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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.

1. Our pledge regarding protecting your medical information:
The privacy of your medical information is extremely important to us. At the South Jersey Women’s Center, we have always taken extreme effort to protect patient confidentiality. However, a recent federal law (HIPPAA) now requires that all medical providers take similar measures and adopt privacy policies that will assure that your medical information is never inappropriately released. The following information describes how our office is complying with the law.

2. Our legal duty:
Our office is required to keep your medical records and all medical information private. We are required to provide you this notice, which describes our legal duties, our privacy practices, and your rights regarding your medical information. We do have the right to make changes to our privacy policy, as long as we continue to comply with the law. Any changes to our privacy policy, however, will be changed in this notice as well.

3. Use and disclosure of medical information:
The following section describes different ways that we may use and disclose information. Whenever it is necessary to disclose information, we will only disclose the absolute minimum information necessary for that purpose. Many of the situations listed below are extremely unusual. However, the law requires that we inform you of any and all possible ways that your health information might be used or disclosed, even the rarest situations.

We will not disclose your information for any purpose not listed below, unless you give us specific and written permission to do so.

• Using and disclosing information to provide medical treatment: We may use medical information about you in order to provide medical treatment or services to you. We may disclose information about you to doctors, nurses, and other staff that are directly involved in taking care of you, in order that they can provide proper care to you.

• Using and disclosing information to obtain payment: We may need to use and disclose information about you in order to receive payment for services that we’ve rendered to you. For example, we may need to provide information about your condition and treatment to you health insurance company in order for them to pay us, or to reimburse you for any care you’ve received. We may also need to tell your health plan, in advance, of any upcoming care in order to obtain any required pre-authorization or to determine if your plan will covered a planned procedure.

• Using and disclosing information to perform health care operation: We may use or disclose your information in order to perform various internal health care operations, which may include employees performance evaluations and employee training programs. If your information is being used for any such internal health care operation, only employees of the Center would have access to your information. Occasionally, insurance companies will require, as part of their physician credentialing, an audit of selected charts from their own patients covered by their insurance plan. In this case, we are required to release information to the insurance company, but we will release only the minimum information as required by law. Insurance companies are bound by the same federal privacy laws as we are, so they are required to protect the information released to them as well.

• Additional uses and disclosures:

• Notification: In the case of an emergency, we may be required to provide information about your general condition and location to a family member, or another person responsible for your care. If you are present, we will get your permission. In the case of an emergency where you are not present or cannot give consent, we will release only the health information that is directly necessary for your health care, according to our professional judgement.

• Court Orders and Judicial and Administrative Proceedings: We may be required to disclose medical information in response to a court order, subpoena, discovery request, or other lawful process, under certain circumstances. We may share limited information with law enforcement officials concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share the medical information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

• Public Health Activities: In some circumstances, we are required by law to disclose medical information to the public health department regarding a patient’s state of health. Instances that require notification include the diagnosis by the Center of certain communicable diseases, and certain non-communicable diseases. We may also be required to disclose your medical information to personnel of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems, or for the purpose of enabling a drug or product recall.

• Abuse or Neglect: We may be required by law to report to the appropriate authorities if we reasonably believe that you are a possible victim of abuse or neglect or a possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or to protect the health and safety of others. We may also be required to share medical information to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from custody.

• Law Enforcement: We may be required by law to report health information to law enforcement officials. These circumstances include reporting as required by a court order, reporting of abuse or neglect or certain other wounds, reporting information regarding an individuals identification or location, reporting suspected victims of crimes, reporting death and crimes on our premises.

4. Your Individual Rights:
You have the right to view or obtain copies of your medical records. All requests must be made in writing. If you request copies of your records, there may be a fee for copy services, however, that fee will not exceed the maximum fee allowed by law.

You have the right to receive a list of all the times that we or our business associates have shared your medical information for purposes other that treatment, payment, or health care operations.

You have the right to request, in writing, that we place additional restrictions on our use or disclosure of you medical information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement, except in the case of an emergency.

You have the right to request that we communicate with you about your medical information by different means, for example, by phone or by mail, or to different locations, for example to a different mailing address.

You have the right to request that we change your medical information in your medical record. We may deny your request if we did not create the information you want changed or for certain other reasons. If we do deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to your record. If we accept your request to change the information, we will make reasonable efforts to inform others, including people that you name, of the change and to include the changes in any future disclosure of information.

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Atlanta SurgiCenter
3114 Mercer University Drive, Suite 100
Atlanta, Georgia 30341