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 describes RBA’s privacy practices, as well as the privacy practices of:
- Any health care professional authorized to enter information into your chart;
- All departments and units of RBA;
- Any member of a volunteer group that RBA allows to help you while you are receiving treatment at RBA;
- All employees, staff, and personnel of RBA; and
- Southeastern Fertility Institute; Southeastern Surgical Associates; and Southeastern Endocrine Labs. These entities, sites, and locations follow the terms of this Notice. In addition, these entities, sites, and locations may share medical information with one another for treatment, payment, or health care operations (which are explained below).
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at RBA. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by RBA. This Notice explains the ways in which we may use and disclose medical information about you. The Notice also describes your rights and certain obligations we have regarding the use and disclosure of medical information.
Federal law requires us to:
Make sure that medical information that identifies you is kept private;
Give you this Notice of our legal duties and privacy practices with respect to medical information about you;
Follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
For the purposes that brought you to RBA
- For Treatment. Doctors, nurses, technicians, or other health care professionals who are involved in taking care of you may use and disclose your medical information to take care of you. For example, your doctor might use your name, age, possible diagnosis, and other information required to obtain laboratory testing.
- Appointment Reminders. RBA may use your medical information to remind you of an appointment for treatment or medical care at RBA.
- Treatment Alternatives. RBA may use your medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. RBA may use your medical information to tell you about other RBA health-related benefits or services.
- For Payment. We may use and disclose medical information to bill for your care. For example, we may inform your health plan about a treatment you are going to receive to obtain prior approval.
- For Health Care Operations. We may use and disclose medical information about you for RBA operations. These uses and disclosures are necessary to operate RBA and make sure that you receive quality care. For example, we may use your medical information to evaluate the performance of our staff in caring for you.
We understand that you came to RBA for a reason, most likely a reason that will entail the evaluation of and possible treatment for a medical condition. We may therefore use or disclose your medical information to carry out tasks involved in your evaluation and treatment, payment for the services rendered to you, and our own operational purposes, as follows:
With Your Authorization
We may use or disclose your medical information for purposes other than treatment, payment, or health care operations only when: 1) you sign an Authorization form, or 2) there are special circumstances as described below in section C. You may revoke your written Authorization at any time, except to the extent that RBA has already relied on the Authorization.. If you decide to revoke, you should complete an RBA Authorization Revocation Form and submit it to RBA. Your revocation will become effective upon its receipt by us.
- Special Circumstances – Without Your Consent or Authorization
- Individuals Involved in Your Care or Payment for Care. We may release medical information about you to a friend or family member who is involved in your medical care. If you are present or coherent, we can disclose your medical information to family and friends when you agree or do not object or we can reasonably infer that you agree. If you are not present or you are incapacitated, we can disclose certain medical information to family and friends when we determine that the disclosure would be in your best interests.
- Threat to Health or Safety. We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Public Health Activities. We may disclose medical information about you for public health activities to federal and state authorities. These activities generally include the following:
- Disclosures to public health authorities to prevent or control disease, injury or disability;
- Disclosures to report reactions to medications or problems with products to the U.S. Food and Drug Administration
- Disclosures to notify individuals of recalls of products they may be using;
- Disclosures to individuals who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- Disclosures as permitted under Georgia law if we reasonably believe that you are a victim of abuse, neglect or domestic violence.
- Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, we might compare the procedures and outcomes from your treatment to the procedures and outcomes for other patients. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, to balance the research needs with patients? need for privacy. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may, however, disclose medical information about you to people preparing to conduct a research project?for example, to help them look for patients with specific medical needs?so long as the medical information they review does not leave RBA. We will almost always ask for your specific permission if the researcher requests access to your name, address or other information that reveals who you are, or will be involved in your care at RBA.
- Health Oversight Activities. We may disclose your medical information to a government agency as required by law for activities such as audits, investigations, inspections, and licensure.
- Lawsuits. If you are involved in a lawsuit or dispute, we may disclose your medical information in response to a court or administrative order. We may also disclose your medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested
- Law Enforcement. We may release your medical information if asked to do so by a law enforcement official:
- Coroners, Medical Examiners and Funeral Directors. We may release your medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of RBA to funeral directors as necessary to carry out their duties.
- Specialized Government Functions. We may release your medical information to authorized units of the government with special functions, such as the U.S. military or the U.S. Department of State
- Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- As Required By Law. We will disclose medical information about you when required to do so by applicable federal, state or local law.
There are special circumstances when we are permitted to use or disclose your medical information without your Authorization. The following explains what these special circumstances are.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding your medical information that we maintain:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you should request an Access Form and submit a completed Access Form to RBA. Specific requirements for access to your medical information are described in the access form.
Right to Amend. If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend your medical information. If you want to amend your information, you must obtain an Amendment Form from and submit a completed Amendment Form to RBA. Specific requirements for amending your medical information are described in the amendment form.
Right to an Accounting of Disclosures. You have the right to request an ?accounting of disclosures.? This is a list of the disclosures we made of your medical information. To request this accounting of disclosures, you should request an RBA Accounting Form and submit a completed Accounting Form to RBA. Specific requirements for an accounting of disclosures are described in the accounting form.
Right to Request Restrictions. 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 limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care. To request restrictions, you should request a Restrictions Form submit the completed form to RBA. Specific information about the right to request restrictions is included in the form.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to RBA. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, www.sfi-online.com. To obtain a paper copy of this notice, please contact RBA.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice, and to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future, as of the effective date of the revised Notice. We will post a copy of the current Notice on our Internet site. In addition, each time you register at or are admitted to RBA for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with RBA or with the Secretary of the Department of Health and Human Services. To file a complaint with us contact our Privacy Officer, Donna Ayers, at the address and telephone number listed below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this Notice will be made only with your written authorization.
FURTHER INFORMATION
For further information, you may contact:
Donna Ayers
Regional COO
Reproductive Biology Associates
1100 Johnson Ferry Road NE
Building 2, Suite 200
Atlanta, GA 30342
Office: 404.459.3472
Fax: 404.256.9497
[email protected]