Kaveh Khajavi, MD, Georgia Spine & Neurosurgery
CenterHIPAA NOTICE OF PRIVACY PRACTICES
Effective Date (October 13, 2003)
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. If you have
any questions about this notice,
please contact Dr. Khajavi's office at
(404) 299-3338. This notice describes the
privacy practices
at our office.
- Maintain the privacy of protected
health information
- Give you this notice
of our legal duties
and privacy practices regarding your
health information
- Follow the terms of
the notice currently in effect.
Described as follows are the ways we may
use and disclose your health information.
Except for the following purposes we will
use and disclose your health information
only with your written permission. You
may revoke such permission at any time
by writing to Kaveh Khajavi, MD, Georgia
Spine & Neurosurgery Center.
We may use and disclose your health information
for your treatment and to provide you
with treatment-related health care services.
For example, we may disclose your health
information
to doctors, nurses, technicians, or other
personnel, including people outside our
office, who are involved in your medical
care and need the information to provide
you with medical care.
We may use and disclose your health information
so that others or we may bill and receive
payment from you, an insurance company,
or a third party for the treatment and
services you received.
For example, we may give information to
your health plan so that they will pay
for your treatment.
We may use and disclose your health information
to evaluate and improve our medical care
and to operate and manage our office.
For example, we may use and disclose
information to a peer review organization
or a health plan that is evaluating our
care. We may also share information with
others that have a relationship with
you for their health care operation activities.
We may use and disclose your health information
to contact you and remind you of your appointment,
to tell you about treatment alternatives
or health-related benefits and services
you could use.
When appropriate, we may share your health
information with a person involved in,
or paying for, your care (such as your
family or a close friend). We may notify
your family about your location or condition
or disclose such information to an entity
assisting in disaster relief.
We may use and disclose your health information
for research. For example, a research
project may involve comparing the health
of patients who received one treatment
to those who received another for the
same condition. Before we do so, the
project needs to go through a special
approval process. Even without special
approval, we may permit researchers to
look at records to help identify patients
who may be included in their research,
as long as they do not remove or copy
any of
your health information.
We will disclose your
health information when required to do
so by international, federal, state or
local law.
We may use and disclose your health information
when necessary to prevent a serious threat
to the health and safety of you, another
person, or the public. Disclosures will
be made only to someone who can prevent
the threat.
We may disclose your health information
to our business associates that perform
functions on our behalf or provide us
with services if necessary. For example,
we may use another company to perform
billing services on our behalf. All of
our
business associates are obligated to protect
the privacy of your information and are
not allowed to use or disclose the information
for any other purpose than appears in their
contract with us.
If you are a member of the armed forces,
we may release your health information
as required by military command authorities.
If you are a member of a foreign military
we may release your health information
to the foreign military command authority.
We may release your health information
for worker's compensation or similar
programs that provide benefits for work-related
injuries or illness.
We may disclose your health information
for public health activities to prevent
or control disease, injury or disability.
We may use your health information in
reporting births or deaths, suspected
child abuse or neglect, medication reactions
or product malfunctions or injuries,
and product recall notifications.
We
may use your health
information to notify someone who may have
been exposed to a disease or may be at
risk for contracting or spreading a disease
or condition. If we are concerned that
a patient may have been a victim of abuse,
neglect, or domestic violence we may ask
your permission to make a disclosure to
an appropriate government authority. We
will make that disclosure only when you
agree or when required or authorized to
do so by law.
We may disclose
your health information to a health oversight
agency for activities
authorized by law. These may include audits
investigations, inspections, and licensure.
These activities are necessary to for the
government to monitor the health care system,
government programs, and compliance with
civil rights laws.
If you are involved
in a lawsuit or dispute, we may disclose
your health information in
response to a court or administrative order.
We may disclose your health 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.
We may release your health
information request by law enforcement
official if 1) there is a court order,
subpoena, warrant, summons or similar
process; 2) if the request is limited to
information needed to identify or locate
a suspect, fugitive, material witness,
or missing person; 3) the information is
about the victim of a crime even if, under
certain very limited circumstances, we
are unable to obtain your agreement; 4)
the information is about a death that may
be the result of criminal conduct; 5) the
information is relevant to criminal conduct
on our premises; and 6) it is needed in
an emergency to report a crime, the location
of a crime or victims, or the identity,
description, or location of the person
who may have committed the crime.
.
We may release your health information
to a coroner, medical examiner, or funeral
director to identify a deceased person
or cause of death, or other similar circumstance.
We may disclose your health information
to authorized federal officials for intelligence
and other national security activities
authorized by law.
If
you are an inmate of a correctional institution
or in custody we may disclose your information
1) for the institution to provide you with
health care, 2) to protect your health and
safety or that of others, and 3) for the
safety and security of the institution.
You have the
right to inspect and copy your medical
and billing records by written request
to Kaveh Khajavi, MD, Georgia Spine & Neurosurgery
Center.
You have the right to
request an amendment to your records by
written request to Kaveh Khajavi, MD
Georgia Spine & Neurosurgery Center.
You have a right to an accounting of
certain disclosures by written request
to Kaveh Khajavi, MD, Georgia Spine & Neurosurgery
Center.
You have
the right to request restriction or limitation
on your health information used for treatment,
payment or health care operations. You
may request
us to limit disclosure to someone involved
in your care or in payment for your care
(such as a spouse) by written request
to Dr. Khajavi. We are not required to
agree
with your request, but we will try to comply.
You have the right to request that
we communicate with you about medical
matters in a certain way or at a
certain location. You can ask, for
example, that we contact you only
by mail or at work. Your written
request must specify how or where
you wish to be contacted and be
addressed to Kaveh Khajavi, MD,
Georgia Spine & Neurosurgery
Center.We will accommodate
reasonable requests.
We may change this notice and make it
effective for medical information we already
have about you as well as new information.
The current notice will be posted and available
at all times. You have a right to request
a paper copy of the current notice at any
visit or by written request to Kaveh Khajavi,
MD, Georgia Spine & Neurosurgery Center.
Kaveh Khajavi, MD
Georgia Spine & Neurosurgery Center
2675 North Decatur Rd. Suite 710
Decatur, GA, 30033
(404) 299-3338
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