Notice of Privacy Practices


Under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), all medical records and other individually identifiable protected heath information (PHI) of which we have knowledge must be kept confidential. All PHI used by us or disclosed by us is covered by this Act regardless of whether this PHI is in electronic, oral or paper form. Several new rights are granted to patient under this Act, allowing control over how your PHI is used, how you can access it, and in some cases amend it. We are required by law to maintain the privacy of your PHI and to provide you with notice of legal duties and privacy practices with respect to your PHI.

This Notice of Privacy Practices is effective on February 22, 2013.

We are bound to abide by the terms of this notice and reserve the right to make revisions to this policy. Should revisions be made, you will be notified in writing, and a copy of the revised policy will be made available at your request. Should any breach of unsecured OHI ever occur, we will notify the patient(s) involved within 10 business days of discovery of this breach. You will be asked to sign a consent form authorizing us to use and disclose your personal heath information only for the following purposes, as defined under the Act:

  • Treatment means the provisions, coordination, or management of health care related services by one or more healthcare providers, including the coordination of management of health care by a healthcare provider with a third party; consultation between healthcare providers relating to a patient; or the referral of the patient for healthcare provider to another. An example of this would be a dentist referral to an orthodontist.
  • Payments mean obtaining agencies; protected reimbursement for the provision of health care; determinations of eligibility; billings; claims management; collection activities; justification of charges; and disclosure to consumer reporting (only certain information may be disclosed). An example of this would be submitting your bill of healthcare services to your insurance company.
  • Health care operations are any activity related to covered functions in which we participate in the function of our offices, such as conducting quality assessment activities; protocol development; case management and care coordination; auditing functions; business management and general administrative activities, including implementation of this regulation; customer service evaluation; resolution of grievances; fundraising; and marketing for which an authorization is not required. An example of this would evaluation customer service given to patient.

We may, without prior consent use or disclosure your PHI to carry out treatment, payment or health care operations:

  • Directly to you at your request;
  • In an emergency treatment situation, if we attempt to obtain such consent as soon as reasonably practicable after the delivery of such treatment, if we required by law to treat you and attempt to obtain consent are unsuccessful, or if we attempt to obtain consent but are unable, due to barriers of communication, but we determine in our professional opinion that treatment is clearly inferred from the circumstances;
  • Pursuant to and in compliance with an authorization signs by you; and
  • Provided that you are informed in advance of the use and disclosure and have the opportunity to agree to or prohibit or restrict the use or disclosure. This may ne an oral agreement between us and may include a directory maintained at our facility containing specific information allowed by the Act.

We may re-identify your personal health information by using codes or removing all individually identifiable health information. All other uses and disclosures will be made only upon securing a written authorization form signed by you. You have the right to revoke this authorization, at any time, upon written notice and we will abide by that request. However, exception would be any actions already taken, replying on your authorization, and prior to revocation notice. If you have paid for services out of pocket, in full, and request that we not disclose PHI related solely to these services to a health plan, we will abide by this request except where required by law to make disclosure. We may contact you to provide appointment reminders or to inform you about treatment alternatives or other health related benefits or services that may be interest to you. A written authorization from you will be required to release the following information:

  • Use and disclose of psychotherapy notes.
  • Use and disclosure of PHI for marketing purposes
  • Disclosure that constitute the sale of PHI
  • Other uses and disclosures of PHI not described in this Notice of Privacy Practices.
Under HIPAA, you have the following rights with respect to your protected health information:
  • No use or disclosure of genetic information will be release for underwriting purposes.
  • You have the right to request restrictions on certain uses and disclosures of protected health information, including restrictions placed upon disclosure to family members, close personal friends, or any other person you may identify. We are, however, not required to agree with a requested restriction;
  • You have the right to receive confidential communications of your protected health information, either directly from us or from us by alternative means of from alternative locations;
  • You have the right to inspect and copy your protected health information, you may also request your PHI in an electronic format if we use an electric (paperless) recordkeeping system.
  • You have the right to amend PHI, however, this request may be denied under certain circumstances;
  • You have the right to receive accounting of disclosures of your protected health information made by us in the six years prior to the date of the amount request; and
  • You have the right to obtain a paper copy of this notice from us, even if you have already agreed to receive the notice electronically
If you feel your privacy rights or the provisions of this notice of privacy policies has been violated, you have the right to file a formal written complaint.

Call 404.697.7497 to schedule your complimentary consultation