Privacy Notice of Health Information Practices

This notice describes West Georgia Healthcare For Women, P.C. may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Please read it carefully.

Understanding Your Health/Record Information
Each time you visit this office, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your medical record, serves as a:

• Basis for planning your care and treatment
• Means of obtaining payment for health care services from your insurance plan
• 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 a third-party payer can verify that services billed were actually provided
• A tool with which we can assess and continually work to improve the care we render and the 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, when, where and why others may access your health information
  • Make more informed decisions when authorizing disclosure to others

Your Health Information Rights
Although your health record is the physical property of West Georgia Healthcare For Women, P.C., the information belongs to you. You have the right to:

• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
• Obtain a paper copy of this notice of information practices upon request
• Inspect and copy your health record as provided for in 45 CFR 164.524
• Amend your health record as provided in 45 CFR 164.528
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
• Request communications of your health information by alternative means or at alternative locations
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities
This organization 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 at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post a revised notice in our office and on our website and provide a paper copy or e-mail a copy to you upon request.

For More Information or to Report a Problem
If you have questions and would like additional information, you may contact our Privacy Officer at 770-214-2121. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services.

We will use your health information for treatment.
For example: Information obtained by a nurse, physician or other member of your healthcare 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 expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way the physician will know how you are responding to treatment.

Should you be referred to or by another physician or healthcare provider, we will provide copies of various reports, treatment plans, etc. 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 needed. Also, your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for hospital admission.

We will use your health information for regular health operations
For example: We will use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We will also call you by name in the waiting room when your physician is ready to see you. We may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointment or leave a message for you to call our office for test results. We may disclose your protected health information to your pharmacist when calling in prescriptions.

We will share your protected health information with third party "business associates" that perform various activities (e.g. billing, collection, transcription, diagnostic and laboratory services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI.

We will not use or disclose your health information without your authorization, except as described in this notice.

This notice was published and became effective on April 14, 2003.