of Privacy Practices
This Notice of Privacy Practices ("Notice") presents the
information that Federal law requires us to give our patients regarding our
must provide this Notice to each patient beginning no later than the date of our
first service delivery to the patient, including service delivered
electronically, after July 1st, 2005. We must make a good faith attempt to
obtain written acknowledgment of receipt of the Notice from the patient. We must
also have the Notice available at the office for patients to request to take
with them. We must post the Notice in our office in a clear and prominent
location where it is reasonable to expect any patients seeking service from us
to be able to read the Notice. Whenever the Notice is revised, we must make the
Notice available upon request on or after the effective date of the revision in
a manner consistent with the above instructions. Thereafter, we must distribute
the Notice to each new patient at the time of service delivery and to any person
requesting a Notice. We must also post the revised Notice in our office as
are required to provide you with this Notice pursuant to the privacy regulations
implementing the Health Insurance Portability and Accountability Act of 1996
("HIPAA") ("Privacy Rules").
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
PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
are required by law to maintain the privacy of your health information. We are
also required to give you this Notice about our privacy practices, our legal
obligations, and your rights concerning your health information. We must follow
the privacy practices that are described in this Notice while it is in effect.
This Notice takes effect July 1st, 2005, and will remain in effect until we
reserve the right to change our privacy practices and the terms of this Notice
at any time, provided such changes are permitted by applicable law. We reserve
the right to make the changes in our privacy practices and the new terms of our
Notice effective for all health information that we maintain, including health
information we created or received before we made the changes. Before we make a
significant change in our privacy practices, we will change this Notice and make
the new Notice available to you when you first receive services from us after
the date the revised Notice becomes effective or upon request.
may request a copy of our Notice at any time. For more information about our
privacy practices, or for additional copies of this Notice, please contact us
using the information listed at the end of this Notice.
AND DISCLOSURES OF HEALTH INFORMATION
use and disclose health information about you for our treatment, payment, and
health care operations. For example:
We may use or disclose your health information to a physician or other health
care provider providing treatment to you.
We may use or disclose your health information to your health insurer to obtain
payment for services we provide to you.
We may use and disclose your health information in connection with our health
care operations. Health care operations include quality assessment and
improvement activities, reviewing the competence or qualifications of health
care professionals, evaluating practitioner and provider performance, conducting
training programs, accreditation, certification, licensing or credentialing
activities. For example, we may use or disclose your health information in order
to conduct an internal assessment of the quality of care we provide.
Involved In Care:
We may use or disclose health information to notify, or assist in the
notification of (including identifying or locating) a family member, your
personal representative or another person responsible for your care, to the
extent necessary to help with your health care or with payment of your health
care, if you agree that we may do so. We may also advise these persons of your
location, your general condition, or death. If you are present, then prior to
use or disclosure of your health information, we will provide you with an
opportunity to object to such uses or disclosures. In the event of your
incapacity or emergency circumstances, we will disclose health information based
on a determination using our professional judgment disclosing only health
information that is directly relevant to the person's involvement in your health
care. We will also use our professional judgment and our experience with common
practice to make reasonable inferences of your best interest in allowing a
person to pick up filled prescriptions, medical supplies, x-rays, or other
similar forms of health information.
Permitted or Required by Law:
We are permitted and in some cases required by law to make certain other
disclosure of health information without your consent.
We may disclose your health information, if appropriate, to the following
entities under the following circumstances:
to public health agencies to satisfy certain reporting requirements, such
as births and deaths, certain communicable diseases, child abuse and other
public health issues;
to health oversight agencies such as governmental auditors, and other
agencies when required;
to any individual when we are ordered by a court or other legal process
to do so;
to law enforcement officials when necessary for law enforcement purposes
and required by law;
to a coroner or medical examiner when necessary to enable them to perform
to organ procurement organizations, to enable them to make suitability
in cases of emergency; or
to researchers if their research has been approved by an institutional
review board and they take certain steps to protect your privacy.
We may use or disclose your health information to provide you with appointment
reminders (such as voicemail messages, postcards, or letters) or information
about treatment alternatives or other health-related benefits and services that
may be of interest to you.
We will not use your health information for marketing communications without
your written authorization.
Other uses and disclosures of your health information will be made if you give
us written authorization to do so. If you give us an authorization, you may
revoke it in writing at any time. Your revocation will not affect any use or
disclosures permitted by your authorization while it was in effect. Unless you
give us a written authorization, we cannot use or disclose your health
information for any reason except those described in this Notice.
have certain rights regarding your health information. These rights include:
the right to obtain a paper copy of this Notice;
the right to inspect and copy your health information (copies are
available for a reasonable fee);
the right to request amendments to your health information you believe to
the right to obtain an accounting of our uses and disclosures of your
health information, subject to certain exceptions;
the right to request restrictions on our permitted uses and disclosures
of your information (although we are not legally obligated to honor this
the right to request that communications regarding your health
information be sent by alternative means or at alternative locations.
you want more information about our privacy practices or have questions or
concerns, please contact us. If you are concerned that we may have violated your
privacy rights or wish to exercise any of your rights described herein, please
contact us using the contact information listed at the end of this Notice. You
also may submit a written complaint to the U.S. Department of Health and Human
Services. We will provide you with the address to file your complaint with the
U.S. Department of Health and Human Services upon request. We support your right
to the privacy of your health information. We will not retaliate in any way if
you choose to file a complaint with us or with the U.S. Department of Health and
Officer: Lirong Zhang, Compliance and Safety Manager
Telephone: 770-814-2212 Fax:
4317 Abbotts Bridge Road, Suite 4
Duluth GA 30097