Notice of Privacy Practices


We understand that your medical information and information about your health is personal. We are committed to maintaining the privacy and security of your protected health information (“PHI”).  This Notice applies to all records about your care that are created or maintained by us.

Our Responsibilities

We are providing you with this Notice to tell you about our legal duties and practices with respect to your PHI. We will abide by the terms of this Notice as are currently in effect.

How We May Use and Disclose Your PHI

The following categories describe different ways we may use and/or share your PHI without a written authorization from you. For each category, an explanation of the category is provided, in some cases with examples. These examples are not meant to include all possible types of use and/or disclosure. However, all of the ways we are permitted to use and disclose your PHI will fall into one of these categories.

Treatment. We use and disclose your PHI to provide you with medical treatment or services or to assist in the coordination or continuation of your care. For example, we may share your PHI with a physician involved in your care who needs information about your symptoms to prescribe appropriate medications.

Payment. We may use and disclose your PHI to receive payment for the care you receive from us. For example, we may be required by your health insurer to provide information regarding your health care status, your need for care and the care that we intend to provide to you so that the insurer will reimburse you or us.

Health Care Operations. We may use and disclose PHI to run our practice, improve your case and contact you when necessary. For example, we may use or disclose your PHI to communicate with you, evaluate the performance of our staff and perform quality assessment activities.

Participation in an HIE.  We may participate in health information exchanges for the purpose of securely exchanging your health information for your treatment, payment, or health care operations or other purposes permitted or required under HIPAA.  Unless you opt-out of the health information exchange, your information may be disclosed to health care providers, pharmacies, or insurance companies in this exchange, and information about you may be received by us through the exchange.  If you opt-out, you can change your election and opt-in at any time by notifying us and completing the opt-in form.

Communications. We may use and disclose your information to provide appointment reminders, leave a message on your answering machine, or leave a message with an individual who answers the phone at your residence. We may, from time to time, contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Required or Permitted by Law. We will disclose your PHI when we are required or permitted to do so by any federal, state or local law.  This includes sharing your PHI with the Department of Health and Human Services if it wants to see that we’re complying with the federal privacy and security laws.

Public Health and Safety Issues. We may disclose your PHI for public health and safety purposes such as:

  • Preventing or control disease, injury or disability
  • Reporting births or deaths
  • Reporting suspected abuse, neglect or domestic violence
  • Reporting reactions to medications or helping with product recalls
  • Preventing or reduce a serious threat to anyone’s health or safety

Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.

Judicial and Administrative Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when we make reasonable efforts to either notify you about the request or to obtain an order protecting your PHI.

Law Enforcement. As permitted or required by State law, we may disclose your PHI to a law enforcement official for law enforcement/emergency purposes.

Coroners, Medical Examiners, Funeral Directors. We may disclose your PHI to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law. We may also disclose your PHI to funeral directors if necessary to carry out their duties.

Organ, Eye or Tissue Donation. We may use or disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

Research Purposes. We may use and disclose your health information for research purposes pursuant to a valid authorization from you or when an institutional review board or privacy board has waived the authorization requirement. Under certain circumstances, your information may also be disclosed without your authorization to researchers preparing to conduct a research project, for research on decedent, or to researchers pursuant to a written data use agreement.

Specified Government Functions. In certain circumstances, the Federal regulations authorize us to use or disclose your PHI to facilitate specified government such as military and veteran’s activities or protection of public officials.

Correctional Institutions. If you are an inmate or in the custody of law enforcement, we may disclose your health information to correctional institutions or law enforcement for such purposes as providing care and for the health and safety of others.

Worker’s Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.

Business Associates. We may contract with one or more third parties (our business associates) in the course of our business operations. We may disclose your health information to our business associates so that they can perform the job we have asked them to do. We require that our business associates sign a business associate agreement and agree to safeguard the privacy and security of your health information.


Consents and Authorizations for Other Uses

While we may use or disclose your health information without your written authorization as explained above, there are other instances where we will obtain your written authorization. Except as otherwise provided in this Notice, we will not use or disclose your health information without your prior written authorization. You may revoke an authorization at any time, except to the extent we have already relied on the authorization and taken action.

Examples of disclosures that require your authorization are:

Others Involved in Your Care.  You have both the right and choice to tell us whether to share information with your family, close friends, or others involved in your care.  If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest.

Notification and Disaster Relief. We may use or disclose your health information to notify your family or personal representative of your location or condition. Unless you object, or there are emergency circumstances, we may also disclose your protected health information to persons performing disaster relief activities.

