Notice Of Privacy Practices

Your Rights Regarding Your PHI

You have the following rights regarding your PHI.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.