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Marcus Autism Center Notice of Privacy Practices

EFFECTIVE APRIL 14, 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.

The Marcus Autism Center is committed to the privacy and confidentiality of your medical information. This notice tells you what we may do with your medical information. Your medical information includes information that identifies you and tells about your past, present or future physical or mental health or condition. Your health information also includes information about related health care services, such as your billing records. We refer to your health information as “Protected Health Information” or “PHI” because we must use or disclose your information only as explained in this Notice. PHI includes your health information created or received by us.

When we say “you” in this Notice, this refers to the individual who is the subject of the health information. For minor patients (children), the patient’s “personal representative” has the right to exercise the rights explained in the Notice. The minor patient’s personal representative is someone who is authorized to act on behalf of the patient such as a parent or guardian.

This Notice describes how we may use and disclose your PHI for treatment, billing, or health care operations. This Notice also describes those uses or disclosures that we may make of your PHI when you do not object, as allowed by your written permission and as allowed without your permission.

You may ask for a paper copy of this Notice today, at your next appointment, or by contacting the Marcus Autism Center Privacy Officer as explained at the end of this Notice. The Notice also is available on our web site at www.marcus.org.

We will do what we say in this Notice. We may change what we do from time to time as needed. If we do, the new notice will be effective for all the PHI that we have. The revised notice will be available on the web site at www.marcus.org.

The Federal Privacy Regulations and State Law give you privacy rights.

You have the right to ask us to restrict how we use or disclose your PHI for treatment, billing, or health care operations. However, we are not allowed to withhold your PHI when we are required by law to disclose it. In an emergency, we are allowed to use or disclose your PHI to treat you. To request a restriction, please make your request to the registration staff. They will help you write your request. We may either agree to your request or turn down your request. If we agree to your request, we are allowed to end the restriction if we tell you. If we end the restriction, it will only affect PHI that was created or received after we notify you.
You have the right to ask that we communicate with you in another way or at another location. You need to provide details about how to contact you. If we are unable to contact you using the information you provide, we may contact you using any information on file. We will not require you to explain why you want this communication. We will honor reasonable requests. However, we require an accurate billing address.
You have the right to see and get a copy of your PHI. Except for some types of PHI such as psychotherapy notes and PHI from research projects while they are in process, you have the right to see and get a copy of your PHI in your medical and billing records. We may charge you a reasonable fee for copying your records. We may deny access if your record relates to a mental health problem and we believe such access may endanger you. You may request that we designate a licensed health care professional to review the denial.
You have the right to ask us to amend your PHI in the medical and billing records. If we accept your request, we will tell you we agree and we will amend our records. (We do not change what is in the record. We add the amended information.) With your assistance, we will notify others who have the prior PHI. If we deny your request, we will provide a written explanation of why we did not make the amendment and explain your rights. We may deny your request if the PHI was not created by us, is not part of the medical and billing records, is not available for inspection, or we determine the PHI is accurate and complete.
You have the right to receive an accounting of disclosures of your PHI made by us since April 14, 2003.

The accounting will not include disclosures made:

to carry out treatment, billing, and health care operations,
to you or your personal representative,
to parties you authorize to receive your PHI,
of information given as permitted through our patient directory,
to your family members or friends who are involved in your care,
for national security or intelligence purposes, or
to correctional institutions or law enforcement officials.

For your protection, we may check your identity for any questions you may have about your treatment or payment activities. We will check your identity whenever we get requests to look at, copy, or amend your records or to obtain a list of disclosures of your PHI. Forms for each of these requests are available from our Health Information Management Department.

The Federal Privacy Regulations and State Law allow us to use or disclose your PHI for the following purposes, but you will have the opportunity to agree or to say no before such uses or disclosures:

To maintain a list of patients and their general condition that may be given to members of the public if they ask for you by name. (Unless you say no, your location and general condition may be given to anyone who asks for you by name.)
To a family member (or any other person identified by you) as needed for your care or payment for your health care. (If you agree or do not say no, your caregivers may use your PHI to do this.)
To locate a family member (or other person responsible for your care) and notify them of your location, general condition, or death. This disclosure may be to a disaster relief agency. (If you agree or do not say no, your caregivers may use your PHI to do this.)

If you want to say no to these uses and disclosures, you may do so by telling your caregivers.