Marketing. Except as otherwise permitted by law, we will not use or disclose your health information for marketing purposes without your written authorization. However, in order to better serve you, we may communicate with you about refill reminders and alternative products. Should you inquire about a particular product-specific good or service, we may also provide you with informational materials. We may also, at times, send you informational materials about a particular product or service that may be helpful for your treatment.

No Sale of Your Health Information. We will not sell your PHI to a third party without your prior written authorization.

Uses and Disclosures of Your Highly Confidential Information. Some federal and/or state laws require special privacy protections for certain highly confidential health information, relating to: (1) psychotherapy services; (2) mental health and developmental disabilities services; (3) alcohol and drug abuse prevention, treatment and referral; (4) HIV/AIDS testing, diagnosis or treatment; (5) venereal disease(s); (6) genetic testing; (7) child abuse and neglect; (8) domestic abuse of an adult with a disability; and/or (9) sexual assault. Unless a use or disclosure is permitted or required by law, we will obtain your written consent or authorization prior to using or disclosing your highly confidential health information to third parties.

Your Rights Regarding Your PHI

You have the following rights regarding your PHI.

  1. Right to Request Restrictions/Disclosures– You have the right to request restrictions on certain uses and disclosures of your PHI. We will consider your request, but are not required to agree to a requested restriction unless the request is not to disclose your health information to a health plan for a particular item or service if the disclosure is for payment or health care operation purposes and you have otherwise paid for the item or service in full. We will notify you of our decision in writing. If we agree to your request, we will comply with your request unless such information is needed to provide emergency treatment to you. If you wish to make a request for restrictions, please submit your written request to the Privacy and Security Officer at 3949 Holcomb Bridge Rd, Peachtree Corners, GA 30092.
  2. Right to Receive Confidential Communications– You have the right to request that communications of your PHI are done by alternative means or at alternative locations. We will accommodate reasonable requests and will notify you if we are unable to agree to your request.  If you wish to receive confidential communications, please submit your written request to the Privacy/Security Officer at 3949 Holcomb Bridge Rd, Peachtree Corners, GA 30092.
  3. Right to Inspect and Obtain a Copy of Your PHI– You have the right to inspect or obtain an electronic or paper copy of your PHI, as provided by law. If you wish to inspect and obtain a copy of your PHI, please submit your written request to the Privacy/Security Officer at 678-369-6282 or by mail to 3949 Holcomb Bridge Rd, Peachtree Corners, GA 30092. We may charge a reasonable, cost-based fee for the copy.
  4. Right to Amend– You may request that your health record be amended if you believe that the health information we have about you is incomplete or incorrect. Requests to amend your health information must be in writing and sent to at 3949 Holcomb Bridge Rd, Peachtree Corners, GA 30092. We may deny your request and if we do, we will notify you in writing of the reason for the denial and your right to submit a statement disagreeing with the denial. We may prepare a response to your statement and will provide you with a copy.
  5. Right to Receive an Accounting– You have the right to obtain a list of instances in which we have disclosed your health information for specified purposes. Your request must be in writing and sent to 3949 Holcomb Bridge Rd, Peachtree Corners, GA 30092. The list will not include disclosures made prior to April 14, 2003, those made for treatment, payment, health care operations purposes (except as required by law), certain disclosures required by law, and disclosures made to, or authorized by you. The first disclosure list in a year is free; if you request additional lists in any year we may charge you a fee.
  6. Right to Receive a Paper Copy of this Notice – You have the right to receive a paper copy of this Notice at any time. To obtain a copy, please request it from the Privacy/ Security Officer.
  7. Right to Receive Notification of Breach – We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  8. Right to Choose Someone to Act for You – If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

Changes to this Notice

We reserve the right to change the terms of this Notice and to make the revised notice provisions effective for all health information we already have about you, as well as any information we may receive in the future. We will post a copy of the current Notice in a clear and prominent location on our website at: A copy of the Notice is also available to you upon request. If we revise the Notice, we will inform you that revisions to the Notice have been made and will inform you of how you can review the revised Notice or request a copy of the revised Notice which will then be sent to you.

Questions Regarding this Notice

If you have any questions or need further information regarding this Notice, you may contact the Privacy/ Security Officer at 855-552-9394.



If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact the Compliance Officer through our toll-free Compliance Hotline at 855-552-9394 or via email at: All complaints will be documented in writing. You will not be retaliated against in any way for filing a complaint.

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