Privacy Policy
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.
Your Rights
You have the right to:
•
Get a
copy of your paper or electronic medical record
•
Correct
your paper or electronic medical record
•
Request
confidential communication
•
Ask us
to limit the information we share
•
Get a
list of those with whom we've shared your information
•
Get a
copy of this privacy notice
•
Choose
someone to act for you
•
File a
complaint if you believe your privacy rights have been violated
Your Choices
You have
some choices in the way that we use and share information as we:
•
Tell
family and friends about your condition
•
Provide
disaster relief
•
Include
you in a hospital directory
•
Provide
mental health care
•
Market
our services and sell your information
•
Raise
funds
Our Uses and Disclosures
We may use and share
your information as we:
|
•
Treat you •
Run our organization •
Bill for your services •
Help with public health and safety issues •
Do research •
Comply with the law •
Respond to organ and tissue donation requests •
Work with a medical examiner or funeral director •
Address workers' compensation, law enforcement, and
other government requests •
Respond to lawsuits and legal actions |
Your Rights
When it
comes to your health information, you have certain rights. This section
explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
•
You can ask to see or get an electronic or paper copy
of your medical record and other health information we have about you. Ask us
how to do this.
•
We will provide a copy or a summary of your health
information, usually within 30 days of your request. We may charge a
reasonable, cost-based fee.
Ask us to correct your medical record
•
You can ask us to correct health information about you
that you think is incorrect or incomplete. Ask us how to do this.
•
We may say "no" to your request, but we'll tell you
why in writing within 60 days.
Request confidential communications
•
You
can ask us to contact you in a specific way (for example, home or office phone)
or to send mail to a different address.
•
We
will say "yes" to all reasonable requests.
Ask us to limit what we use or share
•
You
can ask us not to use or share certain health information for treatment,
payment, or our operations. We are not required to agree to your request, and
we may say "no" if it would affect your care.
•
If
you pay for a service or health care item out-of-pocket in full, you can ask us
not to share that information for the purpose of payment or our operations with
your health insurer. We will say "yes" unless a law requires us to share that
information.
Get a list of those with whom we've shared
information
•
You
can ask for a list (accounting) of the times we've shared your health
information for six years prior to the date you ask, who we shared it with, and
why.
•
We
will include all the disclosures except for those about treatment, payment, and
health care operations, and certain other disclosures (such as any you asked us
to make). We'll provide one accounting a year for free but will charge a
reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this
notice at any time, even if you have agreed to receive the notice
electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
•
If
you have given someone medical power of attorney or if someone is your legal
guardian, that person can exercise your rights and make choices about your
health information.
•
We
will make sure the person has this authority and can act for you before we take
any action.
File a complaint if you feel your rights
are violated
•
If
you believe we have violated your privacy rights, you
may contact the Practice's Privacy Officer in writing at 400 Perimeter Circle
Terrace, Suite 875; Atlanta, Georgia 30346 or by e-mail at Compliance@umpartners.com.
•
You
may file a complaint with the U.S. Department of Health and Human Services
Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W.,
Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
•
We
will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your
choices about what we share. If you have a clear preference for how we share your
information in the situations described below, talk to us. Tell us what you
want us to do, and we will follow your instructions.
In these cases, you
have both the right and choice to tell us to:
•
Share
information with your family, close friends, or others involved in your care
•
Share
information in a disaster relief situation
•
Include
your information in a hospital directory
If
you are not able to tell us your preference, for example if you are
unconscious, we may go ahead and share your information if we believe it is in
your best interest. We may also share your information when needed to lessen a
serious and imminent threat to health or safety.
In these cases we never share your
information unless you give us written permission:
•
Marketing
purposes
•
Sale
of your information
•
Sharing
of psychotherapy notes
Our
Uses and Disclosures
How do we typically use or share your
health information?
We typically use or
share your health information in the following ways.
Treat you
We can use your
health information and share it with other professionals who are treating you.
Run our organization
We can use and share your health information to run
our practice, improve your care, and contact you when necessary.
Bill for your
services
We can use and share your health
information to bill and get payment from health plans or other entities.
How else can we use or share your health information?
We are allowed or required to share your information in
other ways - usually in ways that contribute to the public good, such as public
health and research. We have to meet many conditions in the law before we can
share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public
health and safety issues
We can share health information about you for certain
situations such as:
•
Preventing disease
•
Helping with product recalls
•
Reporting adverse reactions to medications
•
Reporting suspected abuse, neglect, or domestic
violence
•
Preventing or reducing a serious threat to anyone's
health or safety
Do research
We can use or share your information for health
research.
Comply with the law
We will share information about you if state or
federal laws require it, including with the Department of Health and Human
Services if it wants to see that we're complying with federal privacy law.
Respond
to organ and tissue donation requests
We
can share health information about you
with organ procurement organizations.
Work
with a medical examiner or funeral director
We
can share health information with a coroner,
medical examiner, or funeral director when an individual dies.
Address workers'
compensation, law enforcement, and other government requests
We can use or share health information about you:
•
For workers' compensation claims
•
For law enforcement purposes or with a law enforcement
official
•
With health oversight agencies for activities
authorized by law
•
For special government functions such as military,
national security, and presidential protective services
Respond to lawsuits
and legal actions
We can share health information about you in response
to a court or administrative order, or in response to a subpoena.
Our
Responsibilities
•
We are
required by law to maintain the privacy and security of your protected health
information.
•
We will
let you know promptly if a breach occurs that may have compromised the privacy
or security of your information.
•
We must
follow the duties and privacy practices described in this notice and give you a
copy of it.
•
We will not
use or share your information other than as described here unless you tell us
we can in writing. If you tell us we can, you may change your mind at any time.
Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
SMS/TEXT REGISTRATION AND COMMUNICATION
Providing Contact Information By providing contact information, individuals are consenting to use their information for the stated purposes (reminder, notifications, alerts, billing, satisfaction surveys, etc). Personal information collected may include:
- Name
- Email address
- Mobile and/or other telephone number
- Address and/or Zip code
- Any other details you voluntarily choose to submit
Re-Authorization to Communicate with You: When using our services, our organization will periodically re-confirm consent to communicate with individuals about those services.
Revoking Authorization to Communicate with Our Organization (Opt-Out): Individuals may revoke (opt-out, cancel, discontinue) their consent to receive communications at any time by contacting our offices, or by responding to messages in a manner provided within the message (i.e. "you may use the "unsubscribe" link" or "reply STOP to be removed from future messages")
Unauthorized Disclosure and Use of Information: Our organization will not sell or rent information about you. Our organization will not share or disclose personal information, or information regarding SMS text messaging, in a manner that is not compliant with applicable Federal and State Regulations (ex: HIPAA).
Use of Personal Information: Our organization uses information obtained through delivery of services and other sources you provide during Treatment, Payment and Operations and other compatible purposes, such as responding to your inquiries, facilitating, and improving your online experience, and maintaining the security and integrity of our website and messaging services. As a general policy, we use personal information and user data for internal purposes only.
Changes to the Terms of this Notice
This Notice is effective as of
January 1, 2024. We can change the terms
of this notice, and the changes will apply to all information we have about
you. The new notice will be available upon request, in our office, and on our
web site.
Other Information
For additional information or questions regarding this Notice of Privacy Practices, you may contact the Practice's Privacy Officer in writing at 400 Perimeter Circle Terrace, Suite 875; Atlanta, Georgia 30346 or by e-mail at Compliance@umpartners.com.