The Federal Regulations allow the Marcus Autism Center to use and disclose PHI for research under specific rules:

The Marcus Autism Center participates in research studies. When possible, we will obtain your written permission to use or disclose your PHI for research. Federal law also allows us to get permission to use your PHI for research from either an Institutional Review Board or a privacy board under certain conditions. Federal law also allows researchers to look at your PHI when preparing research studies or doing research on those who have died. Federal law requires researchers to agree to protect the privacy of your health information in all cases.

The Federal Privacy Regulations and State Law allow us to use or disclose your PHI with your written permission:

Uses and disclosures not otherwise allowed under the Privacy Regulations and State Law require your written permission.

Your written permission is needed if you want the Marcus Autism Center to make a disclosure of PHI that is not allowed without your permission. For example, you may want your lawyer to have a copy of your medical records. You must give your written permission before we may send your PHI to your lawyer.

Your written permission also is needed if we want to use or disclose your PHI for some reason not allowed without your permission. For example, we may ask your permission to use PHI concerning your diagnosis or treatment to contact you about making a charitable contribution to support research or programs at the Marcus Autism Center. If you give your written permission, we may then use this PHI to contact you. For another example, we may ask your permission to use your PHI in a magazine article about a particular disease or about Marcus Autism Center patients or professionals. If you give your written permission, we may then disclose the PHI you have permitted us to share.

If you do give your permission, you may cancel it at any time. However, uses and disclosures made before your cancellation are not affected by your action. If your cancellation relates to research, researchers are allowed to continue to use the PHI they have gathered before your cancellation if they need it in connection with the research study or follow-up to the study.

The Federal Privacy Regulations and State Law allow us to use or disclose your PHI without your written permission in the following situations:

Treatment. Examples: We may use your PHI when we send specimens to the lab. We may disclose your PHI to another health care provider or specialist to help treat you.
Billing. Examples: We may use your PHI to contact your insurance company to determine if you are enrolled and what coverage you have. We may disclose your PHI to your insurance company to bill for your health care services.
Health Care Operations. Examples: We may use your PHI to evaluate our health care providers. We may use your PHI to train our staff and students. We may use your PHI to develop or evaluate clinical guidelines. We may use your PHI to conduct internal audits. We may use your PHI to remind you of your appointment(s) and, to provide you with information about treatment alternatives or other health-related benefits and our services that may be of interest to you. We may use some PHI, such as your name and address, for our fundraising efforts.
Fundraising. We or our related foundation may disclose or use your name, demographic information and dates of service at the Marcus Autism Center to raise funds on behalf of the Marcus Autism Center.
We also may disclose your PHI, and in some cases we must disclose your PHI:
to business associates who perform some job for us,
to public agencies when we believe there may be possible abuse or neglect,
when we get a court order, a subpoena, or other lawful instructions from courts or public bodies,
to law enforcement officials (under some circumstances and with some restrictions),
to comply with other laws,
to a public health authority for disease control or prevention, to report child abuse or neglect, or for oversight of FDA-regulated products or activities,
to prevent a serious threat to the public health or safety,
to public agencies if we believe a person has been exposed to a communicable disease or there is a person who is at risk of contracting or spreading a disease or condition,
to an employer to evaluate a work-related illness or injury, or to evaluate the workplace in some circumstances,
to a coroner, medical examiner, or funeral director in some circumstances,
to authorized federal officials for intelligence and law enforcement activities,
to an agency administering a public benefits program,
to a health oversight agency for its oversight activities,
to workers' compensation or other similar programs,
to enable organ, eye, or tissue donation and transplantation,
to inform you about the services and treatments we offer and
to permit the Secretary of the U.S. Department of Health and Human Services to see our facilities and information (including PHI) to determine our compliance with privacy requirements.

The Privacy Regulations also allow the Marcus Autism Center to remove most PHI from health information that could possibly identify you and then use this information for research, health oversight, and operations activities without your permission. If we do this, we must have an agreement with anyone we share the information with to use the information only for the permitted purposes and not to ever identify you from the information.

If you believe we have not done with your PHI what we said we would do with your PHI, you may file a written complaint with us. Please send it to the Marcus Autism Center Privacy Officer at the Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329. You may also file a complaint with the Secretary of U.S. Department of Health and Human Services. If you file a complaint, we will not take action against you.

IF YOU WOULD LIKE FURTHER INFORMATION ABOUT THIS NOTICE, PLEASE CONTACT
Farah Chapes, 404.419-4000 or .

THE NOTICE IS EFFECTIVE APRIL 14, 2003 AND SUPERCEDES EARLIER VERSIONS.