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.

We are committed to protecting the privacy of your health information.  This notice describes our legal duties and privacy practices with respect to your health information.  We are required to abide by the terms of our Notice of Privacy Practices currently in effect.

I. Uses/Disclosures without Authorization

A. For Treatment:

We will use and disclose  health information without your authorization to provide, manage, and coordinate your health care and any related services.  For example, our staff may discuss your care at a case conference, or we may disclose your health information without your authorization to an outside health care provider for treatment purposes. We may use and disclose health information when you need a prescription, lab work, or an x-ray.

B. For Payment:

We may use and disclose information without your authorization to bill and collect payment from your health plan or other third party payers.  For instance, we may provide information to your health care plan so they can determine if services are medically necessary or approve additional visits with your physician or therapist.

C. For Health Care Operations:

We are permitted to use and disclose information without your authorization to operate and evaluate our agency.  These activities may include licensing, accreditation, business planning, and quality assessment and improvement.

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II. Uses/Disclosures without Authorization but for which you have Opportunity to Object

During a disaster, we may use or disclose information about you to an agency assisting in disaster relief efforts.  We would do this so that family or other people involved in your care could be notified of your condition, status, and location.

If you are present and able to make health care decisions we will disclose information only with your agreement and only to people you choose to be involved in your care.  However, in an emergency situation, we may disclose information to a spouse, family member, or friend so the person can help with your care.  We will need to decide whether the disclosure is in your best interest and if so, we will only disclose information directly relevant to your care. If applicable, in a non-emergency where you are unable to make health care decisions, we will disclose information to your legally appointed guardian, the state agency responsible for consenting to your care, or a person designated to participate in your care in accordance with a validly executed advance directive.

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III. Uses/Disclosures without Authorization or your Opportunity to Object

We may use and disclose your health information:

A. to medical personnel, such as a paramedic in an emergency treatment situation;

B. when required  by federal, state, or local law;

C. to prevent serious imminent threat to the health or safety of you, the public, or another person. Under these circumstances, we will only disclose information to someone able to help prevent or lessen the threat;

D. for public health activities to prevent or control disease, injury, disability; to report abuse or neglect of a child, the elderly, or someone with a disability;

E. to a health care agency authorized by law to oversee Medicaid, Medicare, and other programs regulating health care and civil rights laws;

F. to a court or administrative agency when ordered by that judge or agency to do so. We may also disclose non-privileged information in response to a subpoena except alcohol and drug abuse program records;

G. to a law enforcement official for enforcement purposes when a court order, subpoena, summons, or similar process requires us to do so.  Also, when we report a crime on our premises or when the disclosure is otherwise required by law;

H. after your death to a medical examiner or coroner with a valid subpoena or a funeral director when necessary;

I. to authorized federal officials protecting national security, the President, or foreign heads of state;

J. to Workers= Compensation programs providing benefits for work-related injuries or illness;

K. if you are a correctional institution inmate or in custody of a law enforcement official to coordinate care or protect the health and safety of you or others.

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IV.  Uses/Disclosures with Permission        

Uses and disclosures not described above will generally be made only with your written authorization.  You have the right to revoke this  authorization at any time.  If you revoke your authorization we will make no further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures  previously authorized.

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V.  Your Rights Regarding your Health Information

A. You have the right to request an opportunity to inspect or receive a copy of health information used to make decisions about your care, including clinical and billing records. Please submit your request in writing to our Medical Records Manager. We may charge a fee for the cost of copying, mailing and supplies associated with your request. Your request to inspect or copy your health information may be denied if the treating physician determines that disclosure is detrimental to your physical or mental health.  A notation to that effect will be made part of your medical record.  If this occurs, you may file a complaint as outlined in Section VII. 

B.  For as long as we keep records about you, you have the right to ask us to amend any health information used to make decisions about your care, including decisions about treatment or payment.  Any amendment to the record will be made on a separate sheet of paper.  It should explain why you believe the information in the record is incorrect or inaccurate and you must sign and date the information.

C. You have the right to request that we provide you with a list of disclosures we have made of your health information.  This list will not include certain disclosures of your health information like those made for purposes of treatment, payment, and health care operations or those you have authorized.  You must submit your request in writing to the Medical Records Manager. The request should state the time period for which you wish to receive an accounting.  This time period cannot exceed six years and cannot include dates before April 14, 2003.  The first accounting you request within a twelve (12) month period will be free. For additional requests during the same twelve (12) month period, there is a charge for the costs of providing the accounting.         

D. You have the right to request restriction on the information we use or disclose about you. A request for restrictions must be made in writing to the Privacy Officer.  We are not required to agree to the request but if we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.

E. You have the right to request how and where we contact you about medical matters.  For example, you may request that we contact you at your work address or phone.  Your request must be in writing.  Whenever reasonably possible, we will try to accommodate the request.

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VI. Confidentiality of Substance Abuse Records

If you receive treatment, diagnosis, or referral for treatment from our drug and alcohol abuse program, federal law and regulations protect the confidentiality of drug and alcohol abuse records.  As a general rule, we may not tell a person outside the program that you attend the program, or disclose information identifying you as an alcohol or drug abuser, unless:

you authorize the disclosure in writing; or

the disclosure is permitted by a court order; or

the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation; or

you commit or threaten to commit a crime either at the drug and alcohol abuse program or against any person who works for our  drug and alcohol program.

Violation of the federal confidentiality laws and regulations is a crime.

You may report suspected violations to the United States Attorney in the district where the violation occurs. Federal law and regulations governing confidentiality of drug and alcohol abuse programs permit us to report suspected child abuse or neglect under state law to appropriate state or local authorities.  Please see 42 U.S.C. ' 290dd-2 for federal law and 42 C.F.R., Part 2 for federal regulations governing confidentiality of alcohol and drug abuse records.

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VII. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U. S. Department of Health and Human Services.  To file a complaint with us, contact our Privacy Officer at:

112 Broad Street
Jonesboro, GA 30236
Phone 770-478-2280

All complaints must be submitted in writing. The Privacy Officer will assist you with writing your complaint, if you request such assistance.  We will not retaliate against you for filing a complaint.

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VIII. Changes to this Notice

The current Notice of Privacy Practices is posted at our administrative office and at each main site where we provide care.  We reserve the right to change the terms of our Notice of Privacy Practices.  We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. Any revisions to our Privacy Notice will be posted at all main sites. Upon request, the receptionist will give you a copy.

It is our practice in some programs to contact you with appointment reminders. We may contact you with information about treatment alternatives, or other health related benefits and services that might be of interest to you. We may also contact you after discharge to evaluate the quality and effectiveness of our services.

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