Privacy Commitment

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.

OUR PRIVACY COMMITMENT

How This Medical Practice May Use or Disclose Your Health Information

This medical practice collects health information about you and stores it in an electronic 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. 

2.  Payment.  We use and disclose medical information about you to obtain payment for the services we provide.   

3.  Health Care Operations.  We may use and disclose medical information about you to operate this medical practice. 

4.  Appointment Reminders.  We may use and disclose medical information to contact and remind you about appointments. 

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 or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, in the event of your death.  We may also disclose information to someone who is involved with your care or helps pay for your care.  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. 

7.  Sale of Health Information. We will not sell your health information without your prior written authorization. 

8.  Required by Law.  As required by law, we will use and disclose your health information, but we will limit 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, and are sometimes required by law, to disclose your health information to public health authorities for purposes related to:  preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food & Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. 

10.  Health Oversight Activities.  We may, and are sometimes required by law, to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.

11.  Judicial and Administrative Proceedings.  We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. 

12.  Law Enforcement.  We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.

13.  Coroners.  We may, and are often required by law, to disclose your health information to coroners in connection with their investigations of deaths.

14.  Organ or Tissue Donation.  We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.

15.  Public Safety.  We may, and are sometimes required by law, to disclose your health information to appropriate

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.  Workers’ Compensation.  We may disclose your health information as necessary to comply with workers’ compensation laws.  We are also required by law to report cases of occupational injury or occupational illness to the employer or workers' compensation insurer.

18.  Change of Ownership.  In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.

19.  Breach Notification. In the case of a breach of unsecured protected health information.

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, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization.  If you do authorize this medical practice to use or disclose your health information for another purpose, 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 information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed

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. 

3.  Right to Inspect and Copy.  You have the right to inspect and copy your health information, with limited exceptions. 

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. 

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 18 of Section A of this Notice of Privacy.

6.  Right to a Paper or Electronic Copy of this Notice.  You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top 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.  Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect.  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, and a copy will be provided at each appointment.   We will post the current notice on our website at www.columbusoto.com

E.  Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer.  If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:   

Roosevelt Freeman, Regional Manager Office for Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
(800) 368-1019
or This email address is being protected from spambots. You need JavaScript enabled to view it.

The complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf.  You will not be penalized in any way for filing a complaint.