NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
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.
Under the Health Insurance Portability and Accountability
Act of 1996 ("HIPAA") we are required to maintain the privacy
of your protected health information and provide you with notice
of our legal duties and privacy practices with respect to such
protected health information.
We are required to abide by the terms of the notice currently in effect.
We reserve the right to change the terms of our notice at any time and to
make the new notice provisions effective for all protected health
information that we maintain. In the event that we make a material revision
to the terms of our notice, you will receive
a revised notice within 60-days of such revision. If you should have any
questions or require further information, please contact our Privacy Officer
at (770) 998-8936 or toll free at (800) 342-5209.
How We May Use or Disclose Your Health Information
The following describes the purposes for which we are permitted or
required by law to use or disclose your health information without your
consent or authorization. Any other uses or disclosures will be made only
with your written authorization and you may revoke such authorization in
writing at any time.
We may use or disclose your health information to provide you with medical
treatment or services. For example, information obtained by a provider
providing health care services to you will record such information in your
record that is related to your treatment. This information is necessary to
determine what treatment you should receive. Health care providers will also
record actions taken by them in the course of your treatment and note how
We may use or disclose your health information in order to process claims or
make payment for covered services you receive under your benefit plan. For
example, your provider may submit a claim to us for payment. The claim form
will include information that identifies you, your diagnosis, and treatment
or supplies used in the course of treatment.
Health Care Operations
We may use or disclose your health information for health care operations.
Health care operations include, but not limited to, quality assessment and
improvement activities, underwriting, premium rating, management and general
administrative activities. For example, members of our quality improvement
team may use information in your health record to assess the quality of care
that you receive and determine how to continually improve the quality and
effectiveness of the services
There may be instances where services are provided to our organization
through contracts with third-party "business associates". Whenever a
business associate arrangement involves the use or disclosure of your health
information, we will have a written contract that requires the business
associate to maintain the same high standards of safeguarding your privacy
that we require of our own employees and affiliates.
Required by Law
We will disclose medical information about you when required to do so by
federal, state or local law.
Communication with Family or Friends
Our service professionals, using their best judgment, may disclose to a
family member, other relative, close personal friend, or any other person
you identify, health information relevant to that person's involvement in
your care or payment related to your care.
We may use or disclose your health information, as necessary, to provide you
with information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
We may disclose information to researchers when their research has been
approved by an institutional review board that has reviewed the research
proposal and established protocols to ensure the privacy of your health
Coroners, Medical Examiners and Funeral Directors
We may disclose health information to a coroner or medical examiner. We may
also disclose medical information to funeral directors consistent with
applicable law to carry out their duties.
Organ Procurement Organizations
Consistent with applicable law, we may disclose health information to organ
organizations or other entities engaged in the procurement, banking, or
transplantation of organs for the purpose of tissue donation and transplant.
We may contact you as part of a fund-raising effort.
As required by law, we may disclose your health information to public health
or legal authorities charged with preventing or controlling disease, injury
Food and Drug Administration (FDA)
We may disclose to the FDA health information relative to adverse events
with respect to food, supplements, product and product defects, or post
marketing surveillance information to enable product recalls, repairs, or
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
To Avert a Serious Threat to Health or Safety
Consistent with applicable federal and state laws, we may use and disclose
health information when necessary to prevent a serious threat to your health
and safety or the health and safety of the public or another person.
Military and Veterans
If you are a member of the armed forces, we may disclose health information
about you as required by military command.
Health Oversight Activities
We may disclose health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections,
Protective Services for the President, National Security and
We may disclose health information about you to authorized federal officials
so they may provide protection to the President, other authorized persons or
foreign heads of state
or conduct special investigations, or for intelligence, counterintelligence,
and other national security activities authorized by law.
We may disclose health information when requested by a law enforcement
official as part of law enforcement activities; investigations of criminal conduct; in response to court orders; in emergency circumstances; or when required to do so by law.
We may disclose health information about an inmate of a correctional institution or under the custody of a law enforcement official to the correctional institution or law enforcement official.
Lawsuits and Disputes
We may disclose health information about you in response to a subpoena,
discovery request, or other lawful order from a court.
We may disclose health information about you to your plan sponsor to carry
out plan administration functions that the plan sponsor performs upon
certification by the plan sponsor that the plan documents have been amended
as set forth under HIPAA regulations.
Your Rights Regarding Your Health Information
The following describes your rights regarding the health information we
maintain about you. To exercise your rights, you must submit your request in
writing to our Privacy Officer at:
100 Mansell Court E.
Roswell, GA 30076
Right to Request Restrictions
You have the right to request that we restrict uses or disclosures of your
health information to carry out treatment, payment, health care operations,
or communications with family or friends. We are not required to agree to a
Right to Receive Confidential Communications
You have the right to request that we send communications that contain your
health information by alternative means or to alternative locations. We must
accommodate your request if it is reasonable and you clearly state that the
disclosure of all or part of that information could endanger you.
Right to Inspect and Copy
You have the right to inspect and copy health information that we maintain
about you in a designated record set. A "designated record set" is a group
of records that we maintain such as enrollment, payment, and claims
adjudication record systems. If copies are requested or you agree to a
summary or explanation of such information, we may charge a reasonable,
cost-based fee for the costs of copying, including labor and supply cost of
copying; postage; and preparation cost of an explanation or summary, if such
is requested. We may deny your request to inspect and copy in certain
circumstances as defined by law. If you are denied access to your health
information, you may request that the denial be reviewed.
Right to Amend
You have the right to have us amend your health information for as long as
we maintain such information. Your written request must include the reason
or reasons that support your request. We may deny your request for an
amendment if we determine that the record that is the subject of the request
was not created by us, is not available for inspection as specified by law,
or is accurate and complete.
Right to Receive an Accounting of Disclosures
You have the right to receive an accounting of disclosures of your health
information made by us in the six years prior to the date the accounting is
requested (or shorter period as requested). This does not include
disclosures made to carry out treatment, payment and health care operations;
disclosures made to you; communications with family and friends; for
national security or intelligence purposes; to correctional institutions or
law enforcement officials; or disclosures made prior to the HIPAA compliance
date of April 14, 2003. Your first request for accounting in any 12-month
period shall be provided without charge. A reasonable, cost-based fee shall
be imposed for each subsequent request for accounting within the same
Right to Obtain a Paper Copy
You have the right to obtain a paper copy of this Notice of Privacy
Practices at any time.
How to File a Complaint if You Believe Your Privacy
Rights Have Been Violated
If you believe that your privacy rights have been violated, please submit
your complaint in writing to:
Attn: Privacy Officer
100 Mansell Court East, Suite 400
Roswell, GA 30076
You may also file a complaint with the Secretary of the Department of
Health and Human Services. You will not be retaliated against for filing a