NOTICE OF PRIVACY POLICIES
Our Privacy Promise to You, Our Patients
YOUR INFORMATION IS IMPORTANT AND CONFIDENTIAL. OUR ETHICS AND POLICIES REQUIRE THAT YOUR INFORMATION BE HELD IN STRICT CONFIDENCE.
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At Southern OB/GYN, we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective April 14, 2003, and applies to all protected health information has described by federal regulations.
UNDERSTAND YOUR HEALTH RECORD/INFORMATION
Each time you visit Southern OB/GYN, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis treatment, and a plan for future care or treatment. This information is 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 third-party payer can verify that services billed were actually provided,
· A tool in educating health 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 you can assess and continually work to improve the care we render and that 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, 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 Southern OB/GYN, the information belongs to you. You have the rights to:
· Obtain a paper copy of this notice of information practices upon request,
· Inspect and copy your health record as provided in 45CFR 164.524,
· Amend your health record as provided in 45CFR 164.528,
· Obtain an accounting of disclosures of your health information by alternative means or at alternative locations,
· Request communications of your health information by alternative means or at alternative locations.
· Request a restriction on certain uses or disclosures of your information as provided in 45CFR 164.522, and
· Revoke your authorization to use or disclosure health information except to the extent that action has already been taken.
Southern OB/GYN 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 as alternative locations.
We reserve the right to change our practices and to make the new provision effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us, or if you agree, we will email the revised notice to you.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your revocation of the authorization according to the procedures included in the authorization.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact our Privacy Officer at (912) 681-3111. If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with an 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 addresses are below:
ATTN: Privacy Officer
1094 Bermuda Run
Statesboro, GA 30458
Office of Civil Rights
U. S. Dept. of Health & Human Services
Independence Ave., S.W.
Washington, D.C. 20201
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS
We will use your health information by treatment.
For example: 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. Your physician will document in your record his or her expectations of the members of your health care teams. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you.
We will use your health information for payment.
For example: 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 will use your health information for regular health operation.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.
Business Associates: There are some services provided in our organization, through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your medical record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Directory: Unless, you notify us that you object, we will use you name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.
Notification: We may use or disclose information to notify or assist in notifying 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.
Research: 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 information.
Funeral directors: We may disclose health 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 procurement organization or other entities engaged in the procurement, banking, or transplantation or organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fund raising: We may contact you as part of a fun-raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers compensation: We may disclose health information not the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information not public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.