NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION
Effective Date: August 22, 2013
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
WHO WILL FOLLOW THIS NOTICE:
If you have any questions about this notice, please contact:
1626 Jeurgens Court
Norcross, GA 30093
Phone: (770) 279 - 6200
This notice describes our affiliated healthcare providers' practices and that of:
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION:
- All departments and units of our affiliated healthcare providers.
- Any member of a volunteer group who may help you while you are a patient of one of our affiliated providers.
- All employees, staff, and other personnel.
We understand that information about you and your health is personal. We are committed to protecting your health information. Our affiliated providers create a record of the care and services that you receive, as well as records regarding payment for those services. These records are necessary 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 or maintained by the healthcare center or agency that will provide care to you, whether created by healthcare center or agency personnel or by your attending physician. Your attending physician may have different policies or notices regarding his or her use and disclosure of health information that was created in his or her office or clinic. This notice will tell you about the ways in which your health information may be used and disclosed by our affiliated healthcare providers. This notice also describes your rights and our obligations regarding the use and disclosure of health information.
Healthcare providers are required by law to:
- Make sure that health information that identifies you is kept private.
- Give you a notice of the legal duties and privacy practices regarding your health information.
- 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 our healthcare providers use and disclose health information. For each category of uses or disclosures, we will explain what we mean and provide some examples. Not every use or disclosure in a category will be listed. However, all of the permissible ways to use and disclose information will fall within one of the following categories.
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 example, a doctor treating you for a broken leg may need to know if you have diabetes, because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments also may share medical information about you in order to coordinate the different things you need, such as prescriptions and lab work.
We may use and disclose your health information so that we can receive payment for the treatment and services that are provided. We may share this information with your insurance company or other payor. If you pay for your health care entirely out-of-pocket in full, you may request that we not share your information with your insurance company. We may contact your insurance company to verify what benefits you are eligible for, to obtain prior authorization, and to tell them about your treatment to make sure that they will pay for your care. We may disclose information to third parties who may be responsible for payment, such as family members, or to bill you. We may disclose information to third parties, such as billing companies, claims processing companies, and collection companies, that help us process payments.
For Healthcare Operations
We may use and disclose medical information about you for "healthcare operations." These uses and disclosures are necessary for the provider's operations and to help make sure that you and others 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 other patients or residents to decide what additional services should be offered, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, therapists, consultants, technicians, medical students, and other personnel for review and learning purposes. We may also combine the health information that we have with health information from other providers 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 healthcare and healthcare delivery without learning who the specific individuals are.
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.
We may place your name on the door to your room, on your meal tray, and on pieces of equipment that you might use, including a wheelchair. This aids our staff in
identifying your items in order to provide you the best possible care. Further, this practice will assist you in locating your room and equipment.
We may use your name, your location or room number in a healthcare center, your general condition (e.g., fair, stable, etc.) and your religious affiliation for directory purposes. This is so that your family, friends, and clergy can visit you in the facility and generally know how you are doing. This information, except for your religious affiliation, may be disclosed to people who ask for you by name. Your religious affiliation may be disclosed to a member of the clergy even if they don't ask for you by name. You have the right to restrict or prohibit some or all of the uses and disclosures described here.
As Required By Law
We will disclose medical information about you when required to do so by federal, state, or local law. If a use or disclosure of health information described in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.
Additional Restrictions on Use and Disclosure
Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. "Highly confidential information" may include confidential information under federal laws governing alcohol and drug abuse information and genetic information, as well as state laws that often protect the following types of information:
- Mental health;
- Genetic tests;
- Alcohol and drug abuse;
- Sexually transmitted diseases and reproductive health information; and
- Child or adult abuse or neglect, including sexual assault.
Confidentiality of Psychotherapy Notes
Psychotherapy notes are notes recorded (in any form) by a mental health professional for the purpose of studying a conversation that took place during a private counseling session. This session can be with a single person, a group, or a family. Conversation notes from a counseling session are separated from the rest of the patient's medical record. Psychotherapy notes do not include: notes about which medicines you are taking or how those medicines affect you; the start and stop times of counseling sessions; the types of treatment you are given; how often treatments are given; the results of clinical tests; and any summary of the following items: diagnosis, functional state, the treatment plan, symptoms, expected outcome, and progress to date.
We must receive your authorization for any use or disclosure of any psychotherapy notes, except: for use by the author of the psychotherapy notes for treatment or health oversight activities; for use or disclosure by PruittHealth Corporation for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; for use or disclosure by PruittHealth Corporation to defend itself in a legal action or other proceeding brought by you; to the extent required to investigate or determine PruittHealth Corporation's compliance with the HIPAA regulations; to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law; for health oversight activities with respect to the oversight of the originator of the psychotherapy notes; for disclosure to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law; or if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
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.
To Those Involved in Your Care
We may disclose medical information about you to people who may be involved in your care, such as your family members, close personal friends and, if applicable, a private sitter. If, at any time, you do not want such people involved in your care to have access to your information, you may instruct us not to make any disclosures to them.
Organized Health Care Arrangement
An organized health care arrangement is a clinically-integrated care setting in which individuals typically receive health care services from more than one health care provider. As an organized health care arrangement, we will share medical information among the participants in the organized health care arrangement, as necessary, to carry out treatment, payment, or health care operations relating to the organized health care arrangement.
