HIPAA Notice

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 YOUR PROTECTED HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

Our Commitment To Your Privacy

Our practice is dedicated to maintaining the privacy of your protected health information (PHI). 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 medical information. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

Understanding Your Health Record/Information

Each time you visit Alliance Orthopaedics & Sports Medicine, a record of your visit is made. Typically, this record contains your symptoms, examination and 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,

• Means of communication among the many health professionals who contribute to your care,

• Legal document describing the care you received,

• Means by which you or a third-party payer can verify that services billed were actually provided,

• A tool in educating heath professionals,

• A source of information for public health officials charged with improving the health of this state and the nation,

• A source of data for our 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: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of Alliance Orthopaedics & Sports Medicine, the information belongs to you. You have the right to:

Obtain a paper copy of this notice of information practices upon request.

Inspect and obtain a copy your health record as provided for in 45 CFR 164.524. 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 of our denial. Another licensed health care professional chosen by us will conduct reviews.

Amend your health record as provided in 45 CFR 164.528. 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 Carolyn Blue, Alliance Orthopaedics & Sports Medicine, 5040 Snapfinger Woods Drive, Suite 206, Decatur, Georgia 30035. You must provide us with a reason that supports your 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 protected health information kept by or for the practice; (c) not part of the medical information 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.

Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528. 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 medical information for non-treatment, non-payment or non-operations purposes. Use of your health information as part of the routine 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 to Carolyn Blue, Alliance Orthopaedics & Sports Medicine, 5040 Snapfinger Woods Drive, Suite 206, Decatur, Georgia 30035. 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-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

Request communications of your health information by alternative means or at alternative locations, . 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 Carolyn Blue, Alliance Orthopaedics & Sports Medicine, 5040 Snapfinger Woods Drive, Suite 206, Decatur, Georgia 30035, 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.

Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. You have the right to request a restriction in our use or disclosure of your protected health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your protected health information 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 your protected health information, you must make your request in writing to Carolyn Blue, Alliance Orthopaedics & Sports Medicine, 5040 Snapfinger Woods Drive, Suite 206, Decatur, Georgia 30035. Your request must describe in a clear and concise fashion:

(a) the information you wish restricted;
(b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply.

• Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Legal Duty

Alliance Orthopaedics & Sports Medicine is required to:

• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested restriction, and
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our Notice and to make the new provisions effective for all health information we have created or maintained in the past, and for any records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue use and disclosure your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact our Privacy Officer, Carolyn Blue at 770-322-7333.

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.

The address for the privacy officer is listed below:

Alliance Orthopaedics & Sports Medicine
ATTN: Carolyn Blue
5040 Snapfinger Woods Drive Suite 206
Decatur, Georgia 30035

All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Use and Disclosure of Your Medical Information

The following categories describe the different ways in which we may use and disclose your medical information. Please note that we will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us.

We will use your health information for treatment.

Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you.

We might use your medical information in order to write a prescription for you, or we might disclose your medical information to a pharmacy when we order a prescription

Additionally, we may disclose your medical information to others who may assist in your care, such as your spouse, children or parents.

Finally, we may also disclose your medical information to other health care providers for purposes related to your treatment. When services are ordered by our physician, we may disclose your health information to business associates so that they can perform the service we’ve asked them to do and bill you or your third party payer for services rendered.

We will use your health information for payment.

Our practice may use and disclose your protected health information in order to bill and collect payment for the services and items you may receive from us. A bill may be sent to you or a third party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits).

We may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.

We may disclose your protected health information to other health care providers and entities to assist in their billing and collection efforts.

We will use your health information for regular health operations.

Our practice may use and disclose your protected health information to operate our business. We may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

Additional Uses And Disclosures:

We may use and disclose medical information for the following purposes.

1. Appointment Reminders. Our practice may use and disclose your medical information to contact you and remind you of an appointment.

2. Health-Related Benefits and Services. Our practice may use and disclose your health information to inform you of potential treatment options or alternatives, health-related benefits or services that may be of interest to you.

3. Release of Information to Family. Health professionals, using their best judgment, may disclose to a family member, other relative, or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care

4. 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.

Use and Disclosure in Certain Special Circumstances

The following categories describe unique scenarios in which we may use or disclose your health information:

1. Public Health Risks. Our practice may disclose your health information to public health authorities that are authorized by law to collect information for the purpose of preventing or controlling disease, injury or disability.

2. Health Oversight Activities.Our practice may disclose your protected health information 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.

3. Lawsuits and Similar Proceedings. Our practice may use and disclose your protected health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your protected health information 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 health information as required by law or in response to a valid subpoena.

5. Serious Threats to Health or Safety. We may disclose your health information when necessary to reduce or prevent a serious threat to your health and safety, the health and safety of another individual or to the public.

6. Military. Our practice may disclose your health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

7. National Security. Our practice may disclose your protected health information to federal officials for intelligence and national security activities authorized by law.

8. Inmates. Our practice may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.

9. Workers compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.