Lanier Family Healthcare, LLC

Effective date:  August 1, 2005

Updated:  May 1, 2013

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.

Who Will Follow This Notice

This notice describes Lanier Family Healthcare’s practices and that of:

• • Any health care professional authorized to enter information into your medical record including members of the office staff
  • All departments and units of our practice
  • Any member of a volunteer group we allow to help you while you are in our practice
  • Other employees, staff and practice personnel

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 practice.  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 Lanier Family Healthcare, whether by care generated by our practice doctors and/or personnel working for the practice.

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.

We are required by law to:

• • Make sure that medical information that identifies you is kept private
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the notice that is currently in effect
  • Most uses and disclosures of psychotherapy notes, uses and disclosures of protected health information (PHI) for marketing purposes, and disclosures that constitute a sale of PHI require patient authorization
  • Other uses and disclosures not described in the Privacy Notices will be made only with authorization from the individual
  • Patients have the right to restrict certain disclosures of PHI to health plans/insurance companies if the patient pays out of pocket in full for the health care service
  • Affected patients have the right to be notified following a breach of unsecured protected health information

How We May Use and Disclose Medical Information About You

The following categories describe different ways that we use and disclose medical information about you:

• • We may use medical information about you to provide you with medical treatment or services
  • We may use and disclose medical information about your treatment and services to bill and collect from you, your insurance company or a third party payer.
  • We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
  • We may release medical information about you to a friend or family member, designated by you, who is involved in your medical care.  We may also give information to someone who helps pay for your care.
  • We will disclose medical information about you when required to do so by federal, state or local law.
  • We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

Special Situations

Military and Veterans:  If you are a member of the armed forces, we may release medical information about you as required by military command authorities.

Workers’ Compensation:  We may release medical information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness. Your written authorization to this release is required, however, if you do not consent to release of information, your workers’ compensation benefits may be denied and you will be responsible for the costs of your medical care.

Public Health Risks:  We may disclose medical information about you for public health activities.  These activities generally include the following:

• • To prevent or control disease, injury or disability
  • To report the abuse or neglect of children, elders and dependent adults
  • To report reactions to medications or problems with products
  • To notify people of recalls of products they may be using
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition

Lawsuits and Disputes:  If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order.  We may disclose medical information about you in response to a subpoena, discovery request or other lawful process.  We may release medical information if asked to do so by a law enforcement official;  In response to a court order, subpoena, warrant, summons or similar process;  To locate a suspect, fugitive, material witness or missing person.  Finally we may release medical information to a coroner or medical examiner.

Your Rights Regarding Medical Information About You

You have the following rights regarding medical information we maintain about you:

You have the right to inspect and copy medical information that may be used to make decisions about your care.

You have the right to amend your medical information if you believe the information we have about you is incorrect or incomplete, You must request in writing for an amendment to be added to your PHI.

You have the right to an accounting of disclosures.

You have the right to request restrictions or limitations on the medical information we use or disclose about you for treatment, payment or health care operations.

You have the right to request confidential communications and that we communicate with you about medical matters in a certain way or at a certain location.

You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

Changes to This Notice

We reserve the right to change this notice and the revised or changed notice will be effective for medical information we already have about you as well as any information we receive in the future.  The current notice will be posted in the office and will include the effective date.

Complaints

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 please contact Billie Orris, our Privacy Officer, at P.O. Box 1852, Cumming, Georgia   30028.

All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

Other Uses of Medical Information

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and we are required to retain our records of the care that we provided to you

Document effective date, May 1, 2013