Notice of Privacy Practices
As required by the Privacy Regulations Created as a result of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT
OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS
TO YOU INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE
HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS
D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
E. YOUR RIGHTS REGARDING YOUR IIHI
A. OUR COMMITMENT TO
YOUR PRIVACY
Our practice is dedicated to dedicated to maintaining the
privacy of your individually identifiable health information (IIHI).
In conducting our business, we will create records regarding you and
the treatment and services we provide to you. We are required by law
to maintain the confidentiality of health information that identifies
you. We also are required by law to provide you with this notice of our
legal duties and the privacy practices that we maintain in our practice
concerning your IIHI. By federal and state law, we must follow the terms
of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must
provide you with the following important information:
- How we may use and disclose your IIHI
-
Your privacy rights in your IIHI
- Our obligations concerning the use and disclosure of you IIHI
The terms of this notice apply to all records containing
your IIHI that are created or retained by our practice. We reserve the
right to revise or amend this Notice of Privacy Practices. Any revision
or amendment to this notice will be effective for all of your records
that our practice has created or maintained in the past, and for any
of your records that we may create or maintain in the future. Our practice
will post a copy of our current Notice in our offices in a visible location
at all times, and you may request a copy of our most recent current Notice
at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS
NOTICE, PLEASE CONTACT:
Administrator
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY
IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in
which we may use and disclose your IIHI.
Treatment. Our practice may use your IIHI to
treat you. For example, we may ask you to have laboratory tests (such
as blood or urine tests), and we may use the results to help us reach
a diagnosis. We might use your IIHI in order to write a prescription
for you. Many of the people who work for our practice, including
but not limited to, our doctors and nurses, may use or disclose your
IIHI in order to treat you or to assist others in your treatment.
Additionally, we may disclose your IIHI to others who may assist
in your care, such as your spouse, children or parents.
Finally, We may also disclose your IIHI to other health care providers
for purposes related to your treatment.
Payment. Our practice may use and disclose you
IIHI in order to bill and collect payment for the services and items
you may receive from us. For example, we may contact your health
insurer to certify that you are eligible for benefits (and for what
range of benefits), and we may provide your insurer with details
regarding your treatment to determine if your insurer will cover,
or pay for, your treatment. We also may use and disclose your IIHI
to obtain payment from third parties that may be responsible for
such costs, such as family members. Also we may use your IIHI to
bill you directly for services and items. We may disclose your IIHI
to other health care providers and entities to assist in their billing
and collection efforts.
Health Care Operations. Our practice may use
and disclose your IIHI to operate our business. As examples of the
ways in which we may use and disclose your information for our operation,
our practice may use your IIHI to evaluate the quality of care you
received from us, or to conduct cost-management and business planning
activities for our practice. We may disclose your IIHI to other health
care providers and entities to assist in their health care operations.
Appointment Reminders. Our practice
may use and disclose your IIHI to contact you and remind you of an
appointment.
Treatment Options. Our practice
may use and disclose your IIHI to inform you of potential treatment
options or alternatives.
Health-Related Benefits and Services. Our
practice may use and disclose your IIHI to inform you of health-related
benefits or services that may be of interest to you.
Release of Information to Family/Friends. Our
practice may release your IIHI to a friend or family member that
is involved in your care, or who assist in taking care of you. For
example, a parent or guardian may ask that a babysitter take their
child to the pediatrician's office for treatment of a cold. In this
example, the babysitter may have access to this child's medical information.
Disclosures Required By Law. Our
practice will use and disclose your IIHI when we are required to
do so by federal, state or local law.
