Medical Associates of North Georgia and the North Georgia Endoscopy Center

Notice of Privacy Practices

As required by the Privacy Regulations 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 ours, may be used and disclosed and how you can get access to your Individually Identifiable Health Information (IIHI).

A. Our Commitment to Your Privacy:     We are dedicated to maintaining the privacy of your IIHI.  In conducting our business, we will crate records regarding you and the treatment and services that we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you and to provide you with this notice of our legal duties and the privacy practices that we maintain in our office 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 these laws are complicated but we must provide you with the following information:

• How we may use and disclose your IIHI 

• Your privacy rights in regard to your IIHI

• Our obligations concerning the use and disclosure of your 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 office has created or maintained in the past and for any of your records that we may create and/or maintain in the future.  We 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 current notice at any time.

B. If you have questions about this notice, please contact our Privacy Officer:

   Kevin Kellogg
320 Hospital Rd.
Canton, Ga 30114
(770) 479-5535 ext. 239 Administration

C. We may use and disclose your IIHI in the following ways:

    1. Treatment:   We may use your IIHI to treat you. (ex. Ask you to have lab tests and use the results to help us reach a diagnosis.  Or in order to write a prescription for you, we might disclose IIHI to a pharmacy).  Many people who work for our practice - including, but not limited to , physicians and nurses, may use or disclose  your IIHI in order to treat you or assist others in your treatment.  We may disclose IIHI to others who may assist in your care, such as your spouse, children, or parents. 

    2. Payment:    Our practice may use and disclose IIHI in order to bill and collect payment for the services and items you receive from us.  (ex. We may contact your health insurer to verify benefits; provide your insurer information regarding your treatment to determine coverage for your treatment; use or disclose IIHI to obtain payment from third parties that may be responsible for such costs, such as family members).  We may use IIHI to bill you directly for services and items.

     3. Health Care Operations: We may use and disclose IIHI to operate our business. (ex. Use your IIHI to evaluate the quality of care you received from us, or to conduct cost management and business planning activities).

    4. Appointment Reminders: We may use and disclose your IIHI to contact you and remind you of an appointment.

    5. Treatment Options:  We may use and disclose your IIHI to inform you of potential treatment options or alternatives.

    6.  Health-related benefits and services:  We may use and disclose your IIHI to inform you of health related benefits or services involved in your care or who assists in taking care of you.

    7. Release of Information to Family or Friends:  We may release your IIHI to a friend or family member that is involved in your care or who assists in taking care of you. (ex. A parent or guardian may ask that a babysitter take their child to the doctor; that babysitter may have access to the child's medical information.

    8. Disclosures Required By Law:  We will use and disclose your IIHI when we are required to do so by federal, state, or local laws.

D. Use and disclosure of your IIHI in certain special occasions: The following categories describe unique scenarios in which we may use or disclose your IIHI:

        1. Public Health Risks: We may disclose your IIHI to public health authorities 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 or injury

• 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 that they may be using has been recalled

• notifying appropriate government agencies and authorities regarding the potential abuse or neglect of an adult person (including domestic violence); however, we will only disclose this information if the patient agrees or we are required by law to disclose this information

• notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

        2. Health Oversight Activities: We may disclose IIHI to a health oversight agency for activities authorized by law, including 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.

       3. Lawsuits and Similar Proceedings: We may disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We may disclose IIHI in response to a discovery 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. 

       4. Law Enforcement:  We may release IIHI if asked to do so by a law enforcement official: 
                                  a. regarding a crime victim in certain situations, if we are able to obtain the person's 
                                      agreement.
                                   b. concerning a death we believe has resulted from criminal conduct
                                   c. regarding criminal conduct at our offices
                                   d. in response to a warrant, summons, court order, subpoena, or similar legal process
                                  e. to identify and / or locate a suspect, material witness, fugitive, or missing person
                                  f. in an emergency to report a crime (including the location or victims of the crime,
                                     or description, identity, or location of the perpetrator).

       5. Deceased patients: We may release IIHI to a medical examiner or coroner if necessary in order for funeral directors to perform their jobs.

       6. Organ and tissue donation: We may release IIHI to organizations that handle organ, eye, or tissue procurement or transplantation including organ donation banks to facilitate these organizations if you are an organ donor.

