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Department of Client Services
Notice of Privacy PracticesEffective Date - April 14, 2003
This notice describes how medical information about you may be used and disclosed, as well as how you can obtain access to this information. Please review it carefully.
This notice describes our practices and that of:
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 from us. We need the record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by us.
This notice describes how 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:
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy your medical/case management information, submit a written request to your Case Manager. If you request a copy of the information, you will be charged a fee for the costs of copying, mailing and other supplies associated with your request.
Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to the Clinic Manager. You must also provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition we may deny your request if you ask us to amend information that:
Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures". This is a list of disclosures we made of medical information about you to others, except for purposes of treatment, payment and operations.
You must submit your request in writing to your Case Manager: Your request should state the time period, which may not be longer than 6 years and may not include dates before April 14, 2003. The first list within a 12-month period will be free. For additional lists, we may charge you for the costs involved.
Right to Request Restrictions: You have the right to request restrictions or limitations on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request: If we do agree, we will comply with your request unless the information is needed to provide necessary emergency care.
To request restrictions; submit your request in writing to your Case Manager. The request must state: a) what information you want to limit; b) whether you want to limit our use, disclosure or both; and, c) to whom you want the limits to apply.
Right to Request Confidential Communications: You have a right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
Requests must be made to the Case Manager in writing: We will accommodate all reasonable requests. Your request must specify how and where you wish to be contacted.
Right to a Paper Copy of this Notice: You have the right to a paper copy of this privacy notice. You may request a copy from any member of our staff at any time.
Except for situations later discussed in this notice, we will use and disclose your medical information, only with your written authorization. If you authorize us to use or disclose your medical information, you may revoke your authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for reasons covered in your written authorization.
You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care we provided you.
The following categories describe different ways that we may use and disclose medical information without your authorization:
For Treatment: We may use medical information about you to provide you with case management services and treatment planning. We may disclose your information to doctors, nurses, nurse practitioners, case managers, residents and medical students, clergy and others who are involved in your care. We may share medical information about you in order to coordinate the different things you need, for example, housing, social service needs, or medical services. We also disclose medical information about you to others in the community who may be involved in your medical care, including other support services organizations.
For Payment: We may use or disclose medical information about you so that the case management services you receive may be billed to and payment may be collected from you, and insurance company or a third party. We may also tell your plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations: We may use and disclose your medical information for everyday operations. These uses and disclosures are necessary to provide case management services and make sure that all of our clients receive quality care. We may disclose your information to doctors, nurses, nurse practitioners, case managers, case manager supervisors, residents and medical students, and other DCS personnel for review and learning purposes. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff. We may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your case manager. We may also call you by name in the waiting room when the DCS staff is ready to see you.
Business Associates: There are some services provided to our organization through contracts with business associates. Examples include physician services, and certain social and support services. When these services are contracted, we disclose your medical information to our business associates so that they can perform the job we asked them to do, and bill you or your third party payer for services rendered. To protect your health information, we require the business associates to appropriately safeguard your information.
Treatment Alternatives: We 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: We may use and disclose medical information to tell you about health-related benefits, services or medical education classes that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a caregiver who may be a friend or family member. We may also give information to someone who helps pay for your care, including federal and state grantors.
Research: Under certain circumstances, we may use and disclose your medical information for research purposes. All research projects are subject to approval by an Institutional Review Board. To participate in a given research project, we must obtain your authorization.
As Required by Law: We will disclose medical information about you when required to do so by federal, state or local law. You will be notified, if required by law, of any such uses or disclosures.
Military: If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
Worker's Compensation: We may release your medical information for worker's compensation or similar legally established programs.
Public Health Risks: We may disclose medical information about you for public health activities. We may use and disclose medical information about you to agencies when necessary to prevent serious threat to your health and the safety of the public or another person. These activities generally include the following:
Health Oversight Activities: We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
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 order or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
We reserve the right to change this notice: We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice throughout the facility. The notice will contain on the first page, the effective date.
If you believe that your privacy rights have been violated, you may call our CQI & Compliance Office (404-870-7780) or submit your complaint in writing to our CQI & Compliance Office, 1605 Peachtree Street, Atlanta, Georgia 30309.
If we cannot resolve your concern, you also have the right to file a written complaint with the Office of the Secretary of the Department of Health and Human Services, Region IV, Atlanta Federal Center, 61 Forsyth Street, S.W., Suite 5B95, Atlanta, Georgia 30303-8909.
The quality of your care will not be jeopardized nor will you be penalized for filing a complaint
We welcome the opportunity to answer additional questions you may have about this notice. You may call us at 404-870-7780 or write us at the CQI &Compliance Office, 1605 Peachtree Street, Georgia 30309. To write the Department of Client Services you may do so at:
General Information: (404) 870-7700Testing: (800) 551-2728Volunteer: (404) 870-7764Comment Line: (678) 999-1212(Anonymous)
1605 Peachtree Street NE, Atlanta, GA 30309-2955(404) 870-7700TTY/Voice: (404) 870-7801
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