Privacy Policy

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THIS POLICY CAREFULLY.

State and federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this notice. We must follow the privacy practices as described below. This notice will take effect on April 14, 2003 and will remain in effect until it is amended or replaced by us.

It is our right to change our privacy practices provided that they comply with the law. Before we make a significant change, this notice will be amended to reflect the change and we will make the new notice available upon request. We reserve the right to make any changes in our privacy practices and the new terms of our notice effective for all health information maintained, created and/or received by us before the date changes were made.

You may request a copy of our privacy notice at any time. Information on contacting us can be found at the end of this notice.

TYPICAL USES AND DISCLOSURES OF HEALTH INFORMATION

We will keep your health information confidential, using it for the following purposes:

Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary or need to know” standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.

Disclosure: We may disclose and/or share your healthcare information with other health care professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and/or other persons you choose to involve in your care, only if you agree that we may do so.

Payment: We may use and disclose your health information to seek payment for services we provide for you. This disclosure involves our business office staff and may include insurance organizations or other businesses that may become involved in the process of mailing statements or collecting unpaid balances.

Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death. If at all possible we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated we will use our professional judgment to disclose only that information directly relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, x-rays, or other similar forms of health information and/or supplies unless you have advised us otherwise.

Healthcare Operations: We will use and disclose your health information to keep our practice operable. Examples of personnel who may have access to this information include, but are not limited to, our medical records staff, outside health or management reviewers and individuals performing similar activities.

Legal Requirements: We may use or disclose your health information when we are required to do so by federal, state or local law. We will use or disclose your information when requested by national security, intelligence, and other state and federal officials and/ or if you are an inmate or otherwise under the custody of law enforcement.

Public Health Responsibility: We will disclose your health care information to report problems with products, reactions to medications, product recalls, disease or infection exposure, and to prevent and control disease, injury and/or disability.

Marketing Health-Related Services: We will not use your health information for marketing purposes unless we have your written authorization to do so.

National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.

Reminders: We may use or disclose your health information to provide you with appointment reminders, including, but not limited to, voicemail messages, postcards or letters. In addition, we may contact you to inform you of health screenings, wellness events or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may contact you about seminars or programs that we are providing.

YOUR PRIVACY RIGHTS AS OUR PATIENT

Access: Upon written request, you have the right to inspect and receive copies of your health information (and that of an individual for whom you are a legal guardian). There will be some limited exceptions. To inspect and copy medical information, you must submit your request in writing to Medical Records. Once approved, an appointment can be made to review your records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies used due to your request.

Amendment: You have the right to amend you healthcare information, if you feel that it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, your request may be denied.

Non-routine Disclosures: You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you that is outside of the information disclosed as described in this document. For example, disclosures for treatment, payment, health care operations, or those, which you have authorized, are part of the expected disclosures and therefore would not be included in a disclosure history.To request this list or accounting of disclosures, you must submit your request in writing.Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.

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.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 the Director of Medical Records marked "personal and confidential." In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

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. To request confidential communications, you must make your request in writing to the Director of Medical Records marked "personal and confidential.”We will not ask you the reason for your request. Your record must specify how or where you would like us to contact you.We will comply with all reasonable requests.

QUESTIONS AND COMPLAINTS

You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us in writing. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

HOW TO CONTACT US

ExecuCare ARC
3985 Steve Reynolds Boulevard
Building B, Suite A
Norcross, GA 30093
770-817-0711

HIPAA Notice of Privacy Practices