        7. Research: We may use and disclose your IIHI for research purposes in limited circumstances.  We will obtain your written authorization to use your IIHI for research purposes except when:    
                     a. our use or disclosure was approved by an institutional review board or a 
                        privacy board
                      b. we obtain the oral or written agreement of a researcher that  
                       (i) the information being sought is necessary for the research study
                        (ii) the use or disclosure of your IIHI is being used only for said research and
                       (iii) the researcher will not remove any of your IIHI from our practice
                     c.  the IIHI sought by the researcher only relates to decedents and the researcher
                         agrees that the use or disclosure is necessary for the research and, if we request
                         it, to provide us with proof of death prior to access to the IIHI of the decedent.

        8. Serious Threats to Health or Safety:  We may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health or 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.

        9. Military: We may disclose IIHI if you are a member of the U.S. or foreign military forces (including veterans) and  if required by the appropriate authorities.

        10. National Security: We may disclose your IIHI to federal officials for intelligence and national security activities authorized by law; or to federal officials in order to protect the President, other officials or foreign heads of state or to conduct investigations.

        11. Inmates: We may disclose 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
                        c. to protect your health and safety or the health and safety of other individuals.

E. Your Rights Regarding Your IIHI:

            You have the following rights regarding the IIHI that we maintain about you:

            1. Confidential Communications: You have the right to request that we communicate with you about your
               health and related issues in a particular manner or location i.e. you may ask that we contact you at home, 
               rather than at your place of employment.  In order to request a type of confidential communication, you 
               must make a written request to our Privacy Officer, Kevin Kellogg, at the address listed in "B" above, specifying
               the requested method of contact or the location where you wish to be contacted. We will accommodate 
               reasonable requests.  You do not have to give a reason for the request.

            2. 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.  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 of  your care, such as family
               members or 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, you must make your request to our Privacy Officer 
               Kevin Kellogg, at the address listed in "B" above, and describe in a clear and concise fashion:
                                a. the information you wish restricted
                                b. whether you are requesting to limit our use
                                c. to whom you want the limits to apply

            3. Inspection and Copies: You have the right to inspect and obtain a copy of the IIHI that may be used to
             make decisions about you including medical records and billing records, but not including psychotherapy notes.
             You must submit your request in writing to: Privacy Officer for Medical Records, 320 Hospital Road, Canton, GA
             30114 in order to inspect and/ or obtain a copy of your IIHI.  We may charge a fee for the costs of copying,
             mailing, labor, and supplies associated with your request.  We may deny your request to inspect / copy in certain
             limited circumstances; however, you may request a review of our denial.  Another licensed health professional
             chosen by us will conduct the reviews.

            4. 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 office.  To request an
            amendment, your request must be made in writing and submitted to the Privacy Officer, Kevin Kellogg at the
            address in item "B" above.  You must provide us with a reason that supports your request for amendment.  We
            will deny your request if you fail to submit your request (and the reason supporting your request) in writing. 
            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 which you would be permitted to inspect and copy
                        c. not created by our office, unless the individual or entity that created the information is not available
                            to amend the information

            5. Accounting and Disclosures: All of our patients have the right to request an "accounting of disclosures" which
            is a list of certain non-routine disclosures our office has made of your IIHI for non-treatment or operations
            purposes.  Use of your IIHI as part of the routine patient care in our practice is not required to be documented
            i.e. the doctor sharing the 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
            to: Privacy Officer - Kevin Kellogg at the address in item "B" above.  All requests for an "accounting of disclosures"
            must state a time period, which may not be longer than 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 requests and you may withdraw your request before you incur any costs.

           6. 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,
            please ask our receptionist at your next visit to our facility, you may print it from your own computer, or you
            may contact our Privacy Officer - Kevin Kellogg, at the address above in item "B."

            7. Right to File a Complaint: If you believe that your privacy rights have been violated, you may file a complaint
            with our practice or the Secretary of the Department of Health and Human Services.  To file a complaint with our
            practice, contact our Privacy Officer - Kevin Kellogg at the address listed in item "B" above.  All complaints must
            be submitted in writing.  You will not be penalized for filing a complaint.

            8. 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 applicable by law.  Any authorization  
            you provide to us regarding the use and disclosure of IIHI may be revoked at any time in writing.  After you revoke
            your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization.
            Please note, we are required to retain records of your care.

             If you have any questions regarding this notice or our health information privacy policies, please
            contact:

             Kevin Kellogg
            Privacy Officer
            320 Hospital Road
            Canton, Ga 30114
            (770) 479-5535
            kkellogg@medassoc.com