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Health Insurance Portability and Accountability Act Information (HIPAA)

Michael A. Quiñones, MD, FACS

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 INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

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

We realize these laws are complicated, but we must provide you the following important information:

The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. You may request a copy of our notice at any time.

B. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT:

Amy S. Hoke
2675 North Decatur Road
Suite 609
Decatur, GA 30033
404-501-9170

C. WE MAY USE AND DISCLOSE YOUR IIHI IN THE FOLLOWING WAYS

  1. Treatment. Our practice may use your IIHI to treat you. Many of the people who work for our practice — including, but not limited to, our doctors and nurses — may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may disclose your IIHI to other health care providers for purposes related to your treatment.
  2. Payment. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. We also may use and disclose your IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services and items. We may disclose your IIHI to other healthcare providers and entities to assist in their billing and collection efforts.
  3. Health Care Operations. Our practice may use and disclose your IIHI in order to operate our business. As examples of the ways in which we may use and disclose your IIHI in order to operate our business, our practice may use your IIHI to evaluate the quality of care you receive from us, or to conduct cost-management and business planning activities for our practice. We may disclose your IIHI to other health care providers and entities to assist in their health care operations.
  4. Treatment Options. Our practice may use and disclose your IIHI in order to inform you of potential treatment options or alternatives.

D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

  1. Public Health Risks. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
    • Maintaining vital records, such as births and deaths
    • Reporting child abuse or neglect
    • Preventing or controlling disease, injury or disability
    • Notifying a person regarding potential exposure to a communicable disease
    • Notifying a person regarding a potential risk for spreading or contracting a disease or condition
    • Reporting reactions to drugs or problems with products or devices
    • Notifying individuals if a product or device they may be using has been recalled
    • Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
    • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
  2. Health Oversight Activities. Our practice may disclose your IIHI 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 IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI 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 IIHI if asked to do so by a law enforcement official:
    • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
    • Concerning a death we believe has resulted from criminal conduct
    • Regarding criminal conduct at our offices
    • In response to a warrant, summons, court order, subpoena or similar legal process
    • To identify/locate a suspect, material witness, fugitive or missing person
    • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
  5. Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.
  6. Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
  7. Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
  8. National Security. Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
  9. Workers’ Compensation. Our practice may release your IIHI for workers’ compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR IIHI

  1. Confidential Communications. 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. In order to request a type of confidential communication, you must make a written request to Amy S. Hoke 404-501-9170 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.
  2. Requesting Restrictions. You have the right to request a restriction in our use and disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment of your care. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise requested by law, in emergencies, or when the information is necessary to treat you. You must make a written request to Amy S. Hoke 404-501-9170. Your request must describe in a clear and concise fashion:
    • The information you wished restricted
    • Whether you are requesting to limit our practice’s use, disclosure or both
    • To whom you want the limits to apply
  3. Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical and billing records, but not including psychotherapy notes. You must submit your request in writing to Amy S. Hoke 404-501-9170. Our practice will charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
  4. Amendment. 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. You must submit your request in writing to Amy S. Hoke 404-501-9170. You must provide us with a reason that supports your requests for amendment. Our practice will deny your request if you fail to submit your request in writing. Also, we may deny your request if what you ask is to amend the information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which 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.
  5. Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list certain non-routine disclosures our practice has made of your IIHI for non-treatment, non-payment or non-operations purposes. Use of your IIHI as part of the routine patient care in our practice is not required to be documented. In order to obtain an “accounting of disclosures”, you must submit your request in writing to Amy S. Hoke 404-501-9170. All requests must state a time period, which may not be longer than 6 years from the last date of disclosure. The first list you request within a 12 month period is free of charge, but there will be a charge for additional requests within the same 12 month period.
  6. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Amy S. Hoke 404-501-9170. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
  7. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care.