I.     Contact Information

After reviewing this Notice, if you need further information or want to contact us for any reason regarding the handling of your health information, please direct any communications to the following contact person:

Privacy Officer
P O Box 1509
Roswell, GA  30077-1509
770-436-9700

II.   Uses and Disclosures of Information

Under federal law, we are permitted to use and disclose personal health information without authorization for treatment, payment, and health care operations.  However, the American Psychiatric Association’s Principles of Medical Ethics or state law may require us to obtain your express consent before we make certain disclosures of your personal health information.  Participants in this organized health care arrangement also share health information with each other, as necessary to carry out treatment, payment, or health care operations relating to the organized health care arrangement.

Treatment

We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.

Payment

We may use and disclose your health information to obtain payment for services we provide to you.

Healthcare Operations

In the course of providing treatment to patients, we perform certain important functions such as quality assessment, training programs, credentialing, medical review, etc.  In performing such functions, we may rely on certain business associates to assist us.   We will share with our business associates only the minimum amount of personal health information necessary for them to assist us.

III.   Permitted or Required Uses and Disclosures without your Authorization or Opportunity to Object:

In addition to uses and disclosures related to treatment, payment, and health care operations, we may also use and disclose your personal information without authorization for the following additional purposes:  your treatment in an emergency or when clinically required; when required to do so by law; for public health purposes; to a person who may be at risk of contracting a communicable disease; to a health oversight agency; to an authority authorized to receive reports of abuse or neglect; in certain legal proceedings; and for certain law enforcement purposes;.  Protected health information may also be disclosed without your authorization to a coroner or medical examiner, and to the legal representative of your estate.

IV.     Psychotherapy Notes

In the course of your care with us, you may receive treatment from a mental health professional (such as a therapist or psychiatrist) who keeps separate notes during the course of your therapy sessions about your conversations.  These notes, known as “psychotherapy notes”, are kept by your physician apart from the rest of your medical record, and do not include basic information such as your medication treatment record, the types and frequencies of treatment you receive, or your test results.

Psychotherapy notes may be disclosed by a therapist only after you have given written authorization to do so. (Limited exceptions exist, e.g. in order for your therapist to prevent harm to yourself or others, and to report child abuse/neglect). You cannot be required to authorize the release of your psychotherapy notes in order to obtain health-insurance benefits for your treatment, or enroll in a health plan. Psychotherapy notes are also not among the records that you may request to review or copy (see discussion of your rights in section VII below).  If you have any questions, feel free to discuss this subject with your therapist.

V.       Your Health Information Rights

Under the law, you have certain rights regarding the health information that we collect and maintain about you.  This includes the right to:

-     Request that we restrict certain uses and disclosures of your health information; we are not, however, required to agree to a requested restriction.

-      Request that we communicate with you by alternative means, such as making records available for pick-up, or mailing them to you at an alternative address, such as a P.O. box.  We will accommodate reasonable requests for such confidential communications.

-      Request to review, or to receive a copy of, the health information about you that is maintained in our files and the files of our business associates (if applicable).  If we are unable to satisfy your request, we will tell you in writing the reason for the denial and your right, if any, to request a review of the decision.

-      Request that we amend the health information about you that is maintained in our files and the files of our business associates (if applicable).  Your request must explain why you believe our records about you are incorrect, or otherwise require amendment.  If we are unable to satisfy your request, we will tell you in writing the reason for the denial and tell you how you may contest the decision, including your right to submit a statement (of reasonable length) disagreeing with the decision.  This statement will be added to your records.

-      Request a list of our disclosures of your health information.  This list, known as an “accounting” of disclosures, will not include certain disclosures, such as those made for treatment, payment, or health care operations.  We will provide you the accounting free of charge, however if you request more than one accounting in any 12 month period, we may impose a reasonable, cost-based fee for any subsequent request.  Your request should indicate the period of time in which you are interested (for example, “from May 1, 2003 to June 1, 2003”).  We will be unable to provide you an accounting for any disclosures made before April 14, 2003, or for a period of longer than six years.

-       Request a paper copy of this Notice.

In order to exercise any of your rights described above, you must submit your request in writing to our contact person (see section III above for information).  If you have questions about your rights, please speak with our contact person, available in person or by phone, during normal office hours.

VI.      To Request Information or File a Complaint

If you believe your privacy rights have been violated, you may file a written complaint by mailing it or delivering it to our contact person (see section III above).  You may complain to the Secretary of Health and Human Services (HHS) by writing to Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201; by calling 1-800-368-1019; or by sending an email to OCRprivacy@hhs.gov.  We cannot, and will not, make you waive your right to file a complaint with HHS as a condition of receiving care from us, or penalize you for filing a complaint with HHS.

VII.      Revisions to this Notice

We reserve the right to amend the terms of this Notice.  If this Notice is revised, the amended terms shall apply to all health information that we maintain, including information about you collected or obtained before the effective date of the revised Notice.  If the revisions reflect a material change to the use and disclosure of your information, your rights regarding such information, our legal duties, or other privacy practices described in the Notice, we will promptly distribute the revised Notice, post it in the waiting area(s) of our office, and make copies available to our patients and others.

VIII.     Effective Date:  4/14/03

This notice does not constitute legal advice, and covers only federal, not state law in effect or proposed as of August 14, 2002.  Subsequent law changes may require form revision.