HIPPA

HIPAA Notice of Privacy Practices

Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and subsequent Privacy Regulations, Dramatic Weight Loss of Atlanta, LLC is required to give you a copy of this Notice that describes our uses and disclosures of your medical information and your rights related to that information.

OUR PLEDGE

We understand that your medical information is personal and we are committed to protecting it.  This Notice applies to all of the records of your care generated by Dramatic Weight Loss of Atlanta, LLC:

• Make sure that your medical information is kept private;

• Give you this Notice of our legal duty

This notice describes how medical information about you may be used and disclosed and how you can get access to this information effective 10/2012. Please review it carefully.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, and healthcare operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected Health Information, or PHI, is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services.

Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operations of the physicians practice, and any other use required by law.

Treatment: We will only use and disclose your protected health information to provide, coordinate, or manage your health care and related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides you care to you, or provide it to a physician whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your protected health information will be used as needed to obtain payment for your health care services.

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. These activities include but are not limited to quality assessment, employee review, training of medical students, and licensing. For example, we may call you be name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointments. We may use or disclose your protected health information in the following situations without your authorization: as required by law, public health issues, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity, and national security. Under the law, we must also make disclosures to you, and when required by the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Georgia and federal law provide additional protection for certain types of medical information, including alcohol or drug abuse, mental health and AIDS/HIV.  These laws may limit whether and how we may disclose this medical information about you to others.

Other Permitted & Required Uses and Disclosures: Disclosures will be made only with your authorization or opportunity to object unless required by law. You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Individual Rights:

1. You have the right to inspect and receive a copy of your protected health information. Our practice will accept such requests in writing. Under federal law, however, you may not inspect or receive a copy of the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.

2. You have the right to request a restriction on the disclosure of your protected health information.  This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends whom may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that you may request. If a physician believes it is in your best interest to permit use and disclosure of our protected health information, your health information will not be restricted. You then have the right to use another healthcare professional.

3. Right to Amend: You have a right to amend the medical information we maintain about you if you believe it is incorrect or something is missing.  You must submit a request for amendment in writing and describe what you believe is in error.  We will respond to your request within 60 days.  We may deny your request to amend your medical record if the information was not created by us, if it is not part of the medical information we maintain about you, or if we determine that your medical information is correct.  If you do not agree with our denial, you may submit a statement of disagreement.

4. Right to Alternate Means of Communication: You have a right to request that we communicate with you about your medical information in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by e-mail.  We will accommodate all reasonable requests.

5. You have the right to obtain a paper copy of this notice: You have a right to receive a paper copy of this Notice even if you agreed to receive it electronically.  To obtain a paper copy of this Notice, contact the Privacy Officer at the information listed below.

6. You have the right to receive an accounting of certain disclosure we have made, if any, of your protected health information: We reserve the right to change the terms of this notice and will post any changes in our waiting areas. You then have the right to object as provided in this notice.

7. You have the right to complain: You may file any complaints with Dramatic Weight Loss of Atlanta, LLC at (770)394-9991, or with the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.

Privacy Officer: Mizette Turner

Address: 4480 North Shallowford Rd., Ste. 206, Dunwoody, GA 30338

Phone: 770-394-9991

Email: info@dramaticweightloss.com