Atlanta Gastroenterology Associates, LLC (AGA) presents this notice to our patients describing how our medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. You have the right to obtain a paper copy of this Notice upon request.
Under Federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, treatment, and related medical information. Your health information also includes payment, billing, and insurance information.
AGA uses health information about you for treatment, analyzing procedures, and lab results. We use information to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances where the law applies, we may be required to use or disclose the information even without your permission.
AGA will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians, and other members of your treatment team will record information in your medical record and use it to determine the most appropriate course of care. AGA may also disclose this information by fax, in person or via telecommunication. We may communicate to other health care providers who are participating in your treatment, to pharmacists who are filling and refilling your prescriptions, and to family members who are helping with your care.
Payment: AGA will use and disclose your health information for payment purposes. For example, AGA may need to obtain authorization from your insurance company before providing certain types of treatment. AGA will submit bills and maintain records of payments from your health plan.
Health Care Operations: AGA will use and disclose your health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, and to assess the care and outcomes of your case and others like it.
AGA knows that family or friends are an integral part of a patient's care. We are often informed that a family member is authorized to schedule an appointment or procedure for a patient, and frequently, it is the family member or friend who is calling AGA to schedule a patient's procedure and/or appointment. If you do not want any family or friends to participate in your appointment scheduling, please notify your AGA Office Manager to document that request in your medical record.
AGA may use your information to contact you with appointment reminders by phone or mail. AGA may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
AGA may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, AGA is permitted to give out health information without your permission for the following purposes:
Required by Law: AGA may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
Research: AGA may use or disclose information for approved medical research.
As required by law, AGA may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
AGA may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
AGA may disclose information in response to an appropriate subpoena or court order.
Subject to certain restrictions, AGA may disclose information required by law enforcement officials.
Deaths: We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.
AGA may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
If you are a member of the armed forces, AGA may release information as required by military command authorities. AGA may also disclose information to correctional institutions or for national security purposes.
AGA may release information about you for workers' compensation or similar programs providing benefits for work-related injuries or illness. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.
You have the following rights with regard to your health information. Please contact AGA's Compliance Officer (listed below) to obtain the appropriate form for exercising these rights.
You may request restrictions on certain uses and disclosures of your health information. AGA is not required to agree to such restrictions, but if we do agree, AGA must abide by those restrictions.
You may ask us to communicate with you confidentially by, for example, sending notices to a special address, or not using postcards to remind you of appointments. Please ask to see your AGA Office Manager to document and initialize this request.
In most cases, you have the right to look at, or get a copy of, your health information. There may be a small charge dictated by Georgia Law for these copies.
If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that AGA correct the existing information or add the missing information. Your AGA physician has the right to refuse your request. A denial letter will be sent in such a case.
You may request a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or health care operations.
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.
We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting area and each examination room. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below.
If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.
If you have any questions, requests or complaints, please contact:
Compliance Officer
Confidential Hotline: 404.253.6852
Email Address: s.robinson@atlantagastro.com
Effective Date: 4/14/2003
©2004 Atlanta Gastroenterology Associates, LLC. All rights reserved.