HIPAA NOTICE OF PRIVACY PRACTICES
Joseph M. Still Burn Centers, Inc.
3675 J. Dewey Gray Circle, Suite 300
Augusta, GA 30909
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.
This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. “Protected health information” 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 health care services.
Rights of the Patient
Obtaining information: When it comes to your health information, you have certain rights. You may obtain a paper copy of this privacy notice promptly at any time, even if you agreed to receive the notice electronically. You can ask to see or get an electronic or paper copy of your medical record and other PHI we have about you. We will provide a copy or summary of your PHI, usually within 30 days of your request. We may charge a reasonable, cost-based fee. You can request a specific method you wish to be contacted about your PHI to insure confidential communications, such as home or office phone, or to send mail to a different address. We will agree with all reasonable requests. If you believe there is PHI that is incorrect or incomplete, you can request a correction. We may say “no” to your request, but will explain why in writing within 60 days.
Withholding/Sharing of Information: You can ask for certain PHI for treatment, payment, or our operations to not be shared. We are not required to agree to your request, and may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket, you can ask us not to share that information for payment purposes or our operations with your health insurer. We will agree unless a law requires us to share that information. You can request a list of the times we’ve shared your PHI for six years prior to the date you ask, including whom we shared it with and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures. We will provide one accounting year for free but will charge a reasonable, cost-based fee if another is requested with a 12-month time period.
You can choose to have information shared with family, close friends, or others involved in your care, in the event of a disaster relief situation, to include information in a hospital directory, or in contacting you for fundraising efforts. If you are unable to tell us your preferences, for example if you are unconscious, we may go ahead and share your PHI if we believe it is in your best interest. We never share your PHI without your written consent in regards to marketing purposes, sale of information, or most sharing of psychotherapy notes.
Assigning power of attorney: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI. We will make sure the person has this authority and can act for you before we take any action.
Filing a complaint: If you feel your rights have been violated, a complaint can be filed by contacting us or by filing a complaint with the U.S. Department of Health and Human Services office for Civil Rights. They may be reached through the mail at 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or online at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
Uses and Disclosures of Protected Health Information
Treatment and public health: We can share your PHI in certain situations regarding your treatment or public health. These may include sharing with other professionals who are treating you, preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, or preventing a serious threat to anyone’s health or safety.
Payment: We can use and share your PHI to bill and get payment from health plans or other entities, such as giving information to your health insurance plan so it will pay for your services.
Organizations: We can use and share your health information to run our practice, improve your care, and contact you when necessary. When an individual dies, we can share PHI with a coroner, medical examiner, or funeral director. We can also share PHI for communications between other administrations such as organ procurement organizations, health research, workers’ compensation claims, law enforcement purposes, health oversight agencies, or special government functions such as military, national security, and presidential protective services. We can also disclose PHI in response to a court or administrative order or subpoena or when state or federal law requires it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Our responsibilities: We are required by law to maintain the privacy and security of your PHI. We will inform you promptly if a breach occurs that may have compromised the privacy or security of your PHI. We will not use or share your PHI other than as described here unless you give permission in writing. If you tell us we can, you can change your mind at any time. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site www.jmsbc.org.
Effective date of this notice: September 1, 2013
This Notice of Privacy Practices applies to the following organizations:
Joseph M. Still Burn Centers, Inc.
Joseph M. Still Burn and Reconstructive Center
Director of Human Resources:
Susan Zachow, CMOM
706-863-9595 ext 7338