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 (“Notice”) applies to Acworth Outpatient Treatment and its staff, volunteers, and all other personnel. We are required by law to maintain the privacy of your Protected Health Information (“PHI”) and to provide you with this Notice of our legal duties and privacy practices concerning your PHI. We are committed to protecting the confidentiality of your health information, and we are required to follow the terms of this Notice.
This Notice is divided into three sections:
Understanding Your Health Information Rights: This section describes your rights regarding the PHI we maintain about you.
Our Responsibilities and Uses and Disclosures of Your Health Information: This section explains how we may use and disclose your PHI.
Special Protections for Substance Abuse Treatment Records: This section outlines the additional, highly confidential protections for your records related to substance abuse treatment, as mandated by federal and Georgia state laws.
1. Understanding Your Health Information Rights
You have the following rights regarding the PHI we maintain about you:
Right to Inspect and Copy Your Health Record: You have the right to inspect and receive a copy of your treatment and billing records. We may charge a reasonable fee for the costs of copying and mailing the record. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to your health information, you may be entitled to have that decision reviewed.
Right to Request a Restriction on Uses and Disclosures: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a restriction on the PHI we disclose to a family member, close friend, or any other person involved in your care or payment for your care. We are not required to agree to your request.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We must accommodate reasonable requests.
Right to Request an Amendment: If you believe that any medical information we have about you is incorrect or incomplete, you may ask us to amend it. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.
Right to an Accounting of Disclosures: You have the right to request a list of the times we have shared your health information for the last six years, including who we shared it with and why.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice. You may ask us for a copy at any time.
2. Our Responsibilities and Uses and Disclosures of Your Health Information
We are required by law to protect the privacy of your PHI. We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
How We May Use and Disclose Your PHI:
For Treatment: We may use your PHI to provide, coordinate, and manage your substance abuse treatment and other medical services.
For Payment: We may use and disclose your PHI to bill and collect payment from you, an insurance company, or a third party for the services we provide.
For Health Care Operations: We may use and disclose your PHI for our internal operations, such as quality assessment, improvement activities, and administrative purposes.
Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment or a need to schedule one.
Disclosures Required by Law: We may disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose information to law enforcement or in response to a court order.
3. Special Protections for Substance Abuse Treatment Records
Federal law, specifically 42 CFR Part 2, and Georgia state law provide special protections for your records relating to substance abuse treatment. We cannot disclose these records without your specific written consent, except in narrowly limited circumstances.
Written Consent Required: In most cases, we cannot share your treatment information for purposes such as payment or communicating with your other medical providers without your explicit written consent. Your written consent must specify the scope, purpose, and timeframe of the disclosure.
Revoking Consent: You have the right to revoke your written consent to disclose information at any time.
Limited Exceptions to Consent: Under 42 CFR Part 2, we are permitted to disclose your treatment information without your consent in only a few specific situations, such as:
To our staff or entities under our administrative control.
To a qualified service organization that agrees to maintain the confidentiality of the information.
To outside auditors, regulatory agencies, or for certain research purposes.
In a life-threatening medical emergency.
To report a crime on our premises or against our personnel.
When required by a valid court order that contains specific findings.
For more information about your rights under 42 CFR Part 2, please ask for our full policy.
Our Contact Information: If you have questions about this Notice, please contact us at:
