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THIS NOTICE DESCRIBES HOW PERSONAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. 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 Payment: We may use and disclose medical information about you so that the treatment and services you receive at the System may be billed to, and payment may be collected from, you, an insurance company or a third party.
For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technologists, medical students, or other System personnel who are involved in taking care of you at the System. We also may disclose medical information about you to people outside the System, who may be involved in your medical care such as family members, clergy or other persons that are part of your care.
For Health Care Operations: We may use and disclose medical information about you for System operations. These uses and disclosures are necessary to run the System and ensure that all of our patients receive quality care. We may also disclose information to doctors, nurses, technologists, medical students, and other System personnel for review and learning purposes.
WHO WILL FOLLOW THIS NOTICE
This notice describes our System’s practices and that of any health care professional authorized to enter information into your System records, all departments and units of the System, any member of a volunteer group, in which we allow a person to help you while you are being treated in any unit of the System, as well as all employees, staff and other System personnel. We reserve the right to change this notice and will post a revised copy of each notice; if we change this notice, we will make the new notice provisions effective for all protected health information that it maintains.
POLICY REGARDING THE PROTECTION OF PERSONAL INFORMATION
We create a record of the care and services you receive at the System. We need this record in order 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 the System, whether made by System personnel or by your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
The law requires us 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 are currently in effect.
Other ways we may use or disclose your protected healthcare information include disclosures to, or for: appointment reminders or instructions, compliance with the law, fundraising activities (which you must approve and for which you can opt-out), health-related benefits and services, the directory of patients, individuals involved in your care or payment for your care, research, or avert a serious threat to health or safety, as well as treatment alternatives.
Other uses and disclosures of your personal information could include disclosures to, for or about: coroners, medical examiners and funeral directors, health oversight activities, inmates, law enforcement, lawsuits and disputes, military personnel and veterans, national security and intelligence activities, organ and tissue donation, protective services for the president and others, public health risks, and worker’s compensation.
NOTICE OF INDIVIDUAL RIGHTS
You have the following rights regarding medical information we maintain about you:
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.
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. We may deny your request to inspect and copy in certain very limited circumstances.
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, the System. To request an amendment, your request must be made in writing and addressed to the Privacy Representative in the department where you received treatment. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if we did not create the information, if it is correct, or if it is complete.
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. You also have the right to 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 about a surgery you had. 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 with emergency treatment.
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. Your request must specify how or where you wish to be contacted.
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we make of medical information about you, but it does not include disclosures related to treatment, payment, operations, or disclosures made with your authorization. To request this list or accounting of disclosures, you must address your request in writing to the Privacy Representative in the department where you received treatment.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the System or with the Secretary of the Department of Health and Human Services. For assistance with filing a complaint with the System, or to file a complaint with the System, contact the Privacy representative in the department or unit in which you want to complain, write to the System’s Privacy Officer at 743 Spring Street, Gainesville, Georgia 30501, or call 770-538-7823. You will not be penalized 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 use will be made only with your written authorization. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.
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