Notice of Privacy Practices for the Assisted Recovery Center of Georgia, Effective Date: <DATE> -- Last Updated: <DATE>
This notice describes how information about you may be used and disclosed and how you can access it. Please review the following information carefully.
How We May Use and Disclose Information About You
The following describes different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following categories.
We may use medical information about you for the purpose of providing medical treatment or services to doctors, nurses, technicians, medical students, volunteers, or other personnel involved in your care at the Assisted Recovery Center of Georgia (ARC of GA). We may also disclose your medical information to people outside of the ARC of GA who may be involved in your care such as friends, family members, if you have indicated that you would like these people to be informed of your care, or employees or medical staff members of any hospital or nursing facility if you are transferred or admitted to the facility for care.
We may disclose medical information about you so that the treatment and services at the ARC of GA may be billed by the ARC of GA and payment collected from you, an insurance company or a third party. We may also disclose your medical information to another health care provider for payment of services you may have received at another medical facility. However, you may request that we not disclose your medical information to any person or entities responsible for paying any portion of the charges you incur as a patient of the ARC of GA provided that you pay all charges in full at the time of the request.
Health-Related Benefits and Services
You will not receive any marketing or advertising communications from us unless you indicate in your signed (or acknowledged) Notice of Privacy Practices that you wish to receive such communications. If you indicate that you would like to receive such communications, we may use and disclose your medical information to inform you of benefits or services that may interest you. The website owned by ARC of GA will send cookies to the device you are using. These are used for purposes including the storage of user preferences, along with the optimization of search results and ad selection. If at any time you decide that you no longer wish to receive such communications, you may elect not to receive further marketing or advertising communications by contacting the number provided or by notifying the ARC of GA’s Privacy Office in writing.
In the following special situations, we may release your medical information: organ and tissue donation, active duty military personnel and veterans, worker’s compensation, public health activities, health oversight activities, lawsuits and disputes, law enforcement, coroners and medical examiners, national security and intelligence activities, protective services for the President and others, inmates, and research, public health threat and safety of others, disaster relief efforts.
Your Rights Regarding Your Medical Information
Our Obligation to You
(1) To make sure that medical information that identifies you is kept private; (2) To notify you regarding our legal duties, your legal rights, and our privacy practices at the ARC of GA; (3) To abide by these terms of notice. You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy
You have a right to inspect and receive a copy of your medical record. If your request is denied you may request that the denial be reviewed, and that decision will be final. You may be charged a fee for the costs associated with copying, mailing, or other supplies associated with the request. If all or any portion of your health information in an electronic format, you may request an electronic copy.
Right to Amend
If you feel that the medical information about you in your record is incorrect or incomplete, you may ask us to amend it. To request an amendment, your request must be made in writing and submitted to the ARC of GA’s Health Information Management department. If your request is denied, you may submit in writing a statement of disagreement and ask that it be included in your medical record.
Right to an Accounting of Disclosures
You have a right to request a list of certain disclosures that we have made regarding your medical information. Submit your request in writing to the ARC of GA’s Privacy Office.
Right to Request Restrictions
You have a right to request a restriction or limitation on the medical information we use or disclose about you, except where disclosure of the information is required by law. To request restrictions, you must make your request in writing to the ARC of GA’s Privacy Office. We are not required to agree to your request. If we do agree, we will comply with your request except where the information is needed to provide you with emergency treatment.
Right to Request Confidential Communications
You have a right to request that we communicate with you about medical matters in a certain way and at a certain location. To request confidential communications, make your request at the time of registration or during your visit.
Right to this Notice
You have a right to a paper copy and may request it at the time of service or by contacting the ARC of GA’s Privacy Office.
Changes to this Notice
We reserve the right to change this notice. We will post a copy of the current notice. The notice will contain the effective date in the top right corner. If the notice changes, a copy will be available to you upon your request.
Investigation of PHI Breach
If we determine that the disclosure of your medical information constitutes a breach of the federal privacy or security regulations governing unsecured protected health information, we will (1) Provide a notice of the breach, (2) Advise you of what we plan to do to mitigate the damage (if any) caused by the breach and (3) Advise on steps you should take to protect yourself from potential harm from the breach.
Sale of Health Information
We will not sell your health information unless you have authorized us to do so in your signed Notice of Privacy Practices.
If you would like more information, contact the ARC of GA’s Privacy Office at 912-352-2425.
If you believe your privacy rights have been violated, you may file a complaint with the ARC of GA or with the Secretary of the United States Department of Health and Human Services. To file a complaint with the ARC of GA, contact the ARC of GA’s Privacy Office by mail at 308 Commercial Drive, Savannah, Georgia 31406, or call 912-352-2425. You will not be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosure of medical information not covered by this notice may be made in accordance with your written permission or as required by law. If you provide us with permission to use or disclose your medical information, you may revoke that permission at any time. To revoke your permission, you must provide your request in writing to the ARC of GA’s Privacy Office.
Our Promise to You
· We will always strive to understand patient needs and requirements and take all reasonable actions necessary to enable ARC of GA to provide high quality services.
· We will treat every patient with dignity, respect and compassion. We will demonstrate sensitivity and responsiveness to patients’ needs by listening attentively and patiently to their comments and concerns.
· We will endeavor to engage the services of only clinicians with proper credentials, experience and expertise in meeting the needs of our patients.
· We will screen our medical professionals against duly authorized licensing and disciplinary authorities for any sanctions of performance or conduct.
· We recognize the rights of patients to receive appropriate and quality care without discrimination due to race, creed, religion, gender, national origin, disability, age, or ability to pay.
· We will strive at all times to provide medical services to patients which are safe, and which comply with all applicable laws, regulations and professional standards.
· We will take reasonable steps to ensure the safety and security of patients, visitors and employees.
· We will respect and continuously strive to protect the confidentiality of all patient information, particularly patient medical records, as required by law.