Privacy Notice

NOTICE OF PRIVACY PRACTICES – GEORGIA RETINA, P.C.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice describes the privacy practices of Georgia Retina, PC including:

  • All office locations
  • Any healthcare professional authorized to enter information into your medical record on behalf of these entities
  • All locations of Georgia Retina involved in treatment, payment, and healthcare operations authorized for access to Protected Health Information
  • All employees, staff, students, and trainees working for this practice

This notice describes the ways in which we may use and disclose your medical information. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

  • Ensure 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 is currently in effect.

Understanding Your Health Record/Information

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. This record typically contains your symptoms, medical history, examination, test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as:

  • A basis for planning your care and treatment
  • A means of communication among the many health professionals who contribute to your care
  • A legal document describing the care you received
  • A means by which you or a third-party payer can verify that services billed were actually provided
  • A tool in educating health professionals
  • A source of data for medical research
  • A source of information for public health officials charged with improving the health of the nation
  • A source of data for facility planning and marketing
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

  1. Ensure its accuracy
  2. Better understand who, what, when, where, and why your health information is accessed
  3. Make more informed decisions when authorizing disclosures to others

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

This section describes different ways that we are permitted to use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and give some examples. 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 following categories.

For Treatment. We may use your medical information to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other medical personnel who are involved in caring for you.  We may also disclose medical information about you to your referring doctor or other doctors outside Georgia Retina, PC who may be involved in maintaining your health or well-being.  For example, we may disclose medical information to your referring physician after your appointment, or to another physician, hospital, ambulatory surgery center or other facility to which we may send you for a procedure or follow-up care.

For Payment. We may use and disclose your medical information so that the treatment and services you receive at Georgia Retina, PC may be billed and payment may be collected from you, an insurance company, or a third party. We may tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. We may also give information to someone who helps pay for your care.

For Healthcare Operations. We may use and disclose your medical information for healthcare operations. Healthcare operations are activities that are necessary to run the practice and to make sure that all of our patients receive quality care.  These include such activities as education, training, and quality improvement.  For example, we may use medical information to review our treatment, services, and to evaluate the performance of our staff in caring for you.  We may also share your medical information with third party business associates that perform various activities (e.g. billing, transcription services) for Georgia Retina, PC.  All business associates of Georgia Retina, PC have signed a written contract with us indicating they will protect the privacy of your protected health information.

Other Examples of Healthcare Operations

Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment at one of our offices. If you do not want us to contact you with appointment reminders, you must send a written notice to our Privacy Officer (see contact information at the end of this notice).

Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or health-related benefits that may be of interest to you.

Research. We may disclose information to researchers when an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.

As Required By Law. We will disclose your medical information when required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose your medical information when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person. Any disclosure, however, would be only to someone able to help prevent the threatened harm.

Special Situations. We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Organ and Tissue Donation. If you are a potential organ donor, we may release medical information to organ procurement organizations, or eye or tissue banks, as necessary, to facilitate organ or tissue donation and transplantation.

Military and Veterans. If you are a member of the armed forces, we may release your medical information as required by law. We may also release medical information about foreign military personnel to the appropriate foreign military authority as required by law.

Workers’ Compensation. We may release your medical information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose, when requested, your medical information for public health activities. These activities generally include the following:

  • To prevent or control disease, injury or disability
  • To report births and deaths
  • To report abuse and/or neglect of a child, elder or disabled person
  • To report reactions to medications or problems with products
  • To notify people of recalls of products they may be using
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition .

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your medical information in response to a court order. Under certain circumstances, we may also disclose your medical information in response to a subpoena or other lawful process, but we will do so only if efforts have been made to tell you about the request or to obtain an order protecting the information requested, or if you or a court have provided written authorization.

Law Enforcement. We may release your medical information if asked to do so by a law enforcement official, if permitted by law:

  • In response to a court order, subpoena, warrant, summons, or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at the hospital; and
  • In emergency circumstances: to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors or designees as necessary to carry out their duties.

National Security and Intelligence Activities. If permitted by law, we may release your medical information to authorized federal officials for intelligence, counter-intelligence, and other national security activities, as authorized by law.

Protective Services for the President and Others. We may disclose your medical information to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations, if permitted by law.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official under certain circumstances, if permitted by law. This release would be necessary: (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

OTHER USES OF YOUR MEDICAL INFORMATION

Other uses and disclosures of your medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Obtain a Copy. You have the right to inspect and obtain a copy of your medical information that may be used to make decisions about your care. This information includes medical and billing records but does not include psychotherapy notes.

To inspect or obtain a copy of your physician’s office records, please contact the office in which you are seen by the doctor. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed.  If you are denied access to your medical information, you may request that the denial be reviewed by writing to the Privacy Officer at the address at the end of this notice.

Right to Amend. If you think that the 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 as long as the information is kept by Georgia Retina, PC. Your request for an amendment will become a legal part of your medical record, to be sent out along with the rest of the record whenever a request for copies is received. No part of the original documentation in the medical record can be destroyed.

To request an amendment of your health record, your request must be made in writing and submitted to our Privacy Officer (see contact information at the end of this notice).

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:

  • Was not created by us, or where the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by Georgia Retina, PC;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Right to Request an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain disclosures or releases we made of your information for which your authorization was not obtained. The list will not include releases made for purposes of treatment, payment, or healthcare operations.

To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer (see contact information at the end of this notice). Your request must state a time period, which may not be longer than six years ago and may not include dates before the compliance date listed on the first page of this notice. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

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 healthcare 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, such as a family member or friend.

We are not required to agree to your request for restrictions. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you.

To request restrictions on your health record, you must make your request in writing to our Privacy Officer (see contact information at the end of this notice).  In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our internal use, our disclosure to an outside party, or both; and (3) to whom you want the limits to apply
(for example, disclosures to your spouse).

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. For example, you can ask that we contact you only at work or only by mail.

To request confidential communications, you must make your request in writing to our Privacy Officer (see contact information below). We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us at any time to give you a copy of this notice. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, please contact the Reception Desk or our Privacy Officer.

You may also obtain a copy of this notice on our Web site: www.garetina.com.

Filing a Privacy Complaint

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer (see contact information below) or with the Secretary of the Department of Health and Human Services.

To file a complaint with the Privacy Officer, please submit your complaint in writing to the address below.  To file a complaint with the Secretary of the Department of Health and Human Services, contact the Office for Civil Rights, DHHS at 61 Forsyth St, SW, Ste. 3B70 Atlanta, GA 30303-8909.  The phone number for this office is 404-562-7886.

You may also submit a complaint electronically by visiting OCR’s website at www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

Contacting Our Privacy Officer

To request any of the above privacy rights or for answers to questions about this Privacy Notice, contact our Privacy Officer:

Privacy Officer
Georgia Retina, PC
1100 Johnson Ferry RD
BLDG 2, Ste. 593
Sandy Springs, GA 30342
Phone: (404) 255-9096
Fax:     (404)255-9097

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will prominently post copies of the current notice in all of our offices. The notice will contain the effective date on the first page, in the top right corner. In addition, each time you come to our office for treatment or healthcare services, a copy of the notice currently in effect will be available to you.