If you hire a private sitter, we will disclose health information about you to aid your sitter in caring for you. There may be private sitters working for other patients or residents of the same facility. These sitters may hear incidental information about you.
We must obtain your authorization prior to using your PHI to send you any marketing materials. We can, however, provide you with marketing materials in a face-to-face encounter without obtaining your authorization. We are also permitted to give you a promotional gift of nominal value, if we so choose, without obtaining your authorization. In addition, we may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without your authorization.
Sale of Your Health Information
We must receive your authorization for any disclosure of your health information that constitutes a sale. Such authorization will state that the disclosure of your information will result in remuneration to PruittHealth Corporation or one of our affiliated healthcare providers.
There are some services provided through contracts with our "business Associates," which are third parties who perform certain services on behalf of affiliated providers. Examples could include attorneys, consultants, or a copy service used when making copies of your health record. When these services are contracted, we will disclose information to these business associates so that they can perform their jobs, and so they can bill for the services rendered. To protect the health information about you, however, we also require the business associates appropriately to safeguard your information.
Electronic Storage and Transmission
We may record and transmit your health information electronically. This includes, but is not limited to, information about the medicines that you take and your prescriptions. Health information may also be shared electronically through local, regional, state, and national health information networks.
Organ and Tissue Donation
If you are an organ donor, we may release health 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 health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
If applicable, we may release health 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 health 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 health 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 healthcare system, government programs, and compliance with applicable laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health 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.
We may release health 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.
- 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 health 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 health information about to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities
We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU:
You have the following rights regarding your health information:
Right to Inspect and Copy
You or your legal representative has the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. If you are a resident of a healthcare center, the center must provide you with access to your records within 24 hours of your request, not including weekends or holidays. The center must provide you with a copy of your records within two (2) working days following your request. If you are not a resident of a healthcare center, you will be provided access in accordance with applicable state and federal law.
To inspect and copy medical information that may be used to make decisions about you, submit your request orally or in writing to your provider. If you request a copy of the information, you may be charged a fee for the costs of copying, mailing, or other supplies associated with your request. If an electronic health record is maintained containing your health information, you will have the right to request that a copy of your health information in an electronic format be provided to you or to a third party that you identify. A reasonable cost-based fee may be charged for sending an electronic copy of your health information.
We may deny your request to inspect and copy your health information in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed, if the denial is made for certain reasons. Another licensed health care professional may 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 health information about you is incorrect or incomplete, you may ask for the information to be amended. You have the right to request an amendment for as long as the information is maintained by the provider.
To request an amendment, your request must be made in writing and submitted to your provider. In addition, you must provide a reason that supports your request.
Your request for an amendment may be denied if it is not in writing or does not include a reason to support the request. In addition, your request may be denied if you ask to amend information that:
- Was not created by a provider affiliated with PruittHealth Corporation, 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 a provider affiliated with PruittHealth Corporation.
- Is not part of the information that you would be permitted to inspect and copy.
- 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 made of health information about you. To request an accounting of disclosures, you must submit your request in writing to your provider. Your request must state a time period that may not be longer than six years prior to the date on which an accounting is requested. Your request should indicate the form in which you want the list (e.g., paper or electronic). The first list you request within a 12-month period will be free. For additional lists, you may be charged for the costs of providing the list. You will be notified 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 health information that we use or disclose about you for purposes of treatment, payment, or healthcare operations. You may also request a limit on the health information that 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 daughter, or that we not use your information in any quality assurance activities.
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 your provider. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit the 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 healthcare 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 your provider. You will not be asked the reason for your request. Every effort will be made to accommodate reasonable requests. 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.
Right to be Notified of Security Breaches
In the event of a Security Breach of "unsecured protected health information," PruittHealth Corporation will fully comply with all legal requirements for breach notification, which will include notification to you of any impact a Security Breach may have on you and/or your family members(s) and will inform you of the actions undertaken to minimize any impact the Security Breach.
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 health information that we already have about you as well as any information we receive in the future. We may distribute the new notice to all patients/clients on service at the time of the change, post a copy of the current notice in the healthcare center/agency, post a copy on PruittHealth Corporation's website. You may also obtain a copy at any of the affiliated providers. The first page of the notice, in the top right-hand corner, will indicate the effective date.
If you believe your privacy rights have been violated, you may file a complaint with your provider or with the Secretary of the Department of Health and Human Services.
To file a complaint with the provider, you may contact the administrator or contact PruittHealth Corporation at (770) 279-6200.
All complaints must be submitted in writing. A complaint may be filed with the Secretary of the Department of Health and Human Services at:
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775
You will not be penalized in any way for filing a complaint.
OTHER USES OF MEDICAL INFORMATION:
Except for uses and disclosures described and limited as set forth in this notice, we will use
and disclose your health information only with a written authorization from you. Once you authorize us to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information. You may take back or "revoke" your authorization at any time in writing, except to the extent that we have already acted based on your authorization. To find out where to mail your written authorization and how to revoke an authorization, contact PruittHealth Corporation at (770) 279-6200. We are required to retain our records of the care that we provided to you.