SURGICAL ASSOCIATES
of Warner Robins, P.C.

NOTICE OF PRIVACY PRACTICES

 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, be treated confidentially. This Act gives you, the patient, significant rights to control how your health information is used.

As required by law, we have prepared this explanation of how we are tasked with maintaining the privacy of your Personal Health Information (PHI) and how we may use and disclose your information. PHI is information about you, including demographic information that may identify you and that relates to your past, present, or future health or condition and related healthcare services.

We may use and disclose your medical records only for each of the following purposes: treatment, payment and healthcare operations.

• Treatment means providing, coordinating, or managing healthcare and related services by one or more healthcare providers. An example of this would include sending information to another physician who is involved in your care.
• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
• Healthcare operations include the business aspects of running our practice. Examples of this are conducting quality assessment and improvement activities, auditing functions, cost-management analysis, the training of medical students, and utilization of transcription or billing services. Business associates occasionally provide services to our organization, i.e., physician services for laboratory, radiology, emergency services, etc., that may require disclosure of your PHI. To ensure your privacy, these associates are required to appropriately safeguard your information.

We may contact you to provide appointment reminders or follow-up visits for diagnostic studies, i.e., annual mammography, etc.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified to you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
• The right to inspect and copy your protected health information.
• The right to amend your protected health information.
• The right to receive an accounting of disclosures of protected health information.
• The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

This notice is effective as of February 1, 2003, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of the Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a written complaint with our office or with the Secretary of Health & Human Services about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.

Effective 02/01/03