| NOTICE OF PRIVACY PRACTICES (NPP) This notice will tell you how we handle information about you. It tells how we use this information in the office, how we share it with other professionals and organizations and how you can see it. We want you to know all this so that you can make the best decisions for yourself and your family. We are also required to tell you about this because of the privacy regulations of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Because this law and the laws of Georgia are very complicated and we don’t want to make you read a lot that may not apply to you, we have simplified some parts. If you have any questions or want to know more about anything in this Notice, please read the complete Notice, available in the waiting room, or ask our privacy officer for more explanation or more details. What do we mean by your medical information? Each time you visit us, or any other health care provider, information is collected about you and your physical and mental health. It may include information about your past or present health or conditions, or treatment you received from us or others, or about payment for health care. The information we collect is known legally as Protected Health Information, or PHI. This information goes into your medical or health care record or a file at the office. In this office, PHI is likely to include - * Your history - which may include childhood, school, work, marital and personal information * Reasons you came for treatment - which may include problems, complaints, symptoms, needs, and goals * Diagnoses - diagnoses are the medical or psychological terms for your problems or symptoms. * Treatment Plan - these are the treatments and services that we think would best help you * Progress notes - Each time you come in, we write down how you are doing, what we observe about you and what you tell us * Records we get from others who treated you * Psychological test scores * Legal matters * Billing and insurance information This list is just to give you an idea – there may be other kinds of information that go into your health care record. We use this information for many purposes. For example: * To plan your care and treatment * To decide how well treatment is working for you * When talking to other health care professionals who are treating you, such as your family doctor or the professional who referred you to us * To document that you actually received the services for which you or your insurance company was billed. * To improve the way we do our job by measuring the results of our work. When you understand what is in your record and what it is used for, you can make better decisions about whom, when and why others should have this information. Although your health care record is the physical property of the doctor who collects the information, the information belongs to you. You can inspect it, read it or review it. If you want a copy, we can make one for you, but there will be a charge for copying and mailing (if you want it to be mailed). In some unusual situations, you cannot see all of what is in your records. If you find anything in your record that you think is incorrect, or something important is missing you can ask us to amend (add information) although in some rare situations, we do not have to agree to do that. Our privacy officer, whose name can be found at the end of this document, can explain exceptions. We will use the information that we get from you mainly to provide you with treatment, to arrange payment, or for some other business activities that are called health care operations. After you read this information, we will ask you to sign a Consent Form to let us use and share your information for very specific purposes described in our privacy practices. If you do not consent and sign this form, we cannot treat you. If we or you want to disclose (send, share, release) your information for any other purposes we will discuss this with you and ask you to sign an Authorization to allow this. Although we are committed to keeping your health information private, there are times when the law requires us to use or share it. For example, * When there is a serious threat to your health and safety or the health and safety of another individual or the public. We will only share information with a person or organization able to help prevent or reduce the threat. * Some lawsuits and legal or court proceedings. If your treatment or evaluation is court ordered, information will be shared with the court and the other parties. * For Workers Compensation, Social Security Disability Assessment and similar benefit programs Your Rights Regarding Your Health Information 1. You can ask us to communicate with your health and related issues in specified ways. For example, you can ask us to call you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask. 2. Other than the circumstance outlined in the NPP, we will not discuss your PHI unless we have an authorization. When we have an authorization to disclose information, you have the right to ask us to limit what we tell certain individuals involved in your care. While we do not have to agree to your request, if we do agree, we will keep our agreement except if it is against the law, or in an emergency or when the information is necessary to treat you. 3. You have the right to look at the health information we have about you, such as your medical and billing records. Psychotherapy notes may not be included. You can even have a copy of these records, but there may be a charge. Talk to your psychologist to arrange to see your records. 4. If you believe the information in your records is incorrect or incomplete, you can ask us to make some kinds of changes (called amending) to your health care information. You must include the reasons why you want to make the changes. You have to make this request in writing and send it to your psychologist. 5. You have a right to have a copy of this notice. If we change our policies, we will post the change in the waiting room, and you can get a copy from your psychologist. 6. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our Privacy Officer and/or with the US Secretary of the Department of Health and Human Services. All complaints must be filed in writing. If you have any questions regarding this notice or our health information privacy policies, please contact our Privacy Officer James S. Fitzgerald, PhD, who can be reached at 678 318 3468 ext. 101. The effective date of this notice is March 15, 2005 |