Notice of Health Information Privacy Practices
At North Georgia Diabetes and Endocrinology we are dedicated to maintain your privacy. Maintaining and protecting the confidentiality of your personal health information is also required by law. This notice explains how your medical information may be used and disclosed and how you can get access to this information. Please review this document before signing.
Uses and Disclosures:
Each time you visit our practice we keep record of your visit. This information is often referred to as your medical record. The following circumstances may require us to use or disclose your health information:
- Basis for planning and providing your care and treatment
- To public health authorities and health oversight agencies who are authorized by law to collect information
- Means of communication among the many health professionals who contribute to your care
- Lawsuits or similar proceedings in response to court or administrative order
- Means by which you or a third-party payer can verify that services billed were actually provided
- If required to do so by a law enforcement provider
- To Federal officials for intelligence and national security activities authorized by law
- To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
- If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
- For Workers Compensation and similar programs
- In order to conduct business of the practice between you (the patient) and your provider, including telephone communication for appointment reminders, information about treatment alternatives or other health-related benefits and services.
Although your health information is the physical property of North Georgia Diabetes and Endocrinology, this information belongs to you. The following is a list of your health information rights:
- You have the right to request and obtain a copy of your health information, including patient health information and billing records as provided by 45 CFR164.524. Please submit your request in writing to North Georgia Diabetes and Endocrinology: Medical Records. There may be a charge for copying medical records.
- You have the right to request in writing a restriction in our use or disclosure of your health information for treatment, payment, or health care operations as provided by 45 CFR 164.522 . Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. We will have 30 days to respond to your request.
- You can request that our practice communicate with you about your health information and related issues in a particular manner or at a certain location. For example, if you would like to called on your cell phone or at work. We will do our best to accommodate reasonable request.
- You have the right to a copy of this notice. You are entitled to receive a copy of this Notice of Privacy Practices. You may request us to give you a copy of this Notice at any time. This Notice is also available on our website at northgeorgiaendocrine.com.
- You have the right to request an amendment of your health information if you believe it is incorrect or incomplete, and as long as the information is kept by or for our practice as provided in 45 CFR 164.528.. To request an amendment, please submit a written request to North Georgia Diabetes and Endocrinology: Medical Records.
- You have the right to receive an accounting of the disclosures of your health information made by our practice up to 6 years prior to the date on which the accounting is requested, except for the disclosures denotes in 45 CFR 164.528.
- You have the right to revoke your authorization to use or disclose health information except to the extent that action has already been taken.
North Georgia Diabetes and Endocrinology is required by law to maintain the privacy of your personal health information and uphold privacy practices with respect to your personal health information. We are required to abide by the terms set forth in this Notice currently in effect.
Additionally this organization is required to:
- Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable request you may have with regards to communicating health information by alternative means or location
- Notify you of a breach of “unsecured” protected health information
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.
Questions or Complaints:
If you have questions or if you would like additional information, you may contact North Georgia Diabetes and Endocrinology at (770) 886-3842.
If you believe your privacy rights have been violated, you have the right to file a complaint with our office or with the secretary of Health and Human Services. You will not be penalized for filing a complaint. To file a complaint with our practice, please submit your concerns in writing.
North Georgia Diabetes and Endocrinology
1505 Northside Boulevard, Suite 2800
Cumming, GA 30041