D. USE AND DISCLOSURE OF YOUR IIHI
IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may
use or disclose your identifiable health information:
Public
Health Risks. Our practice may disclose your IIHI
to public health authorities that are authorized by law to collect
information for the purpose of:
- maintaining vital records, such as births and deaths
- reporting child abuse or neglect
- preventing or controlling disease, injury or disability
- notifying a person regarding potential exposure to
a communicable disease
- notifying a person regarding a potential risk for
spreading or contracting a disease or condition
- reporting reactions to drugs or problems with products
or devices
- notifying individuals if a product or device they
may be using has been recalled
- Notifying appropriate government agency(ies) and
authority(ies) regarding the potential abuse or neglect of an adult
patient (including domestic violence); however, we will only disclose
this information if the patient agrees or we are required or authorized
by law to disclose this information
- Notifying your employer under limited circumstances
related primarily to workplace injury or illness or medical surveillance.
Health Oversight Activities. Our practice may
disclose your IIHI to a health oversight agency for activities authorized
by law. Oversight activities can include, for example, investigations,
inspections, audits, surveys, licensure and disciplinary actions; civil,
administrative and criminal procedures or actions; or other activities
necessary for the government to monitor government programs, compliance
with civil rights laws and the health care system in general.
Lawsuits and Similar Proceedings. Our practice may use and
disclose your IIHI in response to a court or administrative order, if
you are involved in a lawsuit or similar proceeding. We also may disclose
your IIHI in response to a discover request, subpoena or other lawful
process by another party involved in the dispute, but only if we have
made an effort to inform you of the request or to obtain an order protecting
the information the party has requested.
Law Enforcement. We may release IIHI if asked
to do so by a law enforcement official:
- Regarding a crime victim in certain situations, if
we are unable to obtain the persons agreement
- Concerning a death we believe has resulted from criminal
conduct
- Regarding criminal conduct at our offices
- In response to a warrant, summons, court order, subpoena
or similar legal process
- To identify/locate a suspect, material witness, fugitive
or missing person
- In an emergency, to report a crime (including the
location or victim(s) of the crime, or the description, identity
or location of the perpetrator)
Serious
Threats to Health or Safety. Our practice may use and disclose
your IIHI when necessary to reduce or prevent a serious threat to your
health and safety or the health and safety of another individual or
the public. Under these circumstances, we will only make disclosures
to a person or organization able to help prevent the threat.
Military. Our practice may disclose your IIHI if you are a
member of U.S. or foreign military forces (including veterans) and if
required by the appropriate authorities.
National Security. Our practice may disclose your IIHI to federal
officials for intelligence and national security activities authorized
by law. We also may disclose your IIHI to federal officials in order
to protect the President, other officials or foreign heads of state,
or to conduct investigations.
Inmates. Our practice may disclose your IIHI to correctional
institutions or law enforcement officials if you are an inmate or under
the custody of a law enforcement official. Disclosure for these purposes
would be necessary:
(a) for the institution to provide health care
services to you,
(b) for the safety and security of the institution, and/or
(c) to protect your health and safety or the health and safety of other
individuals.
Workers' Compensation. Our practice may release
your IIHI for workers' compensation and similar programs.
E. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we
maintain about you:
Confidential Communications. You
have the right to request that our practice communicate with you
about your health and related issues in a particular manner or at
a certain location. For instance, you may ask that we contact you
at home, rather than work. In order to request a type of confidential
communication, you must make a written request to [Your Physician's
Secretary] specifying the requested method of contact, or the location
where you wish to be contacted. Our practice will accommodate reasonable
requests. You do not need to give a reason for your request.
Requesting Restrictions. You
have the right to request a restriction in our use or disclosure
of your IIHI for treatment, payment or health care operations. Additionally,
you have the right to request that we restrict our disclosure of
your IIHI to only certain individuals involved in your care or the
payment for your care, such as family members and friends. We are
not required to agree to your request; however, if we do agree, we
are bound by our agreement except when otherwise required by law,
in emergencies or when the information is necessary to treat you.
