You have the following rights regarding Health Information the Practice has about you:

 

Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to the below referenced Privacy Officer. The Practice has up to 30 days to make your Health Information available to you and the Practice may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. The Practice may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program. The Practice may deny your request in certain limited circumstances. If the Practice does deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and the Practice will comply with the outcome of the review.

 

Right to an Electronic Copy of Electronic Medical Records. If your Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. The Practice will make every effort to provide access to your Health Information in the form or format you request if it is readily producible in such form or format. If the Health Information is not readily producible in the form or format you request, your record will be provided in either our standard electronic format. If you do not want this form or format, a readable hard copy form will be provided. the Practice may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

 

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information.

 

Right to Amend. If you feel that Health Information the Practice has is incorrect or incomplete, you may request the Practice to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to the below referenced Privacy Officer.

 

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures the Practice made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to the Privacy Officer.

 

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information the Practice uses or disclosed for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information the Practice discloses to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that the Practice not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to the Privacy Officer. the Practice is not required to agree to your request unless you are requesting the Practice restrict the use and disclosure of your Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid “out-of-pocket” in full. If the Practice agrees, we will comply with your request unless the information is needed to provide you with emergency treatment.

 

Right to Request Confidential Communications. You have the right to request that the Practice communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that the Practice only contact you by mail or at work. To request confidential communications, you must make your request, in writing, to the Privacy Officer. Your request must specify how or where you wish to be contacted. the Practice will accommodate reasonable requests.

 

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may request 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, please contact the Privacy Officer.

 

CHANGES TO THIS NOTICE:

 

The Practice reserves the right to change this notice and make the new notice apply to Health Information already obtained as well as any information received in the future. 

If you have any questions about this notice, please contact:

 

 Privacy Officer: Kathy Teclezion (678) 439-1382

 

If you believe your privacy rights have been violated, you may file a complaint in writing by contacting the above-referenced Privacy Officer. Please include your name, phone number, case number and a description of the complaint. You will not be penalized for filing a complaint.

 

You may also file with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). For more information on HIPAA privacy requirements, HIPAA electronic transactions, and code sets regulations and the proposed HIPAA security rules, please visit U.S. Department of Health and Human Services web site at: https://www.hhs.gov/hipaa/index.html.