involve public
health and oversight activities, law-enforcement activities, judicial and
administrative proceedings, and in the event of death. Specifically, we may be required to report to
certain agencies information concerning certain communicable diseases, sexually
transmitted diseases or HIV/AIDS status.
We may also be required to report instances of suspected or documented
abuse, neglect or domestic violence. We
are required to report to appropriate agencies and law-enforcement officials
information that you or another person is in immediate threat of danger to
health or safety as a result of violent activity. We must also provide health information when
ordered by a court of law to do so. We
may contact you from time to time to provide appointment reminders or
information about treatment alternatives or other health-related benefits and
services that may be of interest to you.
You should be aware that we utilize an open room in which several people
may receive intravenous therapy at the same time and in close proximity. We will try to speak quietly to you in a
manner reasonably calculated to avoid disclosing your health information to
others; however, complete privacy may not be possible in this setting. If you would prefer to be treated in a
private room, please let us know and we will do our best to accommodate your
Others Involved in Your
Healthcare: Unless you object, we may disclose to a
member of your family, a relative, a close friend or any other person you
identify, your protected health information that directly relates to that
person’s involvement in your health care.
If you are unable to agree or object to such a disclosure, we may
disclose such information as necessary if we determine that it is in your best
interest based on our professional judgment.
We may use or disclose protected health information to notify or assist
in notifying a family member, personal representative or any other person that
is responsible for your care of your location, general condition or death. Finally, we may use or disclose your
protected health information to an authorized public or private entity to
assist in disaster relief efforts and to coordinate uses and disclosures to
family or other individuals involved in your healthcare.
Communication Barriers and
Emergencies: We may use and disclose your protected health
information if we attempt to obtain consent from you but are unable to do so
because of substantial communication barriers and we determine, using
professional judgment, that you intend to consent to use or disclosure under
the circumstances. We may use or
disclose your protected health information in an emergency treatment
situation. If this happens, we will try
to obtain your consent as soon as reasonably practicable after the delivery of
treatment. If we are required by law or
as a matter of necessity to treat you, and we have attempted to obtain your
consent but have been unable to obtain your consent, we may still use or
disclose your protected health information to treat you.
Except as indicated above,
your health information will not be used or disclosed to any other person or
entity without your specific Authorization, which may be revoked at any
time. In particular, except to the
extent disclosure has been made to governmental entities required by law to maintain
the confidentiality of the information, information will not be further
disclosed to any other person or entity with respect to information concerning
mental-health treatment, drug and alcohol abuse, HIV/AIDS or sexually
transmitted diseases that may be contained in your health records. We likewise will not disclose your
health-record information to an employer for purposes of making employment
decisions, to a liability insurer or attorney as a result of injuries sustained
in an automobile accident, or to educational authorities, without you written
You have certain rights
regarding your health record information, as follows:
(1) You may request that we restrict the uses and
disclosures of your health record information for treatment, payment and
operations, or restrictions involving your care or payment related to that
care. We are not required to agree to
the restriction; however, if we agree, we will comply with it, except with
regard to emergencies, disclosure of the information to you, or if we are
otherwise required by law to make a full disclosure without restriction.
have a right to request receipt of confidential communications of your medical
information by an alternative means or at an alternative location. If you require such an accommodation, you may
be charged a fee for the accommodation and will be required to specify the
alternative address or method of contact and how payment will be handled.
(3) You have the right to inspect, copy and
request amendments to you health records.
Access to your health records will not include psychotherapy notes
contained in them, or information compiled in anticipation of or for use in a
civil, criminal or administrative action or proceeding to which your access is
restricted by law. We will charge a
reasonable fee for providing a copy of your health records, or a summary of
those records, at your request, which includes the cost of copying, postage,
and preparation or an explanation or summary of the information.
(4) All requests for inspection, copying and/or amending
information in your health records, and all requests related to your rights
under this Notice, must be made in writing and addressed to the Privacy Officer
at our address. We will respond to your
request in a timely fashion.
(5) You have a limited right to receive an
accounting of all disclosures we make to other persons or entities of your
health information except for disclosures required for treatment, payment and
healthcare operations, disclosures that require an Authorization, disclosure incidental
to another permissible use or disclosure, and otherwise as allowed by law. We will not charge you for the first
accounting in any twelve-month period; however, we will charge you a reasonable
fee for each subsequent request for an accounting within the same twelve-month
(6) If this notice was initially provided to you
electronically, you have the right to obtain a paper copy of this notice and to
take one home with you if you wish.
You may file a written
complaint to us or to the Secretary of Health and Human Services if you believe
that your privacy rights with respect to confidential information in your
health records have been violated. All
complaints must be in writing and must be addressed to the Privacy Officer (in
the case of complaints to us) or to the person designated by the U.S.
Department of Health and Human Services if we cannot resolve your
concerns. You will not be retaliated
against for filing such a complaint.
More information is available about complaints at the government’s web
All questions concerning this
Notice or requests made pursuant to it should be addressed to
Privacy Officer, 5755 N. Point
Pkwy, alpharetta, ga 30022.