HIPAA Notice of Privacy Practices

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.

Pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), this Notice describes the practices of Peach State Endocrinology (“PSE”), Dr. Korytnaya, and its other providers for its Patients, describing how your medical information may be used or 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 and may print a copy from our website. PSE also respects privacy in regard to credit card information acquired while making a payment through its electronic health record. No information collected while making a payment will be shared in any way, shape or form.

Our Pledge Regarding Medical Information

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at our facilities. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by our facilities, whether made by our personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

Patient Health Information

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 and billing information.

How We Use Your Patient Health Information

PSE 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 without your permission.

Examples of Treatment, Payment, and Health Care Operations

• Treatment: PSE 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. PSE may also disclose this information by fax, in person, or via telecommunication. We may communicate with other health care providers who are participating in your treatment, to pharmacies who are filling and refilling your prescriptions, and to family members who are helping with your care.
• Payment: PSE will use and disclose your health information for patient payment purposes. For example, PSE will submit bills and maintain records of payments.
• Medicare: PSE will use and disclose your health information for Medicare billing purposes for services not covered under the Package chosen by Patient. For example, PSE will submit bills to Medicare and maintain records of Medicare reimbursements.
• Health Care Operations: PSE 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.
• Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at our facilities.

Release of Information to Family and Friends

PSE knows that family and friends are an integral part of a patient’s care. If you wish to authorize a family member or friend to speak with us regarding your care or test results, please write their name and contact information on the Patient Contact Authorization Form or otherwise provide it to PSE in writing. PSE will not release your information to any friend or family without your written consent.

Special Uses

PSE may use your information to contact you with appointment reminders by phone, mail or secured electronic means. PSE may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. This communication may be sent to you via the methods listed above. If you have granted written permission, the above information may also be sent to you via email. By providing your email address in the New Patient Information and Enrollment Form, you authorize the use of email as a method for PSE to communicate with you.

Other Uses and Disclosures

PSE may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, PSE is permitted to give out health information without your permission for the following purposes:

• Required by Law: PSE may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
• Public Health Activities: As required by law, PSE may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
• Health Oversight: PSE may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
• Judicial and Administrative Proceedings: PSE may disclose information in response to an appropriate subpoena or court order.
• Law enforcement Purposes: Subject to certain restrictions, PSE may disclose information required by law enforcement officials.
• Deaths: We may repost information regarding deaths to coroners, medical examiners, funeral and organ donation agencies.
• Serious Threat to Health or Safety: PSE 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.
• Military and Special Government Functions: If you are a member of the armed forces, PSE may release information as required by military command authorities. PSE may also disclose information to correctional institutions or for national security purposes.
• Workers’ Compensation: PSE 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 you 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.
• Treatment Alternatives: PSE may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
• Health-Related Benefits and Services: PSE may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Individual Rights

You have the following rights with regard to your health information. Submit any concerns in writing to PSE’s Office Manager and/or Dr. Korytnaya.

• Request Restrictions: You may request restrictions on certain uses and disclosures of your health information. PSE is not required to agree to such restrictions, but if we do agree, PSE must abide by those restrictions.
• Confidential Communications: You may ask us to communicate with you confidentially. Please ask to see your PSE Office Manager to initiate and document this request.
• Inspect and Obtain Copies: You have the right to see or receive a copy of your health information. There may be a small charge dictated by State law for these copies.
• Amend Information: If you believe information in your record is incorrect, you have the right to request that PSE correct or amend the existing information. Your PSE physician has the right to refuse your request. Regardless, a letter concerning your request will be send within 30 days of said request.
• Accounting of Disclosures: 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.
• Authorization: Your authorization is required for a use or disclosure of psychotherapy notes, for marketing purposes, and for the sale of Protected Health Information.
• Notification of breach: You have a legal right to be notified of a breach of unsecured electronic protected health information.

Our Legal Duty

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.

Changes in Privacy Practices

We may change our policies at any time. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact Dr. Korytnaya or PSE’s office.

Complaints

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 Dr. Korytnaya or PSE’s office. You may also send a written complaint to the U. S. Department of Health and Human Services. Dr. Korytnaya or PSE’s office will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.