In order to request a restriction in our use or disclosure of you
IIHI, you must make your request in writing to Neurological Institute
of Savannah. Your request must describe in a clear and concise fashion;
- the information you wish restricted;
- whether you are requesting to limit our practices use, disclosure
or both; and
- to whom you want the limits to apply
Inspection and Copies. You
have the right to inspect and obtain a copy of the III that may be
used to make decisions about you, including patient medical records
and billing records, but not including psychotherapy notes. You must
submit your request in writing to [Records Librarian] in order to
inspect and/or obtain a copy of your IIHI. Our practice may charge
a fee for the costs of copying, mailing labor, and supplies associated
with your request. Our practice may deny your request to inspect
and/or copy in certain limited circumstances; however, you may request
a review a of our denial. Another licensed health care professional
chosen by us will conduct reviews.
Amendment. You may ask us
to amend your health information if you believe it is incorrect or
incomplete, and you may request an amendment for as long as the information
is kept by or for our practice. To request an amendment, your request
must be made in writing and submitted to [Records Librarian]. You
must provide us with a reason that supports you request for amendment.
Our practice will deny your request if you fail to submit your request
(and the reason supporting your request) in writing. Also, we may
deny your request if you ask us to amend information that is in our
opinion: (a) accurate and complete; (b) not part of the IIHI kept
by or for the practice; (c) not part of the IIHI which you would
be permitted to inspect and copy; or (d) not created by our practice,
unless the individual or entity that created the information is not
available to amend the information.
Accounting of Disclosures. All
of our patients have the right to request an "accounting of disclosures."
An "accounting of disclosures: is a list of certain non-routine disclosures
our practice has made of your IIHI for non-treatment or operations
purposes. Use of your IIHI as part of the routing patient care in
our practice is not required to be documented. For example, the doctor
sharing information with the nurse; or the billing department using
your information to file your insurance claim. In order to obtain
an accounting of disclosures, you must submit your request in writing
[Credit Manager]. All requests for an "accounting of disclosures" must
state a time period, which may not be longer than six (6) years from
the date of disclosure and may not include dates before April 14,
2003. The first list you request within a 12-month period is free
of charge, but our practice may charge you for additional lists within
the same 12-moth period. Our practice will notify you of the costs
involved with additional requests, and you may withdraw your request
before you incur any costs.
Right to a Paper Copy of This
Notice. You are entitled to receive a paper copy of our notice
of privacy practices. You may ask us to give you a copy of this
notice at any time. To obtain a paper copy of this notice, contact
Neurological Institute of Savannah and Center for Spine, 4 Jackson Boulevard, Savannah,
Georgia 31405. Phone: 912-355-1010.
Right to File a Complaint. If
you believe your privacy rights have been violated, you may file
a complaint with our practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with our practice,
contact Neurological Institute of Savannah and Center for Spine, 4 Jackson Boulevard,
Savannah, Georgia 31405. Phone: 912-355-1010. All complaints must
be submitted in writing. You will not be penalized for filing a complaint.
Right to Provide an Authorization
for Other Uses and Disclosures. Our practice will obtain your
written authorization for uses and disclosures that are not identified
by this notice or permitted by applicable law. Any authorization
you provide to us regarding the use and disclosure or your IIHI
may be revoked at any time in writing. After you revoke your authorization,
we will no longer use or disclose you IIHI for the reasons described
in the authorization. Please note, we are required to retain records
of your care.
Again, if you have any questions regarding this notice
or our health information privacy policies please contact: Neurological
Institute of Savannah, 4 Jackson Boulevard, Savannah, Georgia 31405.
Phone: 912-355-1010.
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About us | Our Physicians: Dr. Kevin Ammar, Dr. Roy Baker, Dr. Randolph Bishop, Dr. Cliff Cannon, Dr. Louis G. Horn, IV, Dr. Jay U. Howington, Dr. James Lindley, Jr., Dr. Daniel Y. Suh, Dr. Willard D. Thompson, Dr. Fremont P. Wirth | Expertise | Resources | Contact Us | Driving directions: Savannah, Statesboro, Bluffton, SC (near Hilton Head Island)
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