Notice of Privacy Practice at Southern OB/GYN

Office Information

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.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act requires us to notify you of our legal duties and privacy practices with respect to your protected health information and gives you, the patient, significant new rights to understand and control how your health information is used.

According to HIPAA, we may use and disclose your protected health information without your written authorization for the following reasons:

Treatment including the provision, coordination, or management of health care and related services by one or more health care providers such as in the case of a referral to a specialist;
Payment including activities such as filing an insurance claim in order to obtain reimbursement for services, confirming insurance coverage, obtaining pre-authorizations, and billing and collection procedures; and
Health care operations including administrative, financial, legal, and quality improvement activities, such as a compliance audit, necessary to support and properly conduct treatment and payment activities.

We may contact you, by telephone or mail, to provide appointment reminders, test results, and/or treatment alternatives. You must notify us in advance if you do not wish for us to contact you for any reason.

Any other uses and disclosures, except as allowed or required by law, will be made only with your written authorization. You may revoke an authorization in writing, but such a revocation will not affect actions already taken by us based upon your prior authorization.

Examples of other uses and disclosures allowed or required by law which do not require a written authorization include:

To notify family or other individuals involved in your care of emergency or critical care situations.
For public health and safety purposes to prevent or control disease, injury, or disability threats.
To report suspected victims of abuse, neglect, or domestic violence.
For health oversight activities such as professional licensure and governmental program evaluation.
For judicial and administrative proceedings pursuant to a court order or subpoena.
For law enforcement purposes pursuant to due process.
To assist coroners, medical examiners, and funeral directors in the performance of their duties.
For organ donation purposes.
For research purposes pursuant to a board approved waiver of authorization and research protection policies.
For specialized governmental functions such as national security and intelligence activities.
To comply with workers' compensation requirements pursuant to a signed release.

You have the following rights with respect to your protected health information.

The right to request restrictions on certain uses and disclosures. However, we are not required to agree to such a request.
The right to reasonable requests to receive confidential communications of health information from us by alternative means or at alternative locations.
The right to inspect and/or receive a copy of your records for a reasonable fee.
The right to request a correction or amendment to your records.
The right to receive an accounting of disclosures of your health information.
The right to obtain a paper copy of this notice from us upon request.

For assistance with exercising any of these rights, you may contact the Privacy Officer at the address listed below.

This notice is effective as of April 14, 2003, but we reserve the right to change the terms of this notice in accordance with new/revised laws or office procedures and make the new notice effective for all protected health information that we maintain. We will abide by the terms of the notice currently in effect, and you may receive a copy of the current notice at any time upon request.

If you feel your privacy rights have been violated, you may file a formal, written complaint with our Privacy Officer and/or with the Department of Health&Human Services, Office of Civil Rights at the addresses listed below. We respect your right to file such a complaint and will not retaliate against you for doing so.

Privacy Officer

Southern OB/GYN
220 Northside Drive
Valdosta, GA 31602
(229) 241-2800

U.S. Department of Health & Human Services

Office of Civil Rights
61 Forsyth Street SW, Suite 3B70
Atlanta, GA 30303-8909
(404) 562-7886