Notice of Privacy Practices

KIDS & TEENS PRIMARY HEALTHCARE
BYRON COTTON, M.D

Privacy Officer - Telephone (770) 621-0245
Lynette Morrisey

Effective Date: January 2009
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.
We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information.  We make a record of the medical care we provide and may receive such records from others.  We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. This notice describes how we may use and disclose your medical information.  It also describes your rights and our legal obligations with respect to your medical information.

A.  How this Medical Practice May Use or Disclose Your Health Information
B.  When This Medical Practice May Not Use or Disclose Your Health Information  
C.  Your Health Information Rights
D.  Changes to this Notice of Privacy Practices
E.  Complaints 

A. How this Medical Practice May Use or Disclose Your Health Information
This medical practice collects health information about you and stores it in a chart and on a computer.  This is your medical record.  The medical record is the property of this medical practice, but the information in the medical record belongs to you.  The law permits us to use or disclose your health information for the following purposes:

1. Treatment.  We use medical information about you to provide your medical care.  We disclose medical information to our employees and others who are involved in providing the care you need.  For example, we may share your medical information with other physicians, or other health care providers who will provide services which we do not provide.  Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test.

2. Payment.   We use and disclose medical information about you to obtain payment for the services we provide.  For example, we give your health plan the information it requires before it will pay us.  We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.

3. Health Care Operations.  We may use and disclose medical information about you to operate this medical practice.  Or we may use and disclose this information to get your health plan to authorize services or referrals.  We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management.  We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their efforts to improve health or reduce health care costs, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts. 

4. Appointment Reminders.  We may use and disclose medical information to contact and remind you about appointments.  If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.  We may use any available contact information for reminders.

5. Sign in sheet.  We may use and disclose medical information about you by having you sign in when you arrive at our office.  We may also call out your name when we are ready to see you.

6. Notification and communication with family.  We may disclose your health information to notify a family member or another person responsible for your care about your location and condition in the event of your death.  In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts.  If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances.  If you are unable or unavailable to agree or object, the office will use their best judgment in communication with your family and others.

7. Marketing.  We may contact you to give you information about products or services related to your treatment.

8. Required by law. We will use and disclose your health information limited our use or disclosure to the relevant requirements of the law.  When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.

9. Public health.  We may disclose your health information to public health authorities for purposes related to:  preventing or controlling disease, injury or disability; reporting abuse or neglect; reporting to the FDA problems with products and reactions to medications; and reporting disease or infection exposure.  When we report abuse, we may inform you or your representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm.

10. Health oversight activities.  We may disclose your health information to health oversight agencies subject to the law limitations.

11. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order.  We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.

12. Law enforcement.  We may disclose your health information to a law enforcement official to comply with a court order, etc.

13. Coroners.  We may be required by law, to disclose your health information to coroners in connection with investigations.

14. Organ or tissue donation.  We may disclose your health information in procuring, banking or transplanting organs and tissues.

15. Public safety.  We may disclose your health information to appropriate persons in order to prevent or lessen a serious threat.

16. Specialized government functions.  We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

17. Worker's compensation.  We may disclose your health information as necessary to comply with worker's compensation laws. 

18. Change of Ownership.  In the event that this medical practice is sold or merged, your health information/record will become the property of the new owner. You have the right to request your health information be transferred to another physician.

19. Research.  We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law.

20. Fundraising.  We may use or disclose your demographic information and the dates that you received treatment in order to contact you for fundraising activities.  You have the right to refuse.

B. When This Medical Practice May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, this medical practice will not use or disclose health information which identifies you without your written authorization.  You may revoke your authorization in writing at any time.

C. Your Health Information Rights

1. Right to Request Special Privacy Protections.  You have the right to request restrictions on certain uses and disclosures of your health information, by a written request specifying what limitations you want imposed.  We reserve the right to accept or reject your request, and will notify you of our decision.

2. Right to Request Confidential Communications.  You have the right to request that you receive your health information in a specific way or at a specific location.  We will comply with reasonable requests submitted in writing which specify how you wish to receive communications.

3. Right to Inspect and Copy.  You have the right to inspect and copy your health information, with limited exceptions.  To access your medical information, you must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it.  We will charge a reasonable fee, as allowed by Georgia law.  We may deny your request under limited circumstances.  If we deny your request to access your child's records because we believe allowing access would be reasonably likely to cause substantial harm to your child, you will have a right to appeal our decision.  If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.

4. Right to Amend or Supplement.  You have a right to request that we amend your health information that you believe is incorrect or incomplete.  You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete.  We are not required to change your health information, and will provide you with information about this medical practice's denial and how you can disagree with the denial.  We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), or if the information is accurate and complete as is.  You also have the right to request that we add a statement of up to 250 words concerning any statement you believe to be incomplete or incorrect.

5. Right to an Accounting of Disclosures.  You have a right to receive an accounting of disclosures of your health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 , 2 , 3, 6  and 16 of Section A of this Notice of Privacy Practices for purposes of research or public health which exclude direct patient identifiers, or the disclosures to a health oversight agency or law enforcement official to the extent that providing this accounting would be reasonably likely to impede their activities.

6. You have a right to a paper copy of this Notice of Privacy Practices.

D. Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future.  Until such amendment is made, we are required by law to comply with this Notice.  After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received.  We will keep a copy of the current notice posted in our reception area, as well as have copies available at the front desk.

E. Complaints
Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.  If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to (You will not be penalized for filing a complaint):
Department of Health and Human Services, Office of Civil Rights
Office for Civil Rights/U.S. Department of Health & Human Services
61 Forsyth Street, SW. - Suite 3B70/Atlanta, GA 30323
(404) 562-7886; (404) 331-2867 (TDD)
(404) 562-7881 FAX